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  1. The acutely ACL injured knee assessed by MRI

    DEFF Research Database (Denmark)

    Frobell, R B; Roos, H P; Roos, E M

    2008-01-01

    OBJECTIVES: To map by magnetic resonance imaging (MRI) and quantitative MRI (qMRI) concomitant fractures and meniscal injuries, and location and volume of traumatic bone marrow lesions (BMLs) in the acutely anterior cruciate ligament (ACL) injured knee. To relate BML location and volume to cortical...... depression fractures, meniscal injuries and patient characteristics. METHODS: One hundred and twenty-one subjects (26% women, mean age 26 years) with an ACL rupture to a previously un-injured knee were studied using a 1.5T MR imager within 3 weeks from trauma. Meniscal injuries and fractures were classified......-compartmental meniscal tears were found in 44 (36%) subjects and bi-compartmental in 24 (20%). One hundred and nineteen (98%) knees had at least one BML, all but four (97%) located in the lateral compartment. Knees with a cortical depression fracture had larger BML volumes (P

  2. Healing of the Acutely Injured Anterior Cruciate Ligament: Functional Treatment with the ACL-Jack, a Dynamic Posterior Drawer Brace

    Directory of Open Access Journals (Sweden)

    Matthias Jacobi

    2016-01-01

    Full Text Available Background. The injured anterior cruciate ligament (ACL has a limited healing capacity leading to persisting instability. Hypothesis/Purpose. To study if the application of a brace, producing a dynamic posterior drawer force, after acute ACL injury reduces initial instability. Study Design. Cohort study. Methods. Patients treated with the ACL-Jack brace were compared to controls treated with primary ACL reconstruction und controls treated nonsurgically with functional rehabilitation. Measurements included anterior laxity (Rolimeter, clinical scores (Lysholm, Tegner, and IKDC, and MRI evaluation. Patients were followed up to 24 months. Results. Patients treated with the ACL-Jack brace showed a significant improvement of anterior knee laxity comparable to patients treated with ACL reconstruction, whereas laxity persisted after nonsurgical functional rehabilitation. The failure risk (secondary reconstruction necessary of the ACL-Jack group was however 21% (18 of 86 within 24 months. Clinical scores were similar in all treatment groups. Conclusion. Treatment of acute ACL tears with the ACL-Jack brace leads to improved anterior knee laxity compared to nonsurgical treatment with functional rehabilitation.

  3. The acutely ACL injured knee assessed by MRI: changes in joint fluid, bone marrow lesions, and cartilage during the first year

    DEFF Research Database (Denmark)

    Frobell, R B; Le Graverand, M-P; Buck, R

    2008-01-01

    OBJECTIVES: To investigate changes in the knee during the first year after acute rupture of the anterior cruciate ligament (ACL) of volumes of joint fluid (JF), bone marrow lesions (BMLs), and cartilage volume (VC), and cartilage thickness (ThCcAB) and cartilage surface area (AC). To identify...... factors associated with these changes. METHODS: Fifty-eight subjects (mean age 26 years, 16 women) with an ACL rupture to a previously un-injured knee were followed prospectively using a 1.5T MR imager at baseline (within 5 weeks from injury), 3 months, 6 months, and 1 year. Thirty-four subjects were...... treated with ACL reconstruction followed by a structured rehabilitation program and 24 subjects were treated with structured rehabilitation only. Morphometric data were acquired from computer-assisted segmentation of MR images. Morphometric cartilage change was reported as mean change divided...

  4. Reliability and validity of videotaped functional performance tests in ACL-injured subjects

    DEFF Research Database (Denmark)

    von Porat, Anette; Holmström, Eva; Roos, Ewa

    2008-01-01

    BACKGROUND AND PURPOSE: In clinical practice, visual observation is often used to determine functional impairment and to evaluate treatment following a knee injury. The aim of this study was to evaluate the reliability and validity of observational assessments of knee movement pattern quality...... obtained between the observers' assessment and knee flexion angle, r = 0.37-0.61. The crossover hop test or one-leg hop test was ranked as the most useful test in 172 of 192 occasions (90%) when assessing knee function. CONCLUSION: The moderate to good inter-observer reliability and the moderate criterion...... validity found indicate that the knee movement pattern quality in ACL-injured subjects can be determined by visual observation of more demanding functional tests such as crossover hop on one leg and one-leg hop for distance....

  5. The effect of knee extensor open kinetic chain resistance training in the ACL-injured knee.

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    Barcellona, Massimo G; Morrissey, Matthew C; Milligan, Peter; Clinton, Melissa; Amis, Andrew A

    2015-11-01

    To investigate the effect of different loads of knee extensor open kinetic chain resistance training on anterior knee laxity and function in the ACL-injured (ACLI) knee. Fifty-eight ACLI subjects were randomised to one of three (12-week duration) training groups. The STAND group trained according to a standardised rehabilitation protocol. Subjects in the LOW and HIGH group trained as did the STAND group but with the addition of seated knee extensor open kinetic chain resistance training at loads of 2 sets of 20 repetition maximum (RM) and 20 sets of 2RM, respectively. Anterior knee laxity and measurements of physical and subjective function were performed at baseline, 6 and 12 weeks. Thirty-six subjects were tested at both baseline and 12 weeks (STAND n = 13, LOW n = 11, HIGH n = 12). The LOW group demonstrated a reduction in 133 N anterior knee laxity between baseline and 12 weeks testing when compared to the HIGH and the STAND groups (p = 0.009). Specifically, the trained-untrained knee laxity decreased an average of approximately 5 mm in the LOW group while remaining the same in the other two groups. Twelve weeks of knee extensor open kinetic chain resistance training at loads of 2 sets of 20RM led to a reduction in anterior knee laxity in the ACLI knee. This reduction in laxity does not appear to offer any significant short-term functional advantages when compared to a standard rehabilitation protocol. These results indicate that knee laxity can be decreased with resistance training of the thigh muscles. Randomised controlled trial, Level II.

  6. Radiography of the acutely injured shoulder

    International Nuclear Information System (INIS)

    Neep, M.J.; Aziz, A.

    2011-01-01

    Routine radiological examination of the acute shoulder has been unchanged in radiology departments for many years. At UCLH (University College London Hospitals, UK) this examination consists of two projections, an AP (antero-posterior) and an LS (lateral scapula). Following a review of the related literature and the possible advantages of an axial style projection, a study was performed to evaluate whether a new projection named modified trauma axial (MTA) shoulder projection could replace the existing LS projection in the routine examination of the acute shoulder. A retrospective analysis of 244 acute shoulder examinations over a 5-month period was performed. AP, LS and MTA projections were taken with paired AP and LS, and AP and MTA radiographs were reported separately. 97 traumatic abnormalities were reported using AP and MTA whilst only 64 abnormalities were reported using AP and LS views. The MTA projection demonstrated it was significant for evaluating articular surfaces of the humeral head and glenoid, defects in the humeral head, greater tuberosity fractures, glenoid fractures and fractures of the acromion. It was established that if the LS projection was replaced with the MTA view no traumatic pathologies would have been overlooked and in fact there was a 52% increase in traumatic abnormalities detected. Use of a chi-squared test demonstrated a highly significant difference in the number of traumatic abnormalities detected between the two pairs of projection combinations (p = 0.0004). Based on this study and the examined literature the routine examination of the acutely injured shoulder is recommended to include the AP and MTA projections only.

  7. Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis.

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    Kanakamedala, Ajay C; Burnham, Jeremy M; Pfeiffer, Thomas R; Herbst, Elmar; Kowalczuk, Marcin; Popchak, Adam; Irrgang, James; Fu, Freddie H; Musahl, Volker

    2017-11-08

    A deep lateral femoral notch (LFN) on lateral radiographs is indicative of ACL injury. Prior studies have suggested that a deep LFN may also be a sign of persistent rotatory instability and a concomitant lateral meniscus tear. Therefore, the purpose of this study was to evaluate the relationship between LFN depth and both quantitative measures of rotatory knee instability and the incidence of lateral meniscus tears. It was hypothesized that greater LFN depth would be correlated with increased rotatory instability, quantified by lateral compartment translation and tibial acceleration during a quantitative pivot shift test, and incidence of lateral meniscus tears. ACL-injured patients enrolled in a prospective ACL registry from 2014 to 2016 were analyzed. To limit confounders, patients were only included if they had primary ACL tears, no concurrent ligamentous or bony injuries requiring operative treatment, and no previous knee injuries or surgeries to either knee. Eighty-four patients were included in the final analysis. A standardized quantitative pivot shift test was performed pre-operatively under anesthesia in both knees, and rotatory instability, specifically lateral compartment translation and tibial acceleration, was quantified using tablet image analysis software and accelerometer sensors. Standard lateral radiographs and sagittal magnetic resonance images (MRI) of the injured knee were evaluated for LFN depth. There were no significant correlations between LFN depth on either imaging modality and ipsilateral lateral compartment translation or tibial acceleration during a quantitative pivot shift test or side-to-side differences in these measurements. Patients with lateral meniscus tears were found to have significantly greater LFN depths than those without on conventional radiograph and MRI (1.0 vs. 0.6 mm, p quantitative measures of rotatory instability. Concomitant lateral meniscus injury was associated with significantly greater LFN depth. Based on

  8. Cluster analysis of quantitative MRI T2and T1ρrelaxation times of cartilage identifies differences between healthy and ACL-injured individuals at 3T.

    Science.gov (United States)

    Monu, U D; Jordan, C D; Samuelson, B L; Hargreaves, B A; Gold, G E; McWalter, E J

    2017-04-01

    To identify focal lesions of elevated MRI T 2 and T 1ρ relaxation times in articular cartilage of an ACL-injured group using a novel cluster analysis technique. Eighteen ACL-injured patients underwent 3T MRI T 2 and T 1ρ relaxometry at baseline, 6 months and 1 year and six healthy volunteers at baseline, 1 day and 1 year. Clusters of contiguous pixels above or below T 2 and T 1ρ intensity and area thresholds were identified on a projection map of the 3D femoral cartilage surface. The total area of femoral cartilage plate covered by clusters (%CA) was split into areas above (%CA+) and below (%CA-) the thresholds and the differences in %CA(+ or -) over time in the ACL-injured group were determined using the Wilcoxon signed rank test. %CA+ was greater in the ACL-injured patients than the healthy volunteers at 6 months and 1 year with average %CA+ of 5.2 ± 4.0% (p = 0.0054) and 6.6 ± 3.7% (p = 0.0041) for T 2 and 6.2 ± 7.1% (p = 0.063) and 8.2 ± 6.9% (p = 0.042) for T 1ρ , respectively. %CA- at 6 months and 1 year was 3.0 ± 1.8% (p > 0.1) and 5.9 ± 5.0% (p > 0.1) for T 2 and 4.4 ± 4.9% (p > 0.1) and 4.5 ± 4.6% (p > 0.1) for T 1ρ , respectively. With the proposed cluster analysis technique, we have quantified cartilage lesion coverage and demonstrated that the ACL-injured group had greater areas of elevated T 2 and T 1ρ relaxation times as compared to healthy volunteers. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  9. Diagnostic imaging of the acutely injured patient

    International Nuclear Information System (INIS)

    Berquist, T.H.

    1985-01-01

    This book provides an analysis of pathophysiologic concepts of trauma and reviews the effectiveness of the available imaging modalities in acute trauma of various organ system. Topics covered are chest injuries; abdominal trauma; fractures of long bones; the foot and ankle; the knee; hand and wrist; the elbow; the shoulder; the pelvis hips; the spine; the skull and facial trauma and the clinical assessment of multiple injuries patients. Comparative evaluation of diagnostic techniques of radiography is discussed. Normal anatomy and bone fractures along with soft-tissue injuries are described

  10. Alcohol consumption decreases lactate clearance in acutely injured patients☆

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    Dezman, Zachary D.W.; Comer, Angela C.; Narayan, Mayur; Scalea, Thomas M.; Hirshon, Jon Mark; Smith, Gordon S.

    2017-01-01

    Introduction Alcohol, a common risk factor for injury, has direct toxic effects on the liver. The use of lactate clearance has been well described as an indicator of the adequacy of resuscitation in injured patients. We investigated whether acutely injured patients with positive blood alcohol content (+BAC) had less lactate clearance than sober patients. Methods We conducted a retrospective cohort study of acutely injured patients treated at an urban Level 1 trauma centre between January 2010 and December 2012. Blood alcohol and venous lactate levels were measured on all patients at the time of arrival. Study subjects were patients transported directly from the scene of injury, who had an elevated lactate concentration on arrival (≥3.0 mmol/L) and at least one subsequent lactate measurement within 24 h after admission. Lactate clearance ([Lactate1 − Lactate2]/Lactate1) was calculated for all patients. Chi-squared tests were used to compare values from sober and intoxicated subjects. Lactate clearance was plotted against alcohol levels and stratified by age and Injury Severity Score (ISS). Results Serial lactate concentration measurements were obtained in 3910 patients; 1674 of them had +BAC. Patients with +BAC were younger (mean age: 36.6 [SD 14.7] vs 41.0 [SD 19.9] years [p = 0.0001]), were more often male (83.4% vs 75.9% [p = 0.0001]), had more minor injuries (ISS 400 (23.5 [SD 6.5]). Lactate clearance decreased with increasing BAC irrespective of age and ISS. Conclusions In a large group of acutely injured patients, a dose-dependent decrease in lactate clearance was seen in those with elevated BAC. This relationship will cause a falsely elevated lactate reading or prolong lactate clearance and should be taken into account when evaluating patients with +BAC. PMID:27025567

  11. Alcohol consumption decreases lactate clearance in acutely injured patients.

    Science.gov (United States)

    Dezman, Zachary D W; Comer, Angela C; Narayan, Mayur; Scalea, Thomas M; Hirshon, Jon Mark; Smith, Gordon S

    2016-09-01

    Alcohol, a common risk factor for injury, has direct toxic effects on the liver. The use of lactate clearance has been well described as an indicator of the adequacy of resuscitation in injured patients. We investigated whether acutely injured patients with positive blood alcohol content (+BAC) had less lactate clearance than sober patients. We conducted a retrospective cohort study of acutely injured patients treated at an urban Level 1 trauma centre between January 2010 and December 2012. Blood alcohol and venous lactate levels were measured on all patients at the time of arrival. Study subjects were patients transported directly from the scene of injury, who had an elevated lactate concentration on arrival (≥3.0mmol/L) and at least one subsequent lactate measurement within 24h after admission. Lactate clearance ([Lactate1-Lactate2]/Lactate1) was calculated for all patients. Chi-squared tests were used to compare values from sober and intoxicated subjects. Lactate clearance was plotted against alcohol levels and stratified by age and Injury Severity Score (ISS). Serial lactate concentration measurements were obtained in 3910 patients; 1674 of them had +BAC. Patients with +BAC were younger (mean age: 36.6 [SD 14.7] vs 41.0 [SD 19.9] years [p=0.0001]), were more often male (83.4% vs 75.9% [p=0.0001]), had more minor injuries (ISS400 (23.5 [SD 6.5]). Lactate clearance decreased with increasing BAC irrespective of age and ISS. In a large group of acutely injured patients, a dose-dependent decrease in lactate clearance was seen in those with elevated BAC. This relationship will cause a falsely elevated lactate reading or prolong lactate clearance and should be taken into account when evaluating patients with +BAC. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. The effect of tibial slope in acute ACL-insufficient patients on concurrent meniscal tears.

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    Markl, Isabelle; Zantop, Thore; Zeman, Florian; Seitz, Johannes; Angele, Peter

    2015-08-01

    The aim of this study is to evaluate the effect of the medial and lateral posterior tibial slope (MPTS, LPTS) in patients with acutely ruptured ACL on the menisci. It was hypothesized that medial and lateral meniscus lesions are seen more often with high PTS (posterior tibial slope). We hypothesized that in case of a high tibial slope a possible meniscus lesion is more often located in the posterior horn of the meniscus than in knees with a low tibial slope. We identified 537 patients with ACL insufficiency between 2012 and 2013. Of these, 71 patients were eligible for the study according to the study's criteria. PTS was measured via MRI and classified into two groups: >10° for high tibial slope and ≤10° for low tibial slope. Any meniscal lesion was documented during arthroscopic ACL reconstruction and evaluated regarding meniscal lesion patterns with high and low PTS, taking into account the type and the location of the tear (anterior horn, intermediate part and posterior horn). Statistical analysis for differences in meniscal lesion was performed using Chi-square tests and McNemar tests for dependent variables. The level of significance was set at p ≤ 0.05. High PTS (MPTS and LPTS) was associated with a higher incidence of meniscal lesions with an odds ratio of 2.11, respectively, 3.44; however, no statistical significance was found. Among the total number of ACL-insufficient knees studied, the meniscal lesion spread more often to the posterior part in the group with a low PTS. In contrast, less damage of the posterior horn of the meniscus could be found in the group with a high PTS. High PTS seems to predetermine for meniscal lesion in an acute ACL-insufficient knee. More damage to the posterior part of the menisci could generally be seen but was not associated with a high PTS. There was no statistical significance to support the initial hypothesis. Further research is needed to find out if factors other than tibial slope are risk factors for meniscal

  13. Efficacy of knee joint aspiration in patients with acute ACL injury in the emergency department.

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    Wang, Joon Ho; Lee, Jin Hyuck; Cho, Youngsuk; Shin, Jung Min; Lee, Byung Hoon

    2016-08-01

    To evaluate the influence of joint aspiration on the sensitivity of physical examination for diagnosing acute anterior cruciate ligament (ACL) lesion in the second outpatient-department (OPD) follow-up referred from emergency department (ED). This retrospective study included sixty patients underwent ACL reconstruction with initial visit at ED. They were divided into two groups based on the presence or absence of joint aspiration at ED. All participants were referred to second OPD follow-up within 7-14days after the injury. Clinical manifestation (including visual analogue scale (VAS) for pain, range of motion (ROM), and severity of knee effusion) and physical examination (Lachman test and pivot shift test) were checked in ED and the second OPD follow-up. The group of patients with joint aspiration (G1) showed substantial decreases in mean values of VAS for pain (p=0.005), ROM (p=0.001), and effusion level (pknee joint aspiration. Positive Lachman test was recorded at 76.5% in the second follow-up in G1, which was significantly (p=0.047) higher than that (47.6%) in G2. The percentage of positive pivot shift test was recorded at 76.5% in the second follow-up in G1, which as significantly (pKnee joint aspiration in acute ACL injury with suspected hemarthrosis could be considered as a diagnostic procedure. Joint aspiration in early medical attendance might be able to lower pain scores or raise the sensitivity of physical examination for diagnosing acute ACL injury at follow up visit in orthopedic outpatient department. Retrospective cohort study III. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Magnetic resonance imaging of bone bruising in the acutely injured knee--short-term outcome

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    Davies, N.H.; Niall, D.; King, L.J.; Lavelle, J.; Healy, J.C. E-mail: j.healy@ic.ac.uk

    2004-05-01

    AIM: To investigate the short-term outcome and associated injuries of bone bruising in the acutely injured knee. METHOD AND MATERIALS: Thirty patients (age range 17-39 years, mean 28 years) with bone bruising identified on magnetic resonance imaging (MRI) after an acute knee injury were rescanned 12-14 weeks post-injury. The volume of bone bruising was measured on coronal STIR (short TI inversion recovery) images and correlation made with the presence and type of ligamentous and osteochondral injuries. RESULTS: All bone bruises were present on repeat MRI. Twenty of the 30 patients (67%) had associated anterior cruciate ligament (ACL) injuries, seven of the 30 (23%) had collateral ligament injuries and three of the 30 (10%) had no associated ligamentous injuries. Greater than 50% reduction in bone bruise volume was demonstrated at repeat scanning in 24 of the 30 patients (80%) and less than 50% in five of the 30 patients (17%). One patient showed an increase in volume of bone bruising at follow-up. There was no correlation between initial size or size reduction of bone bruising and the presence/absence or type of associated injuries. In 21 patients the bone bruises resolved from the periphery, whilst eight patients showed bone bruises that resolved towards the joint margin, all of whom had associated osteochondral injuries. Of the 30 patients, 17 showed bone bruising that extended to the joint margin, 10 of whom had associated osteochondral injuries on MRI. On clinical review some degree of knee pain was still present in all but one of the patients reviewed. The single patient who reported complete resolution of symptoms was one of the three patients with isolated bone bruising CONCLUSION: Bone bruises persist for at least 12-14 weeks, which is longer than previously quoted. Two discrete patterns of bone bruise resolution have been demonstrated. The size and persistence of bone bruising is not related to the presence or absence or type of associated ligamentous

  15. Rhabdomyolysis and acute kidney injury in the injured war fighter.

    Science.gov (United States)

    Elterman, Joel; Zonies, David; Stewart, Ian; Fang, Raymond; Schreiber, Martin

    2015-10-01

    Rhabdomyolysis is a recognized complication of traumatic injury. The correlation of an elevated creatine kinase (CK) level and the development of acute kidney injury (AKI) has been studied in the civilian population. We sought to review the prevalence of rhabdomyolysis in injured war fighters and determine if peak CK levels correlate with AKI. This is a retrospective cohort study of patients admitted at a US military treatment facility from January to November 2010. Inclusion criteria were active duty patients transported after explosive, penetrating, or blunt injury. Patients with burns or non-trauma-related admissions were excluded. Rhabdomyolysis was defined as a CK level greater than 5,000 U/L. AKI was defined using the Kidney Disease: Improving Global Outcomes classification. Mann-Whitney U-tests were used to determine the significance for continuous data. Correlations were determined using Spearman's ρ. Significance was set at p Rhabdomyolysis developed in 79 patients (24.8%). The median peak CK for all patients was 4,178 U/L and ranged from 208 U/L to 120,000 U/L. Stage 1, 2, and 3 AKI developed in 56 (17.6%), 3 (0.9%), and 7 (2.2%) patients, respectively. There was a weak but statistically significant correlation between peak CK and AKI (r = 0.26, p rhabdomyolysis in combat casualties and would allow for standardized comparisons in future work. Epidemiologic/prognostic study, level III.

  16. Correlation study of podocyte injur y and kidney function in patients with acute kidney injur y

    Directory of Open Access Journals (Sweden)

    You-Gang Feng

    2016-11-01

    Full Text Available Objective: To investigate the correlation between the podocyte injury indexes in urine such as nephrin, desmin, P-cadherin, podocin, podocalyxin and CD2-associated protein (CD2AP and the kidney function in patients with acute kidney injury (AKI. Methods: A total of 120 severe postsurgical patients treated in the Intensive Care Unit of our hospital from May 2012 to October 2015 were selected and divided into AKI group (n = 38 and non-AKI group (n = 82 according to the diagnostic criteria of AKI. After admission to the Intensive Care Unit for 24 h, their blood samples were collected to detect the contents of serum creatinine (Scr, serum urea (SUrea, b2-microglobulin (b2-MG and cystatin C (Cys-C, and urine samples were collected to detect the contents of kidney injury molecule-1 (KIM-1, liver-type fatty acid binding protein (L-FABP, Netrin-1, nephrin, desmin, P-cadherin, podocin, podocalyxin and CD2AP. Results: For patients in AKI group, the contents of Scr, SUrea, b2-MG and Cys-C in their blood samples and the contents of KIM-1, L-FABP, Netrin-1, nephrin, desmin, Pcadherin, podocin, podocalyxin and CD2AP in their urine samples were both significantly higher than those in non-AKI group. The contents of nephrin, desmin, P-cadherin, podocin, podocalyxin and CD2AP in urine samples and contents of Scr, SUrea, b2-MG, Cys-C and neutrophil gelatinase associated lipocalin in blood samples were positively correlated with the contents of KIM-1, L-FABP, and Netrin-1 in urine. Conclusions: Contents of podocyte injury molecules in urine of patients with acute kidney injury such as nephrin, desmin, P-cadherin, podocin, podocalyxin and CD2AP raised remarkably and the changes were consistent with the changes of kidney function indexes in the blood and urine samples.

  17. THE ACUTE EFFECTS OF THE PREVENT INJURY ENHANCE PERFORMANCE PROGRAMME (PEP) ON ACL INJURY RISK FACTORS

    OpenAIRE

    Clarke, S; McCann, C

    2015-01-01

    The purpose of this study was to determine the immediate effects the prevent injury enhance performance programme (PEP) had on lower extremity biomechanics in relation to anterior cruciate ligament (ACL) risk factors compared to when it was not performed. 8 healthy males were required to perform a number of drop rebound jumps as a task that mimicked the sudden deceleration seen during ACL injuries. The PEP significantly (p

  18. MRI findings in acute diffuse axonal injured patients

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    Sato, Hidetaka [Nippon Medical School, Tokyo (Japan)

    2001-07-01

    Diffuse axonal injury (DAI) in the acute stage was clinically evaluated using magnetic resonance imaging (MRI), which is considered superior to computed tomography (CT) in detecting parenchymal brain lesions. MRI was disadvantageous, however, to patients suffering from acute severe head injury because of the long time required to construct imaging and unstable patient vital signs. We conducted MRI safely under a high magnetic field (1.5 tesla) in acute DAI by close observation and with nonmagnetic respirator and electrocardiographic monitoring. MRI was conducted in 95 patients diagnosed with DAI classified into mild (14), moderate (17) and severe (64) DAI by criteria established by Gennarelli (1986). In patients with mild or moderate DAI, CT revealed no lesion in the parenchymal area although MRI detected lesions in every case, mainly in cortical white matter or basal ganglia. In patients with severe DAI, CT revealed parenchymal lesions in 14 although MRI detected further lesions in cortical white matter, basal ganglia, corpus callosum and brainstem in every case. These results correspond well to the experimental model Gennarelli's. This study concluded that MRI was useful in assessing acute DAI patients. (author)

  19. An injured man with acute altered mental status.

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    Chuang, Hung-Yu; Kung, Lu-Chih; Huang, Ming-Yuan

    2018-03-01

    A 58-year-old man sustained injuries due to accidental fall from a height of 5 m onto a solid floor while operating a crane. He was fully conscious without external evidence of head injury when presented to the ED. The patient had multiple fractures involving the fourth, fifth and seventh of the left ribs, left iliac wing and superior ramus of the pelvis, comminuted fracture of the left femur shaft, and an open fracture of the mandible. Two hours after ED presentation, the patient developed acute confusion and lethargy, which rapidly progressed to coma and respiratory distress, and was subsequently intubated with mechanical ventilation support. Emergent CT scan of the head is shown (figure 1).emermed;35/3/148/F1F1F1Figure 1CT scan of the head without contrast. What is the most likely diagnosis?A. Cerebral haemorrhageB. Brain metastasisC. Cerebral fat embolismD. Diffuse axonal injury. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. [Are there Sex Differences Regarding Ski Length to Height Ratio, Ski Length to Weight Ratio, Sidecut Radius and Ski Boot Sole Abrasion among ACL Injured Male and Female Skiers?

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    Posch, Markus; Ruedl, Gerhard; Tecklenburg, Katja; Helle, Kenneth; Schranz, Alois; Burtscher, Martin

    2017-06-01

    Introduction  Female skiers suffer from knee injuries twice as much as male skiers, and the risk of an injury to the anterior cruciate ligament (ACL) is three times greater among females compared to males. The sex-specific ACL injury risk depends on internal (e. g. age, skiing skills, fitness level) and external (e. g. slope and weather conditions, ski equipment) factors. However, it is not clear whether male and female recreational skiers with an ACL injury differ regarding the sidecut radius and ski boot sole abrasion. Method  This questionnaire-based study was conducted in the winter seasons 2014/15 and 2015/16. During those periods, data of ACL-injured skiers were collected at an Austrian ski clinic. The questionnaire included information about demographics, skiing skills, type of fall, binding release, and injury diagnosis. Furthermore, the ski length and sidecut radius were notated from the ski, and abrasion of ski boot sole was measured at the toe and heel piece of the ski boot using a caliper. Results  In total 164 ACL-injured skiers (67 % females) with a mean age of 41.7 ± 11.5 years were recorded. Males used significantly longer skies compared to females (168.3 ± 6.6 vs. 157.5 ± 5.9 cm, p ski length to height ratio (94.0 ± 3.4 vs. 94.1 ± 3.3 %) showed no significant difference between the two sexes. The ski length to weight ratio was significantly different between females and males (2.5 ± 0.3 vs. 2.0 ± 0.2 cm/kg). The sidecut radius (13.5 ± 1.4 vs. 15.6 ± 2.6 m, p ski boot soles, neither at the toe piece (5.4 ± 1.2 vs. 5.5 ± 1.1 mm) nor at the heel piece (6.0 ± 1.7 vs. 6.0 ± 1.6 mm) between females and males. For both sexes the most common type of fall was the forward fall with body rotation (approximately 59 %). Failure of binding release was significantly more often reported by females compared to males (86 vs. 44 %, p ski length to weight ratio, and the

  1. Protective effects of parmelia tinctorum preparations on acute radiation-injured mice

    International Nuclear Information System (INIS)

    Hong Ge; Li Songnian; Liu Peixun; Sheng Xiu

    2009-01-01

    Objective: To investigate the radiation protection effect of Parmelia tinctorum preparations in dosage, drug administration time, administration methods and different preparation methods on acute radiation-injured mice, and find out the best therapeutic project. Methods: Kunming mice were injected (ip) with 10 mg/kg, 20 mg/kg, 40 mg/kg, 80 mg/kg of Parmelia tinctorum preparations before irradiation respectively, then irradiated by 9 Gy 60 Co γ-ray. The 30-day survival rates and the protection factors were observed. By the same method, another group of mice were injected (ip) with Parmelia tinctorum preparations at 15 min, 30 min, 1 h, 2 h, 4 h before irradiation respectively, the 30-day survival rates and the protection factors were observed. The protective effect of Parmelia tinctorum preparations from intramuscular and oral routes were compared with the same method. The protective effect of Parmelia tinctorum water extract preparations and alcohol extract preparations were compared. Results: A certain dosage (20-80 mg/kg) of Parmelia tinctorum preparations could greatly improve the 30-day survival rates and the protection factors of radiation-injured mice. Parmelia tinctorum preparations had significant therapeutic effect on 60 Co γ-ray radiation-injured mice at 15 min-1 h before irradiation. Administration of Parmelia tinctorum preparations by intramuscular injection showed a little lower efficacy than by intraperitoneal injection, but administration the same dose orally had no significant radiation protective effect. Parmelia tinctorum preparations extracted by water injected (ip) before irradiation had the same radiation protective effect with those extracted by 50% alcohol. Conclusion: Parmelia tinctorum preparations have a certain protective effect on acute radiation-injured mice. The best therapeutic project is injected (ip) with 40 mg/kg of Parmelia tinctorum preparations at 30 min before irradiation. (authors)

  2. Management of Acute Combined ACL-Medial and Posteromedial Instability of the Knee.

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    Medvecky, Michael J; Tomaszewski, Paul

    2015-06-01

    Medial collateral ligament (MCL) injuries are the most common ligamentous injury of the knee. The extent of injury can range from a minor first-degree (1-degree) sprain to an extensive third-degree (3-degree) sprain that can propagate across the knee, rupturing one or both cruciate ligaments, and result in a knee subluxation or dislocation. A common pattern involves the combined anterior cruciate ligament (ACL) and MCL injury that is the focus of this chapter. The vast majority of these combined medial-sided injuries are treated nonoperatively with delayed reconstruction of the ACL injury in athletically active individuals. The MCL and associated medial structures are carefully assessed on physical examination, and classification of injury is based upon abnormal limits of joint motion. In vitro cadaveric biomechanical testing has given us a better understanding of ligament deficiency and altered joint motion. Consistency in terminology is necessary for proper classification of injury and reproducible categorization of injury patterns to be able to compare both nonoperative and operative treatment of various injury patterns.

  3. Increased sphingosine-1-phosphate improves muscle regeneration in acutely injured mdx mice

    Science.gov (United States)

    2013-01-01

    Background Presently, there is no effective treatment for the lethal muscle wasting disease Duchenne muscular dystrophy (DMD). Here we show that increased sphingosine-1-phoshate (S1P) through direct injection or via the administration of the small molecule 2-acetyl-4(5)-tetrahydroxybutyl imidazole (THI), an S1P lyase inhibitor, has beneficial effects in acutely injured dystrophic muscles of mdx mice. Methods We treated mdx mice with and without acute injury and characterized the histopathological and functional effects of increasing S1P levels. We also tested exogenous and direct administration of S1P on mdx muscles to examine the molecular pathways under which S1P promotes regeneration in dystrophic muscles. Results Short-term treatment with THI significantly increased muscle fiber size and extensor digitorum longus (EDL) muscle specific force in acutely injured mdx limb muscles. In addition, the accumulation of fibrosis and fat deposition, hallmarks of DMD pathology and impaired muscle regeneration, were lower in the injured muscles of THI-treated mdx mice. Furthermore, increased muscle force was observed in uninjured EDL muscles with a longer-term treatment of THI. Such regenerative effects were linked to the response of myogenic cells, since intramuscular injection of S1P increased the number of Myf5nlacz/+ positive myogenic cells and newly regenerated myofibers in injured mdx muscles. Intramuscular injection of biotinylated-S1P localized to muscle fibers, including newly regenerated fibers, which also stained positive for S1P receptor 1 (S1PR1). Importantly, plasma membrane and perinuclear localization of phosphorylated S1PR1 was observed in regenerating muscle fibers of mdx muscles. Intramuscular increases of S1P levels, S1PR1 and phosphorylated ribosomal protein S6 (P-rpS6), and elevated EDL muscle specific force, suggest S1P promoted the upregulation of anabolic pathways that mediate skeletal muscle mass and function. Conclusions These data show that S1P is

  4. Longitudinal Evaluation of Stair Walking Biomechanics in Patients with ACL Injury.

    Science.gov (United States)

    Lepley, Adam S; Gribble, Phillip A; Thomas, Abbey C; Tevald, Michael A; Sohn, David H; Pietrosimone, Brian G

    2016-01-01

    After anterior cruciate ligament (ACL) injury and reconstruction, abnormal biomechanics during daily tasks may have prominent and detrimental long-term consequences on knee joint health. The purpose of this study was to longitudinally evaluate hip and knee joint biomechanics during stair ascent and descent in patients with acute ACL injury and at return to activity after ACL reconstruction. Twenty individuals with unilateral ACL injury (age, 20.9 ± 4.4 yr; height, 172.4 ± 7.5 cm; mass, 76.2 ± 12.2 kg) that were scheduled to undergo surgical reconstruction were compared with 20 healthy matched controls (age, 21.7 ± 3.7 yr; height, 173.7 ± 9.9 cm; mass, 76.1 ± 19.7 kg). Lower extremity biomechanics were recorded using three-dimensional motion analysis during stair ascent and descent at two testing sessions (before surgery and at approximately 6 months after surgery or when they were allowed to return to unrestricted physical activity). Time between sessions for healthy participants was matched on the basis of the ACL group. Peak sagittal and frontal plane knee and hip joint angles and moments, joint angles at initial contact, and joint excursions across stance phase were evaluated. The ACL-injured limb of patients experienced smaller knee extension moments than the uninjured limb and healthy controls during stair ascent and descent (P ACL reconstruction. During stair ascent, ACL patients experienced more extended knee joint positions and less sagittal plane knee joint excursions, coupled with greater frontal plane hip joint excursions (P ACL injury experience reductions in knee flexion angle and knee extension moments during stair walking. These alterations were observed both before and after reconstruction, suggesting that early gait retraining interventions may be beneficial in these patients.

  5. ACL Reconstruction

    Science.gov (United States)

    ... in moderate exercise and recreational activities, or play sports that put less stress on the knees. ACL reconstruction is generally recommended if: You're an athlete and want to continue in your sport, especially if the sport involves jumping, cutting or ...

  6. ACL Injuries

    Science.gov (United States)

    ... U.S. Soccer have seen positive results and fewer injuries with PEP. The Santa Monica Sports Medicine Foundation (SMSMF) created this program. There is no clear evidence that use of a knee brace prevents ACL injuries. There also is no ...

  7. The association between acute alcohol consumption and discharge against medical advice of injured patients in the ED.

    Science.gov (United States)

    Jeong, Joo; Song, Kyoung Jun; Kim, Yu Jin; Cho, Jin Seong; Park, Ju Ok; Lee, Seung Chul; Ro, Young Sun; Holmes, James F

    2016-03-01

    A paucity of data exists on the prevalence and predictors of discharging injured patients against medical advice from emergency departments. The aim of this study is to investigate the association between acute alcohol use and being discharged against medical advice. We performed a prospective, observational study of injured patients enrolled into the Korean Centers for Disease and Prevention injury surveillance program in 7 tertiary, academic, and teaching hospitals from June 1, 2008, to November 31, 2011. Injured patients were assigned to 1 of 3 groups: discharged against medical advice, regular discharge, and transferred or admitted. Multivariable logistic regression models were used to analyze the association between acute alcohol use and being discharged against medical advice. A total of 125,327 patients were enrolled, and 3473 (2.8%) were discharged against medical advice. The proportion of acute alcohol use was significantly higher among the patients who were discharged against medical advice (40.1%) than the regular discharged (16.6%) or transferred/admitted (15.5%) patients. In a regression model, acute alcohol use increased the risk of being discharged against medical advice (adjusted odds ratio, 1.86; 95% confidence interval, 1.70-2.03). In addition, we identified the interaction between acute alcohol use and intention of injury. Acute alcohol use had a significant association with the discharge against medical advice with the unintentional injury (adjusted odds ratio, 2.56; 95% confidence interval, 2.30-2.84). Patients with acute alcohol use before sustaining an injury are at increased risk of being discharged against medical advice from the emergency departments. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Kinesio taping as a treatment method in the acute phase of ACL reconstruction: A double-blind, placebo-controlled study.

    Science.gov (United States)

    Balki, Selvin; Göktaş, Hanım Eda; Öztemur, Zekeriya

    2016-12-01

    In this study, we aimed on investigating the effects of Kinesio taping (KT) in acute postoperative rehabilitation phase of anterior cruciate ligament (ACL) reconstruction. Thirty male patients (mean age: 28.1 years) with ACL reconstruction were randomly assigned to two groups: (1) an experimental group to receive a KT treatment through the muscle and lymphatic correction techniques; or (2) a control group for sham KT. Both interventions were applied twice during a 10-day period from the fourth postoperative day. All patients received the same rehabilitation program for three months. The groups were compared according to range of motion (ROM), pain, swelling and muscle strength before treatment and on the fifth and tenth treatment days. Subjective evaluations were made with the Lysholm, modified Cincinnati and Tegner scores on the first and third postoperative months. Intragroup comparisons showed significant improvements in both groups on the fifth and tenth day and first and third month evaluations (p < 0.05). In comparison to the control group, the experimental group showed significant improvements in swelling around the patella, all pain measurements and hamstring muscle strength on the fifth KT day and knee flexion range of motion (ROM), night pain, all swelling measurements and hamstring muscle strength on the tenth KT day (p < 0.05). Our results revealed that KT techniques applied in addition to the acute rehabilitation program of ACL reconstruction are beneficial in treatment of pain, swelling, knee flexion ROM, and hamstring muscle strength. Level I, Therapeutic study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  9. Long Term Changes in Muscles around the Knee Joint after ACL Resection in Rats: Comparisons of ACL-Resected, Contralateral and Normal Limb

    Directory of Open Access Journals (Sweden)

    Mahiro Ohno, Hiroto Fujiya, Katsumasa Goto, Mitsutoshi Kurosaka, Yuji Ogura, Kanaka Yatabe, Takaaki Kudo, Hajime Kobayashi, Hisateru Niki, Haruki Musha

    2017-09-01

    Full Text Available The purpose of this study was to investigate the long-term effects of anterior cruciate ligament (ACL resection on the morphological and contractile characteristics of rectus femoris (RF and semimembranosus (SM muscles in both injured and contralateral hindlimbs in rats. Wistar male rats (8-week old were used. Rats were divided into two groups; ACL-resected and (sham-operated control groups. Furthermore, right and left limbs of rats in the ACL-resected group were assigned as ACL-resected and contralateral groups, respectively, at 1 day, 1, 4, and 48 weeks after ACL resection. No ACL-resection-associated changes in the mass of both muscles were observed 1 week after ACL resection. On the other hand, ACL-resection-associated reduction on mean fiber cross-sectional area (fiber CSA in RF muscle lasted 48 weeks after ACL resection. Furthermore, ACL-resection associated increase in fiber composition of type I fiber in RF muscle in contralateral limbs. In addition, long-term effects of ACL resection were observed in both ACL-resected and contralateral limbs. Evidences from this study suggested that ACL resection may cause to change in the morphological (fiber CSA and contractile (distribution of fiber types properties of skeletal muscles around the knee joint in not only injured but also contralateral limb. Rehabilitation for quantitative and qualitative muscle changes by ACL resection may be required a special care for a long-term period.

  10. Experiences and needs of parents of critically injured children during the acute hospital phase: A qualitative investigation.

    Science.gov (United States)

    Foster, Kim; Young, Alexandra; Mitchell, Rebecca; Van, Connie; Curtis, Kate

    2017-01-01

    Physical injury is a leading cause of death and disability among children worldwide and the largest cause of paediatric hospital admission. Parents of critically injured children are at increased risk of developing mental and emotional distress in the aftermath of child injury. In the Australian context, there is limited evidence on parent experiences of child injury and hospitalisation, and minimal understanding of their support needs. The aim of this investigation was to explore parents' experiences of having a critically injured child during the acute hospitalisation phase of injury, and to determine their support needs during this time. This multi-centre study forms part of a larger longitudinal mixed methods study investigating the experiences, unmet needs and well-being of parents of critically injured children over the two-year period following injury. This paper describes parents' experiences of having a child 0-13 years hospitalised with critical injury in one of four Australian paediatric hospitals. Semi-structured interviews were conducted with forty parents and transcribed verbatim. The data were managed using NVIVO 10 software and thematically analysed. Forty parents (26 mothers and 14 fathers) of 30 children (14 girls and 16 boys aged 1-13 years) from three Australian States participated. The majority of children were Australian born. Three main themes with sub-themes were identified: navigating the crisis of child injury; coming to terms with the complexity of child injury; and finding ways to meet the family's needs. There is a need for targeted psychological care provision for parents of critically injured children in the acute hospital phase, including psychological first aid and addressing parental blame attribution. Parents and children would benefit from the implementation of anticipatory guidance frameworks informed by a family-centred social ecological approach to prepare them for the trauma journey and for discharge. This approach could

  11. MR diffusion tensor imaging in the evaluation of neural progenitor cells transplantation to acute injured canine spinal cord

    International Nuclear Information System (INIS)

    Wang Xiaoying; Tan Ke; Ni Shilei; Bao Shengde; Jiang Xuexiang

    2006-01-01

    Objective: To observe the effect of transplantation of telomerase immortalized human neural progenitor cells to acute injured canine spinal cord by using MR diffusion tensor imaging (DTI). Methods: Telomerase immortalized human neural progenitor cells with expression of green fluorescent protein were prepared for transplantation. Eight adult canines with left spinal cord hemisection at the level of T13 were examined by MR diffusion tensor imaging four times sequentially: prior to injury, one week after injury, one week after transplantation (two weeks after injury), and four weeks after transplantation. Results: The ADC values of the injured spinal cord were (1.00 ± 0.15) x 10 -3 mm 2 /s, (1.65 ± 0.45) x 10 -3 mm 2 /s, (1.44 ± 0.48) xl0 -3 mm 2 /s, and (1.43 ± 0.26) x 10 -3 mm 2 /s, respectively. There was statistically significant difference between the data obtained at different times (F= 6.038, P=0.005). The FA values of the injured spinal cord were 0.59±0.11, 0.30±0.17, 0.36±0.25, and 0.34±0.11, respectively. There was also statistically significant difference between the data obtained at different times (F=5.221, P=0.009). The ADC values of the intact spinal cord were (1.01±0.17) x 10 -3 mm 2 /s, (1.32±0.06) x 10 -3 mm 2 /s, (1.10±0.24) x 10 -3 mm 2 /s, and (1.14±0.22) x 10 -3 mm 2 /s, respectively. There was no statistically significant difference between the data obtained at different times (F=1.303, P=0.306). The FA values of the intact spinal cord were 0.60 ± 0.09, 0.38 ± 0.25, 0.46 ± 0.15, and 0.50 ± 0.21, respectively. There was also no statistically significant difference between the data obtained at different times (F=2.797, P=0.072). Conclusion: DTI can provide useful information for spinal cord injury and regeneration in experimental spinal cord injury. (authors)

  12. Does the lateral intercondylar ridge disappear in ACL deficient patients?

    NARCIS (Netherlands)

    van Eck, Carola F.; Morse, Kenneth R.; Lesniak, Bryson P.; Kropf, Eric J.; Tranovich, Michael J.; van Dijk, C. Niek; Fu, Freddie H.

    2010-01-01

    The aim of this study was to determine whether there is a difference in the presence of the lateral intercondylar ridge and the lateral bifurcate ridge between patients with sub-acute and chronic ACL injuries. We hypothesized that the ridges would be present less often with chronic ACL deficiency.

  13. Update on rehabilitation following ACL reconstruction

    Directory of Open Access Journals (Sweden)

    John Nyland

    2010-09-01

    Full Text Available John Nyland, Emily Brand, Brent FisherDepartment of Orthopaedic Surgery, Division of Sports Medicine, University of Louisville, Louisville, KY, USAAbstract: As anterior cruciate ligament (ACL reconstruction has evolved to less invasive, more anatomical approaches, rehabilitation of the injured athlete has likewise become more progressive and innovative, with a sound understanding of graft and fixation strength and biologic healing-remodeling constraints. This review discusses these innovations including specific considerations before surgery, when planning rehabilitation timetables, and the importance of reestablishing nonimpaired active and passive knee range of motion and biarticular musculotendinous extensibility in positions of function. Concepts of self-efficacy or confidence and reestablishing the “athlete role” are also addressed. Since ACL injury and reinjury are largely related to the influence of structure-form-function on dynamic knee joint stability, the interrelationships between sensorimotor, neuromuscular, and conventional resistance training are also discussed. Although pivot shift “giving way” relates to function loss following ACL injury, anterior translational laxity often does not. Although there is growing evidence that progressive eccentric training may benefit the patient following ACL reconstruction, there is less evidence supporting the use of functional ACL knee braces. Of considerable importance is selecting and achieving a criteria-based progression to sports-specific training, reestablishing osseous homeostasis and improved bone density, blending open and closed kinetic chain exercises at the appropriate time period, and appreciating the influence of the trunk, upper extremities, and sports equipment use on knee loads. We believe that knee dysfunction and functional recovery should be considered from a local, regional, and global perspective. These concepts are consolidated into our approach to prepare

  14. An anterior cruciate ligament injury does not affect the neuromuscular function of the non-injured leg except for dynamic balance and voluntary quadriceps activation

    NARCIS (Netherlands)

    Zult, Tjerk; Gokeler, Alli; van Raay, Jos J. A. M.; Brouwer, Reinoud W.; Zijdewind, Inge; Hortobagyi, Tibor

    The function of the anterior cruciate ligament (ACL) patients' non-injured leg is relevant in light of the high incidence of secondary ACL injuries on the contralateral side. However, the non-injured leg's function has only been examined for a selected number of neuromuscular outcomes and often

  15. The effects of ACL injury on quadriceps and hamstring torque, work and power.

    Science.gov (United States)

    Pincivero, Danny M; Heller, Brandan M; Hou, Su-I

    2002-09-01

    The aim of this study was to assess isokinetic torque, work and power between non-injured, ACL (anterior cruciate ligament)-deficient and ACL-reconstructed individuals. Ten healthy, non-injured individuals, seven unilateral ACL-deficient individuals and six unilateral ACL-reconstructed individuals were assessed for isokinetic quadriceps and hamstring strength at 1.05 and 3.14 rad.s-1. Peak torque, total work, average power and the ratio of peak torque to body mass were computed for both velocities. Peak torque was also corrected for body mass, using allometric modelling. The non-injured individuals showed significantly greater quadriceps peak torque to body mass ratios than the ACL-deficient and ACL-reconstructed individuals at both velocities, and greater hamstring peak torque to body mass ratios than the ACL-deficient group at 3.14 rad.s-1 (P quadriceps and hamstring peak torque, total work and average power than the non-injured individuals at 1.05 rad.s-1 (P quadriceps at both velocities (P hamstring peak torque and total work than the non-injured individuals at both velocities (P quadriceps muscle values were significantly higher in the non-involved than the involved limb. The hamstring peak torques corrected for body mass were significantly higher in the non-involved than the involved limb only at 1.05 rad.s-1. The main finding from the present study is that isokinetic measures in ratio-scaled or absolute units yield a different outcome and, hence, interpretation compared with the allometric approach.

  16. A Retrospective Analysis of Concurrent Pathology in ACL-Reconstructed Knees of Elite Alpine Ski Racers.

    Science.gov (United States)

    Jordan, Matthew J; Doyle-Baker, Patricia; Heard, Mark; Aagaard, Per; Herzog, Walter

    2017-07-01

    Anterior cruciate ligament (ACL) tear is the most frequent injury in alpine ski racing, and there is a high prevalence of ACL reinjury. Limited data exist on the concurrent pathology with primary ACL tears in elite alpine ski racers and the magnitude of injury progression after primary ACL reconstruction (ACLR). To evaluate (1) the involvement of intra-articular and multiligament pathologies at the time of primary ACLR, (2) the subsequent progression in meniscal/chondral injuries, and (3) the occurrence of ACL reinjury in elite alpine ski racers. Case series; Level of evidence, 4. Primary ACLR operative reports (n = 28) were obtained for 32 elite alpine ski racers along with the reports of 20 operative procedures that occurred subsequent to primary ACLR. Operative reports were evaluated to identify the presence/location of multiligament injury, meniscal tears, and chondral lesions. At the time of primary ACLR, a majority of knees (82%; 23/28) demonstrated concurrent injury compared with isolated ACL tears; 32% of knees sustained multiligament injuries (9/28), and 8 involved the ipsilateral medial collateral ligament (MCL). Of the ACL-injured knees, 54% had chondral lesions, of which 73% were sustained in the lateral knee compartment, and 82% of meniscal tears (14/17) were complex in nature. Bilateral ACL tears were seen in 22% of the participants, and 28% underwent ACL revision. In the case of ACL revision or future meniscal/chondral surgery, 60% of meniscal tears and 80% of chondral lesions had worsened since the time of primary ACLR. Concurrent injury was common in this group of elite ski racers. Primary ACL tears were typically accompanied by lateral compartment chondral lesions and complex meniscal tears that worsened over time. ACL/MCL tears were the most common multiligament injury pattern.

  17. CURRENT CONCEPTS IN ACL RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Freddie H. Fu

    2008-09-01

    Full Text Available Current Concepts in ACL Reconstruction is a complete reference text composed of the most thorough collection of topics on the ACL and its surgical reconstruction compiled, with contributions from some of the world's experts and most experienced ACL surgeons. Various procedures mentioned throughout the text are also demonstrated in an accompanying video CD-ROM. PURPOSE Composing a single, comprehensive and complete information source on ACL including basic sciences, clinical issues, latest concepts and surgical techniques, from evaluation to outcome, from history to future, editors and contributors have targeted to keep the audience pace with the latest concepts and techniques for the evaluation and the treatment of ACL injuries. FEATURES The text is composed of 27 chapters in 6 sections. The first section is mostly about basic sciences, also history of the ACL, imaging, clinical approach to adolescent and pediatric patients are subjected. In the second section, Graft Choices and Arthroscopy Portals for ACL Reconstruction are mentioned. The third section is about the technique and the outcome of the single-bundle ACL reconstruction. The fourth chapter includes the techniques and outcome of the double-bundle ACL reconstruction. In the fifth chapter revision, navigation technology, rehabilitation and the evaluation of the outcome of ACL reconstruction is subjected. The sixth/the last chapter is about the future advances to reach: What We Have Learned and the Future of ACL Reconstruction. AUDIENCE Orthopedic residents, sports traumatology and knee surgery fellows, orthopedic surgeons, also scientists in basic sciences or clinicians who are studying or planning a research on ACL forms the audience group of this book. ASSESSMENT This is the latest, the most complete and comprehensive textbook of ACL reconstruction produced by the editorial work up of two pioneer and masters "Freddie H. Fu MD and Steven B. Cohen MD" with the contribution of world

  18. Geometric Characteristics of the Knee Are Associated With a Noncontact ACL Injury to the Contralateral Knee After Unilateral ACL Injury in Young Female Athletes.

    Science.gov (United States)

    Levins, James G; Argentieri, Erin C; Sturnick, Daniel R; Gardner-Morse, Mack; Vacek, Pamela M; Tourville, Timothy W; Johnson, Robert J; Slauterbeck, James R; Beynnon, Bruce D

    2017-12-01

    Contralateral anterior cruciate ligament (CACL) injury after recovery from a first-time ACL rupture occurs at a high rate in young females; however, little is known about the risk factors associated with bilateral ACL trauma. The geometric characteristics of the contralateral knee at the time of the initial ACL injury are associated with risk of suffering a CACL injury in these female athletes. Case-control study; Level of evidence, 3. Sixty-two female athletes who suffered their first noncontact ACL injury while participating in sports at the high school or college level were identified, and geometry of the femoral notch, ACL, tibial spines, tibial subchondral bone, articular cartilage surfaces, and menisci of the contralateral, uninjured, knee was characterized in 3 dimensions. We were unable to contact 7 subjects and followed the remaining 55 until either a CACL injury or an ACL graft injury occurred or, if they were not injured, until the date of last contact (mean, 34 months after their first ACL injury). Cox regression was used to identify risk factors for CACL injury. Ten (18.2%) females suffered a CACL injury. Decreases of 1 SD in femoral intercondylar notch width (measured at its outlet and anterior attachment of the ACL) were associated with increases in the risk of suffering a CACL injury (hazard ratio = 1.88 and 2.05, respectively). Likewise, 1 SD decreases in medial-lateral width of the lateral tibial spine, height of the medial tibial spine, and thickness of the articular cartilage located at the posterior region of the medial tibial compartment were associated with 3.59-, 1.75-, and 2.15-fold increases in the risk of CACL injury, respectively. After ACL injury, subsequent injury to the CACL is influenced by geometry of the structures that surround the ACL (the femoral notch and tibial spines). This information can be used to identify individuals at increased risk for CACL trauma, who might benefit from targeted risk-reduction interventions.

  19. Biomechanics Associated with Patellofemoral Pain and ACL Injuries in Sports.

    Science.gov (United States)

    Weiss, Kaitlyn; Whatman, Chris

    2015-09-01

    Knee injuries are prevalent among a variety of competitive sports and can impact an athlete's ability to continue to participate in their sport or, in the worst case, end an athlete's career. The aim was to evaluate biomechanics associated with both patellofemoral pain syndrome (PFPS) and anterior cruciate ligament (ACL) injuries (in sports involving landing, change in direction, or rapid deceleration) across the three time points frequently reported in the literature: pre-injury, at the time of injury, and following injury. A search of the literature was conducted for research evaluating biomechanics associated with ACL injury and PFPS. The Web of Science, SPORTDiscus, EBSCO, PubMed, and CINAHL databases, to March 2015, were searched, and journal articles focused on ACL injuries and PFPS in sports that met the inclusion criteria were reviewed. The search methodology was created with the intent of extracting case-control, case, and cohort studies of knee injury in athletic populations. The search strategy was restricted to only full-text articles published in English. These articles were included in the review if they met all of the required selection criteria. The following inclusion criteria were used: (1) The study must report lower extremity biomechanics in one of the following settings: (a) a comparison of currently injured and uninjured participants, (b) a prospective study evaluating risk factors for injury, or (c) a study reporting on the injury event itself. (2) The study must include only currently active participants who were similar at baseline (i.e. healthy, high school level basketball players currently in-season) and include biomechanical analysis of either landing, change in direction, or rapid deceleration. (3) The study must include currently injured participants. The studies were graded on the basis of quality, which served as an indication of risk of bias. An adapted version of the 'Strengthening the Reporting of Observational Studies in

  20. ACL-reconstructed and ACL-deficient individuals show differentiated trunk, hip, and knee kinematics during vertical hops more than 20 years post-injury.

    Science.gov (United States)

    Markström, Jonas L; Tengman, Eva; Häger, Charlotte K

    2018-02-01

    Little is known regarding movement strategies in the long term following injury of the anterior cruciate ligament (ACL), and even less about comparisons of reconstructed and deficient knees in relation to healthy controls. The present purpose was to compare trunk, hip, and knee kinematics during a one-leg vertical hop (VH) ~20 years post-ACL injury between persons treated with surgery and physiotherapy (ACL R ), solely physiotherapy (ACL PT ), and controls (CTRL). Between-leg kinematic differences within groups were also investigated. Sixty-six persons who suffered unilateral ACL injury on average 23 ± 2 years ago (32 ACL R , 34 ACL PT ) and 33 controls performed the VH. Peak trunk, hip, and knee angles during Take-off and Landing phases recorded with a 3D motion capture system were analysed with multivariate statistics. Significant group effects during both Take-off and Landing were found, with ACL PT differing from CTRL in Take-off with a combination of less knee flexion and knee internal rotation, and from both ACL R and CTRL in Landing with less hip and knee flexion, knee internal rotation, and greater hip adduction. ACL R also presented different kinematics to ACL PT and CTRL in Take-off with a combination of greater trunk flexion, hip flexion, hip internal rotation, and less knee abduction, and in Landing with greater trunk flexion and hip internal rotation. Further, different kinematics and hop height were found between legs within groups in both Take-off and Landing for both ACL groups, but not for CTRL. Different kinematics for the injured leg for both ACL groups compared to CTRL and between treatment groups, as well as between legs within treatment groups, indicate long-term consequences of injury. Compensatory mechanisms for knee protection seem to prevail over time irrespective of initial treatment, possibly increasing the risk of re-injury and triggering the development of osteoarthritis. Detailed investigation of movement strategies during the VH

  1. Polymorphic Types in ACL2

    Directory of Open Access Journals (Sweden)

    Benjamin Selfridge

    2014-06-01

    Full Text Available This paper describes a tool suite for the ACL2 programming language which incorporates certain ideas from the Hindley-Milner paradigm of functional programming (as exemplified in popular languages like ML and Haskell, including a "typed" style of programming with the ability to define polymorphic types. These ideas are introduced via macros into the language of ACL2, taking advantage of ACL2's guard-checking mechanism to perform type checking on both function definitions and theorems. Finally, we discuss how these macros were used to implement features of Specware, a software specification and implementation system.

  2. Interaction of dependent and non-dependent regions of the acutely injured lung during a stepwise recruitment manoeuvre.

    Science.gov (United States)

    Gómez-Laberge, Camille; Rettig, Jordan S; Smallwood, Craig D; Boyd, Theonia K; Arnold, John H; Wolf, Gerhard K

    2013-02-01

    The benefit of treating acute lung injury with recruitment manoeuvres is controversial. An impediment to settling this debate is the difficulty in visualizing how distinct lung regions respond to the manoeuvre. Here, regional lung mechanics were studied by electrical impedance tomography (EIT) during a stepwise recruitment manoeuvre in a porcine model with acute lung injury. The following interaction between dependent and non-dependent regions consistently occurred: atelectasis in the most dependent region was reversed only after the non-dependent region became overdistended. EIT estimates of overdistension and atelectasis were validated by histological examination of lung tissue, confirming that the dependent region was primarily atelectatic and the non-dependent region was primarily overdistended. The pulmonary pressure-volume equation, originally designed for modelling measurements at the airway opening, was adapted for EIT-based regional estimates of overdistension and atelectasis. The adaptation accurately modelled the regional EIT data from dependent and non-dependent regions (R(2) > 0.93, P < 0.0001) and predicted their interaction during recruitment. In conclusion, EIT imaging of regional lung mechanics reveals that overdistension in the non-dependent region precedes atelectasis reversal in the dependent region during a stepwise recruitment manoeuvre.

  3. ACL Rupture in Collegiate Wrestler

    Directory of Open Access Journals (Sweden)

    Lindsay A. Palmer

    2016-05-01

    Full Text Available Objective: To educate others on unique Anterior Cruciate Ligament tears and percentage of usage of the ACL in normal daily function. Background: Patient is an eighteen year old male participating in wrestling and football at the time of the injury. Patient now only participates in wrestling. No previous knee or chronic injuries were reported prior to this injury. Patient was playing football during the time of injury. The patient stated that he planted his foot down and was tackled at the same time when the injury occurred. The patient felt his knee twist and buckle. Patient complained of clicking inside the knee and had minimal swelling. He also complained of it being difficult to bear weight at the time. The patient did not seek further treatment until two months after the injury occurred when he received an MRI. His MRI showed a positive finding for an Anterior Cruciate Ligament rupture. His previous Athletic Trainer could not find a positive diagnosis for the patient prior to the MRI. Differential Diagnosis: Possible meniscal or ACL injury. Treatment: Doctors officially diagnosed the injury as a complete rupture of the ACL. The patient did not receive surgery immediately. Doctors have stated that he only uses about 50% of his ACL on a daily basis compared to a normal person who uses about 95% of their ACL daily. Because of this, the patient played on his rupture for seven months before receiving surgery. He played a whole season of high school football and a whole season of wrestling his senior year with the ACL ruptured. The patient only used a brace for better comfort during the seven months. The patient then received reconstructive surgery to repair the rupture. A hamstring tendon graft was used to repair the ruptured ACL. Because a tendon was taken from the hamstring, patient experienced a tight ACL and hamstring of the left leg post-surgery. The patient participated in Physical Therapy for five months to strengthen and stretch the new

  4. Proprioception in Patients With Anterior Cruciate Ligament Tears: A Meta-analysis Comparing Injured and Uninjured Limbs.

    Science.gov (United States)

    Kim, Hyun-Jung; Lee, Jin-Hyuck; Lee, Dae-Hee

    2017-10-01

    Because of a reduction in the number of mechanoreceptors or alterations of their characteristics, anterior cruciate ligament (ACL) tears lead not only to mechanical instability but also to impaired proprioception. Purpose/Hypothesis: This study analyzed whether ACL tears cause a greater decrease in proprioception in injured than in uninjured knees. The hypothesis was that knee proprioception after ACL tears would decrease more in injured than in contralateral uninjured knees, regardless of the method used to measure knee proprioception. Meta-analysis. We identified studies comparing proprioception in ACL-injured and contralateral intact knees using threshold for detection of passive motion (TTDPM) or joint position sense (JPS) tests. JPS was assessed by measuring the reproduction of passive positioning (RPP) or active repositioning (RAP) of the knee. Sixteen studies were included in this meta-analysis. The pooled results of subgroup analyses of TTDPM for both 20° and 40° of knee flexion showed that mean angle of error was 0.23° (95% CI, 0.08°-0.37°) greater in ACL-injured than in contralateral intact knees ( P = .002). Pooled data RAP and RPP subgroup analyses also showed that the mean angle of error was 0.94° higher in ACL-injured than in contralateral intact knees. The mean difference in angle of error between ACL-injured and contralateral intact knees was 0.71° greater (95% CI, 0.68°-0.74°; P Proprioception of ACL-injured knees was decreased compared with contralateral intact knees, as determined by both joint movement (kinesthesia) and joint position. The magnitude of loss of proprioception was greater in joint position than in joint movement.

  5. Targeted drug delivery into reversibly injured myocardium with silica nanoparticles: surface functionalization,  natural biodistribution, and acute toxicity

    Directory of Open Access Journals (Sweden)

    Michael M Galagudza

    2010-03-01

    Full Text Available Michael M Galagudza1, Dmitry V Korolev1, Dmitry L Sonin1, Viktor N Postnov2, Garry V Papayan3, Ivan S Uskov1, Anastasia V Belozertseva1, Eugene V Shlyakhto11Institute of Experimental Medicine, VA. Almazov Federal Heart, Blood and Endocrinology Center, St-Petersburg, Russian Federation; 2Chemical Faculty, St-Petersburg State University, St-Petersburg, Russian Federation;  3Department of Pathophysiology, IP. Pavlov State Medical University, St-Petersburg, Russian FederationAbstract: The clinical outcome of patients with ischemic heart disease can be significantly improved with the implementation of targeted drug delivery into the ischemic myocardium. In this paper, we present our original findings relevant to the problem of therapeutic heart targeting with use of nanoparticles. Experimental approaches included fabrication of carbon and silica nanoparticles, their characterization and surface modification. The acute hemodynamic effects of nanoparticle formulation as well as nanoparticle biodistribution were studied in male Wistar rats. Carbon and silica nanoparticles are non-toxic materials that can be used as carriers for heart-targeted drug delivery. Concepts of passive and active targeting can be applied to the development of targeted drug delivery to the ischemic myocardial cells. Provided that ischemic heart-targeted drug delivery can be proved to be safe and efficient, the results of this research may contribute to the development of new technologies in the pharmaceutical industry.Keywords: nanocarriers, targeted drug delivery, myocardial ischemia

  6. Regeneration of injured renal tubules.

    Science.gov (United States)

    Yoshida, Makoto; Honma, Shigeyoshi

    2014-01-01

    Acute kidney injury (AKI), clinically defined by high serum creatinine and low urine flow, has many complicated pathophysiological features including tubular and glomerular injury. Although renal tubules are thought to be constituted by highly differentiated epithelial cells, it is possible to repair injured nephrons by the healing process. Several studies have revealed that AKI, especially AKI caused by ischemia/reperfusion injury or nephrotoxic medication, depends on a number of factors, including activation of transcriptional factors, endothelial injury of peritubular small vessels, immune responses, and inflammatory processes associated with necrosis and apoptosis of renal tubular epithelium. For regeneration of injured tubules, partly dedifferentiated progenitor-like cells fill the injured site and constitute the tubular structure and function, although the source of these cells is still under debate. It is essential to understand the molecular, cellular, and genetic mechanisms of AKI and tubular regeneration for the development of therapies to prevent and treat kidney injury.

  7. Repeat neuroimaging of mild traumatic brain-injured patients with acute traumatic intracranial hemorrhage: clinical outcomes and radiographic features.

    Science.gov (United States)

    Kreitzer, Natalie; Lyons, Michael S; Hart, Kim; Lindsell, Cristopher J; Chung, Sora; Yick, Andrew; Bonomo, Jordan

    2014-10-01

    Emergency department (ED) management of mild traumatic brain injury (TBI) patients with any form of traumatic intracranial hemorrhage (ICH) is variable. Since 2000, our center's standard practice has been to obtain a repeat head computed tomography (CT) at least 6 hours after initial imaging. Patients are eligible for discharge if clinical and CT findings are stable. Whether this practice is safe is unknown. This study characterized clinical outcomes in mild TBI patients with acute traumatic ICH seen on initial ED neuroimaging. This retrospective cohort study included patients presenting to the ED with blunt mild TBI with Glasgow Coma Scale (GCS) scores of 14 or 15 and stable vital signs, during the period from January 2001 to January 2010. Patients with any ICH on initial head CT and repeat head CT within 24 hours were eligible. Cases were excluded for initial GCS 24 hours old, pregnancy, concomitant nonminor injuries, and coagulopathy. A single investigator abstracted data from records using a standardized case report form and data dictionary. Primary endpoints included death, neurosurgical procedures, and for discharged patients, return to the ED within 7 days. Differences in proportions were computed with 95% confidence intervals (CIs). Of 1,011 patients who presented to the ED and had two head CTs within 24 hours, 323 (32%) met inclusion criteria. The median time between CT scans was 6 hours (interquartile range = 5 to 7 hours). A total of 153 (47%) patients had subarachnoid hemorrhage, 132 (41%) patients had subdural hemorrhage, 11 (3%) patients had epidural hemorrhage, 78 (24%) patients had cerebral contusions, and 59 (18%) patients had intraparenchymal hemorrhage. Four of 323 (1.2%, 95% CI = 0.3% to 3.2%) patients died within 2 weeks of injury. Three of the patients who died had been admitted from the ED on their initial visits, and one had been discharged home. There were 206 patients (64%) discharged from the ED, 28 (13.6%) of whom returned to the ED

  8. Anterior cruciate ligament (ACL) injury -- aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000681.htm Anterior cruciate ligament (ACL) injury - aftercare To use the sharing features ... that connects a bone to another bone. The anterior cruciate ligament (ACL) is located inside your knee joint and ...

  9. Comparison of hamstring muscle behavior for anterior cruciate ligament (ACL) patient and normal subject during local marching

    Science.gov (United States)

    Amineldin@Aminudin, Nurul Izzaty Bt.; Rambely, A. S.

    2014-09-01

    This study aims to investigate the hamstring muscle activity after the surgery by carrying out an electromyography experiment on the hamstring and to compare the behavior of the ACL muscle activity between ACL patient and control subject. Electromyography (EMG) is used to study the behavior of muscles during walking activity. Two hamstring muscles involved which are semitendinosus and bicep femoris. The EMG data for both muscles were recorded while the subject did maximum voluntary contraction (MVC) and marching. The study concluded that there were similarities between bicep femoris of the ACL and control subjects. The analysis showed that the biceps femoris muscle of the ACL subject had no abnormality and the pattern is as normal as the control subject. However, ACL patient has poor semitendinosus muscle strength compared to that of control subject because the differences of the forces produced. The force of semitendinosus value for control subject was two times greater than that of the ACL subject as the right semitendinosus muscle of ACL subject was used to replace the anterior cruciate ligament (ACL) that was injured.

  10. Surgical Management and Treatment of the Anterior Cruciate Ligament/Medial Collateral Ligament Injured Knee.

    Science.gov (United States)

    Dale, Kevin M; Bailey, James R; Moorman, Claude T

    2017-01-01

    The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. The anterior cruciate ligament (ACL) is the most commonly injured ligament in conjunction with the MCL. Most MCL injuries can be treated nonoperatively, whereas the ACL often requires reconstruction. A good physical examination is essential for diagnosis, whereas radiographs and MRI of the knee confirm diagnosis and help guide treatment planning. Preoperative physical therapy should be completed before surgical management to allow for return of knee range of motion and an attempt at MCL healing. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Evidence-Based ACL Reconstruction

    Directory of Open Access Journals (Sweden)

    E. Carlos RODRIGUEZ-MERCHAN

    2015-01-01

    Full Text Available There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACLreconstruction. The purpose of this article is to answer the following questions: 1 Bone patellar tendon bone (BPTB reconstruction or hamstring reconstruction (HR; 2 Double bundle or single bundle; 3 Allograft or authograft; 4 Early or late reconstruction; 5 Rate of return to sports after ACL reconstruction; 6 Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analysesfocused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years.

  12. Impact of treatment strategy and physical performance on future knee-related self-efficacy in individuals with ACL injury

    DEFF Research Database (Denmark)

    Flosadottir, Vala; Frobell, Richard; Roos, Ewa M

    2018-01-01

    BACKGROUND: In people with anterior cruciate ligament (ACL) injury, high self-efficacy facilitates recovery, indicated by improved muscle function, reduced knee symptoms and increased physical activity. Impact of treatment on future self-efficacy is however not well investigated. The aims...... of the study were to 1) investigate knee-related self-efficacy 6 years after acute ACL injury in patients treated with exercise therapy alone or in combination with either early or the option of delayed ACL reconstruction (ACLR), and 2) to investigate associations between single-leg physical performance...... at various time points after ACL injury and knee self-efficacy at 6 years after injury. METHODS: Participants (n = 121) originated from the KANON-study (ISRCTN84752559), a treatment RCT including active adults with acute ACL injury treated with structured exercise therapy combined with early or the option...

  13. [Impact of Self-Reported Fatigue on ACL Injuries in Alpine Skiing: A Sex Comparison].

    Science.gov (United States)

    Ruedl, G; Helle, K; Tecklenburg, K; Schranz, A; Fink, C; Posch, M; Burtscher, M

    2015-12-01

    In recreational alpine skiing, about one third of all injuries affect the knee joint, and the most common diagnosis in adult male and female skiers is a tear of the anterior cruciate ligament (ACL), which makes up 15 - 21 % of all injuries. General preventive recommendations to reduce the incidence of ski injuries include avoiding fatigue. However, it seems unclear to what extent ACL injuries in male and female recreational skiers are related to perceived fatigue. This study was conducted as a prospective questionnaire-based investigation in two Austrian ski injury clinics during the five winter seasons between 2009/2010 and 2013/2014. In total, 588 skiers (67.9 % females) with a mean age of 42.1 ± 10.9 years were interviewed about demographics, skiing ability, skiing behaviour, fitness, day and time of accident, skiing duration and perceived fatigue at the moment of accident. ACL injured males reported a significantly higher skiing ability and fitness level as well as a more risky behaviour on ski slopes compared to females. About one third of males and females injured their ACL within the first day of the ski trip and about 57 % within the first two days, with no sex differences. However, a significantly higher number of female skiers sustained an ACL injury during the first hour of skiing (28 vs. 17 %) as well as during the first two hours of skiing compared to males (52 vs. 44 %). About 81 % of males and females felt no fatigue or just a trace of fatigue in their legs at the time of accident, with no sex differences. Based on the findings of this study, fatigue does not seem to be a major risk factor for an ACL injury among male and female recreational skiers. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Differential properties of human ACL and MCL stem cells may be responsible for their differential healing capacity

    Directory of Open Access Journals (Sweden)

    Fu Freddie H

    2011-06-01

    Full Text Available Abstract Background The human anterior cruciate ligament (hACL and medial collateral ligament (hMCL of the knee joint are frequently injured, especially in athletic settings. It has been known that, while injuries to the MCL typically heal with conservative treatment, ACL injuries usually do not heal. As adult stem cells repair injured tissues through proliferation and differentiation, we hypothesized that the hACL and hMCL contain stem cells exhibiting unique properties that could be responsible for the differential healing capacity of the two ligaments. Methods To test the above hypothesis, we derived ligament stem cells from normal hACL and hMCL samples from the same adult donors using tissue culture techniques and characterized their properties using immunocytochemistry, RT-PCR, and flow cytometry. Results We found that both hACL stem cells (hACL-SCs and hMCL stem cells (hMCL-SCs formed colonies in culture and expressed stem cell markers nucleostemin and stage-specific embryonic antigen-4 (SSEA-4. Moreover, both hACL-SCs and hMCL-SCs expressed CD surface markers for mesenchymal stem cells, including CD44 and CD90, but not those markers for vascular cells, CD31, CD34, CD45, and CD146. However, hACL-SCs differed from hMCL-SCs in that the size and number of hACL-SC colonies in culture were much smaller and grew more slowly than hMCL-SC colonies. Moreover, fewer hACL-SCs in cell colonies expressed stem cell markers STRO-1 and octamer-binding transcription factor-4 (Oct-4 than hMCL-SCs. Finally, hACL-SCs had less multi-differentiation potential than hMCL-SCs, evidenced by differing extents of adipogenesis, chondrogenesis, and osteogenesis in the respective induction media. Conclusions This study shows for the first time that hACL-SCs are intrinsically different from hMCL-SCs. We suggest that the differences in their properties contribute to the known disparity in healing capabilities between the two ligaments.

  15. NFL Combine Athletic Performance after ACL Reconstruction

    OpenAIRE

    Marshall, Nathan E.; Keller, Robert A.; Mehran, Nima; Austin, William; Moutzouros, Vasilios

    2016-01-01

    Objectives: The purpose of this study was to determine the functional performance of NFL combine participants after ACL reconstruction compared with an age-, size-, and position-matched control group. The hypothesis was that there would be no difference between players after ACL reconstruction as compared with controls in functional athletic performance. Methods: A total of 98 NFL-caliber athletes who had undergone primary ACL reconstruction and participated in the NFL scouting combine betwee...

  16. How does functionality proceed in ACL reconstructed subjects? Proceeding of functional performance from pre- to six months post-ACL reconstruction.

    Directory of Open Access Journals (Sweden)

    Frieder Cornelius Krafft

    Full Text Available This is the first study examining functionality of subjects with anterior cruciate ligament (ACL tears and a subsequent reconstruction comprehensively by multiple test sessions from pre- to six months post-reconstruction. The purpose was to evaluate if a generally applied rehabilitation program restores functionality to levels of healthy controls. Subjects with unilateral tears of the ACL were compared to matched healthy controls throughout the rehabilitation. 20 recreational athletes were tested: T1 (preoperative, 6 weeks after tear; T2, 6 weeks, T3, 3 months, T4, 6 months post-reconstruction. At all test sessions, subjects self-evaluated their activity level with the Tegner activity score and their knee state with the Knee Injury and Osteoarthritis Outcome Score. Passive range of motion during knee flexion and extension and leg circumference were measured as functional clinical tests. Bilateral countermovement jumps, one-leg jumps for distance and isometric force tests in knee flexion and extension with 90° and 110° knee angle were conducted as functional performance tests. For determination of functionality, leg symmetry indices (LSIs were calculated by dividing values of the injured by the uninjured leg. In the ACL group most LSIs decreased from T1 to T2, and increased from T2 and T3 to T4. LSIs of ACL subjects remained lower than LSIs of healthy controls at 6 months post-reconstruction in nearly all parameters. Self-evaluation of ACL subjects showed, additionally, that activity level was lower than the pre-injury level at 6 months post-reconstruction. Low LSIs and low self-evaluation indicate that knee joint functionality is not completely restored at 6 months post-reconstruction. The study shows that multiple comprehensive testing throughout the rehabilitation gives detailed images of the functional state. Therefore, the functional state of ACL reconstructed individuals should be evaluated comprehensively and continuously throughout the

  17. The effects of ACL injury on knee proprioception: a meta-analysis.

    Science.gov (United States)

    Relph, N; Herrington, L; Tyson, S

    2014-09-01

    It is suggested the anterior cruciate ligament (ACL) plays a significant role in knee proprioception, however, the effect of ACL injury on knee proprioception is unclear. Studies utilising the two most common measurement techniques, joint position sense and threshold to detect passive motion, have provided evidence both for and against a proprioceptive deficient following ACL injury. The objective of the study was to undertake a meta-analysis investigating the effects of ACL injury, treated conservatively or by reconstruction, on proprioception of the knee, measured using joint position sense and/or threshold to detect passive movement techniques. Seven databases were searched from their inception to September 2013 using the subject headings 'anterior cruciate ligament, proprioception, postural sway, joint position sense, balance, equilibrium or posture' to identify relevant studies. PRISMA guidelines were followed as much as possible. Studies that investigated the effect of ACL injury on either knee joint kinaesthesia or position sense were included in this review. Two reviewers independently extracted data using a standardised assessment form. Comparisons were made using a fixed effect model with an inverse variance method using Review Manager Software (V5.1). Patients with ACL injury have poorer proprioception than people without such injuries (SMD=0.35°; P=0.001 and SMD=0.38°; P=0.03) when measured using joint position sense and threshold to detect passive motion techniques respectively. Patients had poorer proprioception in the injured than uninjured leg (SMD=0.52°; Pproprioception of people whose ACL was repaired was better than those whose ligament was left unrepaired (SMD=-0.62°; Pproprioception deficits compared to uninjured knees and control groups. Although differences were statistically significant, the clinical significance of findings can be questioned. Clinical practitioners using joint position sense or threshold to detect passive motion

  18. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: is PFP itself a predictor for subsequent ACL injury?

    Science.gov (United States)

    Myer, Gregory D; Ford, Kevin R; Di Stasi, Stephanie L; Foss, Kim D Barber; Micheli, Lyle J; Hewett, Timothy E

    2015-01-01

    Identifying risk factors for knee pain and anterior cruciate ligament (ACL) injury can be an important step in the injury prevention cycle. We evaluated two unique prospective cohorts with similar populations and methodologies to compare the incidence rates and risk factors associated with patellofemoral pain (PFP) and ACL injury. The 'PFP cohort' consisted of 240 middle and high school female athletes. They were evaluated by a physician and underwent anthropometric assessment, strength testing and three-dimensional landing biomechanical analyses prior to their basketball season. 145 of these athletes met inclusion for surveillance of incident (new) PFP by certified athletic trainers during their competitive season. The 'ACL cohort' included 205 high school female volleyball, soccer and basketball athletes who underwent the same anthropometric, strength and biomechanical assessment prior to their competitive season and were subsequently followed up for incidence of ACL injury. A one-way analysis of variance was used to evaluate potential group (incident PFP vs ACL injured) differences in anthropometrics, strength and landing biomechanics. Knee abduction moment (KAM) cut-scores that provided the maximal sensitivity and specificity for prediction of PFP or ACL injury risk were also compared between the cohorts. KAM during landing above 15.4 Nm was associated with a 6.8% risk to develop PFP compared to a 2.9% risk if below the PFP risk threshold in our sample. Likewise, a KAM above 25.3 Nm was associated with a 6.8% risk for subsequent ACL injury compared to a 0.4% risk if below the established ACL risk threshold. The ACL-injured athletes initiated landing with a greater knee abduction angle and a reduced hamstrings-to-quadriceps strength ratio relative to the incident PFP group. Also, when comparing across cohorts, the athletes who suffered ACL injury also had lower hamstring/quadriceps ratio than the players in the PFP sample (p15 Nm of knee abduction load

  19. Anterior crucate ligament (ACL) injury

    Science.gov (United States)

    ... foot is cool and blue after a knee injury. This means that the knee joint may be dislocated, and blood vessels to the foot may be injured. This is a medical emergency. Prevention Use proper techniques when playing sports or exercising. Some college sports programs teach athletes ...

  20. Anatomic Double-bundle ACL Reconstruction

    NARCIS (Netherlands)

    Schreiber, Verena M.; van Eck, Carola F.; Fu, Freddie H.

    2010-01-01

    Rupture of the anterior cruciate ligament (ACL) is one of the most frequent forms of knee trauma. The traditional surgical treatment for ACL rupture is single-bundle reconstruction. However, during the past few years there has been a shift in interest toward double-bundle reconstruction to closely

  1. Treatment for acute anterior cruciate ligament tear

    DEFF Research Database (Denmark)

    Frobell, Richard B; Roos, Harald P; Roos, Ewa M

    2013-01-01

    To compare, in young active adults with an acute anterior cruciate ligament (ACL) tear, the mid-term (five year) patient reported and radiographic outcomes between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL...

  2. Rehabilitation after ACL Injury: A Fluoroscopic Study on the Effects of Type of Exercise on the Knee Sagittal Plane Arthrokinematics

    Directory of Open Access Journals (Sweden)

    Sadegh Norouzi

    2013-01-01

    Full Text Available A safe rehabilitation exercise for anterior cruciate ligament (ACL injuries needs to be compatible with the normal knee arthrokinematics to avoid abnormal loading on the joint structures. The objective of this study was to measure the amount of the anterior tibial translation (ATT of the ACL-deficient knees during selective open and closed kinetic chain exercises. The intact and injured knees of fourteen male subjects with unilateral ACL injury were imaged using uniplanar fluoroscopy, while the subjects performed forward lunge and unloaded/loaded open kinetic knee extension exercises. The ATTs were measured from fluoroscopic images, as the distance between the tibial and femoral reference points, at seven knee flexion angles, from 0° to 90°. No significant differences were found between the ATTs of the ACL-deficient and intact knees at all flexion angles during forward lunge and unloaded open kinetic knee extension (. During loaded open kinetic knee extension, however, the ATTs of the ACL deficient knees were significantly larger than those of the intact knees at 0° (. It was suggested that the forward lunge, as a weight-bearing closed kinetic chain exercise, provides a safer approach for developing muscle strength and functional stability in rehabilitation program of ACL-deficient knees, in comparison with open kinetic knee extension exercise.

  3. MR imaging of bone bruise associated with ACL tear

    Energy Technology Data Exchange (ETDEWEB)

    Yamato, Minoru (Dokkyo Univ., Mibu, Tochigi (Japan). School of Medicine); Yamagishi, Tsuneo; Kobayashi, Tsuyoshi

    1993-01-01

    The authors reviewed 56 MR studies of the knee performed for suspected cruciate ligament tear at the Tokyo Metropolitan Hiroo Hospital from April 1990 to March 1991. There were 10 patients with abnormal signal in the subcortical bone marrow. Eight of these patients had concomitant anterior cruciate ligament (ACL) tear with no evidence of fracture on plain radiographs of the knee. The abnormal signals were all seen in the lateral compartment, almost invariably in the middle third of the lateral femoral condyle and posterolateral aspect of the tibial plateau, and were of low intensity on T1-weighted and proton density images and of high intensity on T2-weighted images. It was speculated that these abnormalities resulted from impaction of the lateral femoral condyle into the posterior lip of the tibial plateau due to rotary subluxation of the tibia. One patient had a follow-up study three months later, which revealed complete resolution of bone bruise. It was concluded that bone bruise associated with ACL tear is seen specific locations, which may be a useful secondary sign of acute ACL tear. (author).

  4. Differences in collagen gene expression in male and female anterior cruciate ligament injured athletes

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    X Liu

    2009-09-01

    Full Text Available Anterior Cruciate Ligament (ACL injuries occur two to eight times more frequently in women than men. However, it remains unclear whether gender differences exist in ACL at the molecular level. Using reverse transcript polymerase chain reaction (RT-PCR with histological analysis, the gene expressions of collagen types I and III of fibroblasts from ACLs of 17 male and 17 female athletes with acute ACL tears were studied. Female athletes were found to have a significantly lower gene expression of collagen I. No significant difference was found in type III collagen gene expression between male and female athletes. This finding may help us to explain the higher incidence of ACL injury in female athletes from the molecular perspective.

  5. Effects of ACL Reconstructive Surgery on Temporal Variations of Cytokine Levels in Synovial Fluid

    Directory of Open Access Journals (Sweden)

    Marco Bigoni

    2016-01-01

    Full Text Available Anterior cruciate ligament (ACL reconstruction restores knee stability but does not reduce the incidence of posttraumatic osteoarthritis induced by inflammatory cytokines. The aim of this research was to longitudinally measure IL-1β, IL-6, IL-8, IL-10, and TNF-α levels in patients subjected to ACL reconstruction using bone-patellar tendon-bone graft. Synovial fluid was collected within 24–72 hours of ACL rupture (acute, 1 month after injury immediately prior to surgery (presurgery, and 1 month thereafter (postsurgery. For comparison, a “control” group consisted of individuals presenting chronic ACL tears. Our results indicate that levels of IL-6, IL-8, and IL-10 vary significantly over time in reconstruction patients. In the acute phase, the levels of these cytokines in reconstruction patients were significantly greater than those in controls. In the presurgery phase, cytokine levels in reconstruction patients were reduced and comparable with those in controls. Finally, cytokine levels increased again with respect to control group in the postsurgery phase. The levels of IL-1β and TNF-α showed no temporal variation. Our data show that the history of an ACL injury, including trauma and reconstruction, has a significant impact on levels of IL-6, IL-8, and IL-10 in synovial fluid but does not affect levels of TNF-α and IL-1β.

  6. Proprioceptive deficits after ACL injury : are they clinically relevant?

    NARCIS (Netherlands)

    Gokeler, Alli; Benjaminse, Anne; Hewett, Timothy E.; Lephart, Scott M.; Engebretsen, Lars; Ageberg, Eva; Engelhardt, Martin; Arnold, Markus P.; Postema, Klaas; Otten, Egbert; Dijkstra, Pieter U.

    Objective To establish the clinical relevance of proprioceptive deficits reported after anterior cruciate ligament (ACL) injury. Material and methods A literature search was done in electronic databases from January 1990 to June 2009. Inclusion criteria for studies were ACL deficient (ACL-D) and ACL

  7. Variability in ACL tunnel placement: observational clinical study of surgeon ACL tunnel variability.

    Science.gov (United States)

    Wolf, Brian R; Ramme, Austin J; Wright, Rick W; Brophy, Robert H; McCarty, Eric C; Vidal, Armando R; Parker, Richard D; Andrish, Jack T; Amendola, Annunziato

    2013-06-01

    Multicenter and multisurgeon cohort studies on anterior cruciate ligament (ACL) reconstruction are becoming more common. Minimal information exists on intersurgeon and intrasurgeon variability in ACL tunnel placement. Purpose/ The purpose of this study was to analyze intersurgeon and intrasurgeon variability in ACL tunnel placement in a series of The Multicenter Orthopaedic Outcomes Network (MOON) ACL reconstruction patients and in a clinical cohort of ACL reconstruction patients. The hypothesis was that there would be minimal variability between surgeons in ACL tunnel placement. Cross-sectional study; Level of evidence, 3. Seventy-eight patients who underwent ACL reconstruction by 8 surgeons had postoperative imaging with computed tomography, and ACL tunnel location and angulation were analyzed using 3-dimensional surface processing and measurement. Intersurgeon and intrasurgeon variability in ACL tunnel placement was analyzed. For intersurgeon variability, the range in mean ACL femoral tunnel depth between surgeons was 22%. For femoral tunnel height, there was a 19% range. Tibial tunnel location from anterior to posterior on the plateau had a 16% range in mean results. There was only a small range of 4% for mean tibial tunnel location from the medial to lateral dimension. For intrasurgeon variability, femoral tunnel depth demonstrated the largest ranges, and tibial tunnel location from medial to lateral on the plateau demonstrated the least variability. Overall, surgeons were relatively consistent within their own cases. Using applied measurement criteria, 85% of femoral tunnels and 90% of tibial tunnels fell within applied literature-based guidelines. Ninety-one percent of the axes of the femoral tunnels fell within the boundaries of the femoral footprint. The data demonstrate that surgeons performing ACL reconstructions are relatively consistent between each other. There is, however, variability of average tunnel placement up to 22% of mean condylar depth

  8. Improving the sensitivity of the hop index in patients with an ACL deficient knee by transforming the hop distance scores

    Directory of Open Access Journals (Sweden)

    Thomas Scott G

    2006-02-01

    Full Text Available Abstract Background The one leg hop for distance is one of the most commonly employed functional tests utilized in the evaluation of the ACL deficient and reconstructed patient. While the reliability of the hop test scores has been well established, validity studies have revealed low sensitivity rates in detecting functional limitations using the hop index (the ratio or percentage of limb performance. However, the impact of the inherent limitations associated with the hop index have not been investigated to date. One specific limitation relates to the impact of the differences in the underlying hop distance scores. Therefore, this pilot study set out to determine: 1 the impact that between limb differences in hop distance has on the sensitivity of the hop index in detecting functional limitations and; 2 whether a logarithmic transformation of the underlying hop distance scores improves the sensitivity of the hop index. Methods A cross sectional design involving the evaluation of one leg hop for distance performance in a consecutive sample of 10 ACL deficient males with an isolated ACL tear awaiting reconstructive surgery and nine gender, age-matched controls. Results In the ACL deficient, the hop index was associated with the distance hopped on the non-injured limb (r = -0.66, p = 0.04 but not on the injured limb. Transformation (logarithmic of the hop distance scores and re-calculation of the hop index using the transformed scores increased the sensitivity of the hop index in the detection of functional limitations from 20 to 60% and 50 to 70% using the normal limb symmetry reference norms of ≥ 85% and 90% respectively. Conclusion The distance hopped on the non-injured limb is a critical factor in detecting functional limitations using the hop index in patients with an ACL deficient knee. Logarithmic transformation of the hop distance scores minimizes the effect of the arithmetic differences between limbs however; the sensitivity of the hop

  9. Noninjured Knees of Patients With Noncontact ACL Injuries Display Higher Average Anterior and Internal Rotational Knee Laxity Compared With Healthy Knees of a Noninjured Population.

    Science.gov (United States)

    Mouton, Caroline; Theisen, Daniel; Meyer, Tim; Agostinis, Hélène; Nührenbörger, Christian; Pape, Dietrich; Seil, Romain

    2015-08-01

    Excessive physiological anterior and rotational knee laxity is thought to be a risk factor for noncontact anterior cruciate ligament (ACL) injuries and inferior reconstruction outcomes, but no thresholds have been established to identify patients with increased laxity. (1) To determine if the healthy contralateral knees of ACL-injured patients have greater anterior and rotational knee laxity, leading to different laxity profiles (combination of laxities), compared with healthy control knees and (2) to set a threshold to help discriminate anterior and rotational knee laxity between these groups. Case-sectional study; Level of evidence, 3. A total of 171 healthy contralateral knees of noncontact ACL-injured patients (ACL-H group) and 104 healthy knees of control participants (CTL group) were tested for anterior and rotational laxity. Laxity scores (measurements corrected for sex and body mass) were used to classify knees as hypolax (score 1). Proportions of patients in each group were compared using χ(2) tests. Receiver operating characteristic curves were computed to discriminate laxity between the groups. Odds ratios were calculated to determine the probability of being in the ACL-H group. The ACL-H group displayed greater laxity scores for anterior displacement and internal rotation in their uninjured knee compared with the CTL group (P knees of patients with noncontact ACL injuries display different laxity values both for internal rotation and anterior displacement compared with healthy control knees. The identification of knee laxity profiles may be of relevance for primary and secondary prevention programs of noncontact ACL injuries. © 2015 The Author(s).

  10. Near-infrared Spectroscopy to Reduce the Prophylactic Fasciotomies for and Missed Cases of Acute Compartment Syndrome in Soldiers Injured in OEF/OIF

    Science.gov (United States)

    2010-10-01

    Thornton C. Proceedings: blood flows in the lower leg during recovery from fractures of the tibia and fibula . J Physiol. 1975;251: 22P. 32. Sandegard J...patients we operated on last week for burst fractures , had severe lower extremity injuries, but they were closed or Grade 1 or 2 open fractures , more...Twenty-six patients with acute unilateral tibial fractures and twenty-five uninjured volunteer control subjects were enrolled. Near-infrared

  11. ACL Research Retreat VI : An update on ACL injury risk and prevention

    NARCIS (Netherlands)

    R.J. Schmitz; M. Collins; D.A. Padua; Anne Benjaminse; A.M. Chaudhari; S.J. Schultz

    2012-01-01

    It has been well recognized that multiple factors, whether individually or in combination, contribute to noncontact anterior cruciate ligament (ACL) injury. The ongoing mission of the ACL Research Retreat is to bring clinicians and researchers together to present and discuss the most recent advances

  12. Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries

    Energy Technology Data Exchange (ETDEWEB)

    Dyck, Pieter van; Smet, Eline de; Gielen, Jan L.; Parizel, Paul M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Clockaerts, Stefan [University College Hospitals, Department of Orthopaedics, London (United Kingdom); Vanhoenacker, Filip M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); AZ St-Maarten, Department of Radiology, Antwerp (Belgium); Lambrecht, Valerie [Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); Wouters, Kristien [Antwerp University Hospital and University of Antwerp, Department of Biostatistics, Antwerp (Belgium)

    2016-10-15

    To determine the frequency of anterolateral ligament (ALL) injury in patients with acute anterior cruciate ligament (ACL) rupture and to analyse its associated injury patterns. Ninety patients with acute ACL rupture for which MRI was obtained within 8 weeks after the initial trauma were retrospectively identified. Two radiologists assessed the status of the ALL on MRI by consensus. The presence or absence of an ALL abnormality was compared with the existence of medial and lateral meniscal tears diagnosed during arthroscopy. Associated collateral ligament and osseous injuries were documented with MRI. Forty-one of 90 knees (46 %) demonstrated ALL abnormalities on MRI. Of 49 knees with intact ALL, 15 (31 %) had a torn lateral meniscus as compared to 25 torn lateral menisci in 41 knees (61 %) with abnormal ALL (p = 0.008). Collateral ligament (p ≤ 0.05) and osseous injuries (p = 0.0037) were more frequent and severe in ALL-injured as compared with ALL-intact knees. ALL injuries are fairly common in patients with acute ACL rupture and are statistically significantly associated with lateral meniscal, collateral ligament and osseous injuries. (orig.)

  13. An anterior cruciate ligament injury does not affect the neuromuscular function of the non-injured leg except for dynamic balance and voluntary quadriceps activation.

    Science.gov (United States)

    Zult, Tjerk; Gokeler, Alli; van Raay, Jos J A M; Brouwer, Reinoud W; Zijdewind, Inge; Hortobágyi, Tibor

    2017-01-01

    The function of the anterior cruciate ligament (ACL) patients' non-injured leg is relevant in light of the high incidence of secondary ACL injuries on the contralateral side. However, the non-injured leg's function has only been examined for a selected number of neuromuscular outcomes and often without appropriate control groups. We measured a broad array of neuromuscular functions between legs of ACL patients and compared outcomes to age, sex, and physical activity matched controls. Thirty-two ACL-deficient patients (208 ± 145 days post-injury) and active and less-active controls (N = 20 each) participated in the study. We measured single- and multi-joint neuromuscular function in both legs in each group and expressed the overall neuromuscular function in each leg by calculating a mean z-score across all neuromuscular measures. A group by leg MANOVA and ANOVA were performed to examine group and leg differences for the selected outcomes. After an ACL injury, duration (-4.3 h/week) and level (Tegner activity score of -3.9) of sports activity decreased and was comparable to less-active controls. ACL patients showed bilateral impairments in the star excursion balance test compared to both control groups (P ≤ 0.004) and for central activation ratio compared to active controls (P ≤ 0.002). There were between-leg differences within each group for maximal quadriceps and hamstring strength, voluntary quadriceps activation, star excursion balance test performance, and single-leg hop distance (all P quadriceps force accuracy and variability, knee joint proprioception, and static balance. Overall neuromuscular function (mean z-score) did not differ between groups, but ACL patients' non-injured leg displayed better neuromuscular function than the injured leg (P quadriceps activation, ACL patients had no bilateral neuromuscular deficits despite reductions in physical activity after injury. Therapists can use the non-injured leg as a reference to assess the

  14. The clinical and technical evaluation of a remote telementored telesonography system during the acute resuscitation and transfer of the injured patient.

    Science.gov (United States)

    Dyer, Dianne; Cusden, Jane; Turner, Chris; Boyd, Jeff; Hall, Rob; Lautner, David; Hamilton, Douglas R; Shepherd, Lance; Dunham, Michael; Bigras, Andre; Bigras, Guy; McBeth, Paul; Kirkpatrick, Andrew W

    2008-12-01

    Ultrasound (US) has an ever increasing scope in the evaluation of trauma, but relies greatly on operator experience. NASA has refined telesongraphy (TS) protocols for traumatic injury, especially in reference to mentoring inexperienced users. We hypothesized that such TS might benefit remote terrestrial caregivers. We thus explored using real-time US and video communication between a remote (Banff) and central (Calgary) site during acute trauma resuscitations. A existing internet link, allowing bidirectional videoconferencing and unidirectional US transmission was used between the Banff and Calgary ERs. Protocols to direct or observe an extended focused assessment with sonography for trauma (EFAST) were adapted from NASA algorithms. A call rota was established. Technical feasibility was ascertained through review of completed checklists. Involved personnel were interviewed with a semistructured interview. In addition to three normal volunteers, 20 acute clinical examinations were completed. Technical challenges requiring solution included initiating US; audio and video communications; image freezing; and US transmission delays. FAST exams were completed in all cases and EFASTs in 14. The critical anatomic features of a diagnostic examination were identified in 98% of all FAST exams and a 100% of all EFASTs that were attempted. Enhancement of clinical care included confirmation of five cases of hemoperitoneum and two pneumothoraces (PTXs), as well as educational benefits. Remote personnel were appreciative of the remote direction particularly when instructions were given sequentially in simple, nontechnical language. The remote real-time guidance or observation of an EFAST using TS appears feasible. Most technical problems were quickly overcome. Further evaluation of this approach and technology is warranted in more remote settings with less experienced personnel.

  15. NFL Combine Athletic Performance after ACL Reconstruction

    Science.gov (United States)

    Marshall, Nathan E.; Keller, Robert A.; Mehran, Nima; Austin, William; Moutzouros, Vasilios

    2016-01-01

    Objectives: The purpose of this study was to determine the functional performance of NFL combine participants after ACL reconstruction compared with an age-, size-, and position-matched control group. The hypothesis was that there would be no difference between players after ACL reconstruction as compared with controls in functional athletic performance. Methods: A total of 98 NFL-caliber athletes who had undergone primary ACL reconstruction and participated in the NFL scouting combine between 2010 and 2014 were reviewed and compared with an age-, size-, and position-matched control group. Data recorded for each player included a 40-yard dash, vertical leap, broad jump, shuttle drill, and 3-cone drill. Results: With regard to speed and acceleration, the mean 40-yard dash time for ACL-reconstructed players was 4.74 seconds (range, 4.33-5.55 seconds) compared with controls at 4.74 seconds (range, 4.34-5.38 seconds; P = .96). Jumping performance was also similar, with a mean vertical leap for ACL-reconstructed players of 33.35 inches (range, 23-43 inches) and broad jump of 113.9 inches (range, 96-136 inches) compared with respective values for the controls of 33.22 inches (range, 23.5-43.5 inches; P = .84) and 113.9 inches (range, 92-134 inches; P = .99). Agility and quickness testing measures also did not show a statistically significantly difference, with ACL-reconstructed players performing the shuttle drill in 4.37 seconds (range, 4.02-4.84 seconds) and the 3-cone drill in 7.16 seconds (range, 6.45-8.14 seconds), respectively, compared with respective times for the controls of 4.37 seconds (range, 3.96-5.00 seconds; P = .91) and 7.18 seconds (range, 6.64-8.24 seconds; P = .75). Conclusion: This study suggests that after ACL reconstruction, high-caliber athletes can achieve equivalent levels of perfor- mance with no statistically significant differences compared with matched controls. This information is unique when advising high-level athletes on athletic

  16. Reducing the Risk of ACL Injury in Female Athletes

    Science.gov (United States)

    McDaniel, Larry W.; Rasche, Adrienna; Gaudet, Laura; Jackson, Allen

    2010-01-01

    The Anterior Cruciate Ligament (ACL) is located behind the kneecap (patella) and connects the thigh bone (femur) to the shin bone (tibia). Stabilizing the knee joint is the primary responsibility of the ACL. Injuries that affect the ACL are three to five times more common in females than males. This is a result of anatomical, biomechanical,…

  17. Proprioceptive deficits after ACL injury : Are they clinically relevant?

    NARCIS (Netherlands)

    T.E. Hewett; Anne Benjaminse; Engelhardt M; M.P. Arnold; S.M. Lephart; K. Postema; L. Engebretsen; A. Gokeler; E. Ageberg; P.U. Dijkstra; E. Otten

    2012-01-01

    OBJECTIVE: To establish the clinical relevance of proprioceptive deficits reported after anterior cruciate ligament (ACL) injury. MATERIAL AND METHODS: A literature search was done in electronic databases from January 1990 to June 2009. Inclusion criteria for studies were ACL deficient (ACL-D) and

  18. The concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction

    NARCIS (Netherlands)

    Hofbauer, M.; Muller, B. [=Bart; Murawski, C. D.; van Eck, C. F.; Fu, F. H.

    2014-01-01

    To describe the concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction. The PubMed/Medline database was searched using keywords pertaining to ACL reconstruction. Relevant articles were reviewed in order to summarize important concepts of individualized surgery in ACL

  19. Psychopathological responses of physically injured persons

    Directory of Open Access Journals (Sweden)

    Lešić Aleksandar

    2003-01-01

    seriousness of injuries but also to the circumstances of their occurrence. The proneness to develop PTSD symptoms was not in correlation with the preparedness for accident, it being much poorer in peacetime injuries, as opposed to wartime patients, who had been prepared to the possibility of injury occurrence. The highest value of family homogeneity (FHI was established in the wartime injured, which led us to conclude that the injury contributed to the cohesion of the family from which the patient came. By extracting some questions related to psychopathological entities such as insomnia, depression, somatization, anxiety, and cognitive disorders, the following results were obtained. Depression was the most frequent in both groups of injuries. Anxiety was also present in the control group; and insomnia and somatization, that is, conversion symptoms, were present in both groups of the injured. By examining narrower psychological characteristics of the wartime injured revealed dissociation problems derangement to be the most frequent. Then follow the symptoms of depression which occur significantly more frequently in the wartime injured in comparison to the peacetime injured. The phenomenological symptoms of derangement and depression proved to be reliable parameters of physical trauma. It is also significant that the three characteristics showed correlation to psychopathological responses: severity of surgery, paralysis and acute injury.

  20. Examination of Knee Morphology After Secondary Ipsilateral ACL Injury Compared With Those That Have Not Been Reinjured: A Preliminary Study.

    Science.gov (United States)

    Digiacomo, Jessica E; Palmieri-Smith, Riann M; Redman III, John A; Lepley, Lindsey K

    2018-01-01

    Modifiable and nonmodifiable risk factors have been identified for sustaining a primary anterior cruciate ligament (ACL) injury; however, less research is available examining risk factors for a second injury. Identifying whether bony morphological factors are different (or more exaggerated) among those that experience a secondary ACL injury is critical to understanding if nonmodifiable risk factors are associated with a second injury. To determine if bony morphology is different among those that experience a secondary ACL reinjury as compared with those that do not. Case-control. University laboratory. ACL participants were tracked after return to play following primary reconstruction, and if individuals experienced a second ipsilateral injury (ACLx2; n = 14, 8f/6m, 17.9 ± 4.0 y), the primary clinical MRI was analyzed for bony morphological risk factors. ACLx2 participants were matched to individuals (sex, age, height, graft, gender, and activity level) that had undergone reconstruction but did not experience reinjury (ACLx1, n = 14, 8f/6m, 18.7 ± 4.0 y). Ten controls were also enrolled (5m/5f, 20.8 ± 3.9 y) for the purposes of comparing the authors' ACL data against healthy knees. Lateral and medial posterior tibial slopes (LPTS, MPTS), notch shape index (NSI), and medial tibial plateau depth of concavity (MDC). All ACL-reconstructed patients (combined ACLx1 and ACLx2 group) had a steeper LPTS than controls (d = 0.87, 95% CI 0.11-1.60, P = .023); however, no difference in LPTS was found between ACLx1 and ACLx2 (P > .05). No differences in MPTS, NSI, and MDC were found between all ACL participants (combined ACLx2 and ACLx1) and controls or between ACLx1 and ACLx2 (P > .05). Compared to healthy individuals, a steeper LPTS is a common bony abnormality in all ACL-injured participants. Individuals that go on to experience a second ipsilateral ACL injury do not have more exaggerated bony morphology than those that do not

  1. The risk assessment score in acute whiplash injury predicts outcome and reflects biopsychosocial factors

    DEFF Research Database (Denmark)

    Kasch, Helge; Qerama, Erisela; Kongsted, Alice

    2011-01-01

    One-year prospective study of 141 acute whiplash patients (WLP) and 40 acute ankle-injured controls.......One-year prospective study of 141 acute whiplash patients (WLP) and 40 acute ankle-injured controls....

  2. Acute Management of the Traumatically Injured Pelvis.

    Science.gov (United States)

    Skitch, Steven; Engels, Paul T

    2018-02-01

    Severe pelvic trauma is a challenging condition. The pelvis can create multifocal hemorrhage that is not easily compressible nor managed by traditional surgical methods such as tying off a blood vessel or removing an organ. Its treatment often requires reapproximation of bony structures, damage control resuscitation, assessment for associated injuries, and triage of investigations, as well as multimodality hemorrhage control (external fixation, preperitoneal packing, angioembolization, REBOA [resuscitative endovascular balloon occlusion of the aorta]) by multidisciplinary trauma specialists (general surgeons, orthopedic surgeons, endovascular surgeons/interventional radiologists). This article explores this complex clinical problem and provides a practical approach to its management. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. ACLED Country Report: Central African Republic

    Science.gov (United States)

    2015-01-01

    faith. While this is one aspect of the conflict, to consider the conflict overall to be religious in nature would be incorrect (Käihkö & Utas , 2014...2013 – the second most violent year on record for CAR. Targeted violence against civilians is a significant charac- teristic of the conflict in CAR...and publications can be found at www.acleddata.com or by contacting info.africa@acleddata.com. Follow ACLED on Twitter for realtime updates, news and

  4. The iliotibial band in acute knee trauma: patterns of injury on MR imaging.

    Science.gov (United States)

    Mansour, Ramy; Yoong, Philip; McKean, David; Teh, James L

    2014-10-01

    To delineate the spectrum of knee injuries associated with sprains and tears of the distal iliotibial band (ITB). A retrospective review of 200 random MRI scans undertaken for acute knee trauma was performed. Scans were excluded if there was a history of injury over 4 weeks from the time of the scan, septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. In each scan, the ITB was scored as normal, minor sprain (grade 1), severe sprain (grade 2), and torn (grade 3). The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 27.4 years (range, 9-69 years) and 71.5% (n = 143) of the patients were male. The ITB was injured in 115 cases (57.5%). The next most common soft tissue structure injured was the anterior cruciate ligament (ACL) in 53.5% of cases (n = 107). Grade 1 ITB injury was seen in 90 of these 115 cases (45%), grade 2 injury in 20 cases, and grade 3 injury in only five cases. There is a significant association between ITB injury and ACL rupture (p knee trauma and is associated with significant internal derangement of the knee, especially cruciate ligament rupture, posterolateral corner injury, and patellar dislocation.

  5. Fourier Series Formalization in ACL2(r

    Directory of Open Access Journals (Sweden)

    Cuong K. Chau

    2015-09-01

    Full Text Available We formalize some basic properties of Fourier series in the logic of ACL2(r, which is a variant of ACL2 that supports reasoning about the real and complex numbers by way of non-standard analysis. More specifically, we extend a framework for formally evaluating definite integrals of real-valued, continuous functions using the Second Fundamental Theorem of Calculus. Our extended framework is also applied to functions containing free arguments. Using this framework, we are able to prove the orthogonality relationships between trigonometric functions, which are the essential properties in Fourier series analysis. The sum rule for definite integrals of indexed sums is also formalized by applying the extended framework along with the First Fundamental Theorem of Calculus and the sum rule for differentiation. The Fourier coefficient formulas of periodic functions are then formalized from the orthogonality relations and the sum rule for integration. Consequently, the uniqueness of Fourier sums is a straightforward corollary. We also present our formalization of the sum rule for definite integrals of infinite series in ACL2(r. Part of this task is to prove the Dini Uniform Convergence Theorem and the continuity of a limit function under certain conditions. A key technique in our proofs of these theorems is to apply the overspill principle from non-standard analysis.

  6. TIBIAL LANDMARKS IN ACL ANATOMIC REPAIR

    Directory of Open Access Journals (Sweden)

    M. V. Demesсhenko

    2016-01-01

    Full Text Available Purpose: to identify anatomical landmarks on tibial articular surface to serve as reference in preparing tibial canal with respect to the center of ACL footprint during single bundle arthroscopic repair.Materials and methods. Twelve frozen knee joint specimens and 68 unpaired macerated human tibia were studied using anatomical, morphometric, statistical methods as well as graphic simulation.Results. Center of the tibial ACL footprint was located 13,1±1,7 mm anteriorly from posterior border of intercondylar eminence, at 1/3 of the distance along the line connecting apexes of internal and external tubercles and 6,1±0,5 mm anteriorly along the perpendicular raised to this point.Conclusion. Internal and external tubercles, as well as posterior border of intercondylar eminence can be considered as anatomical references to determine the center of the tibial ACL footprint and to prepare bone canals for anatomic ligament repair.

  7. The Vertical Drop Jump Is a Poor Screening Test for ACL Injuries in Female Elite Soccer and Handball Players: A Prospective Cohort Study of 710 Athletes.

    Science.gov (United States)

    Krosshaug, Tron; Steffen, Kathrin; Kristianslund, Eirik; Nilstad, Agnethe; Mok, Kam-Ming; Myklebust, Grethe; Andersen, Thor Einar; Holme, Ingar; Engebretsen, Lars; Bahr, Roald

    2016-04-01

    The evidence linking knee kinematics and kinetics during a vertical drop jump (VDJ) to anterior cruciate ligament (ACL) injury risk is restricted to a single small sample. Still, the VDJ test continues to be advocated for clinical screening purposes. To test whether 5 selected kinematic and kinetic variables were associated with future ACL injuries in a large cohort of Norwegian female elite soccer and handball players. Furthermore, we wanted to assess whether the VDJ test can be recommended as a screening test to identify players with increased risk. Cohort study; Level of evidence, 2. Elite female soccer and handball players participated in preseason screening tests from 2007 through 2014. The tests included marker-based 3-dimensional motion analysis of a drop-jump landing. We followed a predefined statistical protocol in which we included the following candidate risk factors in 5 separate logistic regression analyses, with new ACL injury as the outcome: (1) knee valgus angle at initial contact, (2) peak knee abduction moment, (3) peak knee flexion angle, (4) peak vertical ground-reaction force, and (5) medial knee displacement. A total of 782 players were tested (age, 21 ± 4 years; height, 170 ± 7 cm; body mass, 67 ± 8 kg), of which 710 were included in the analyses. We registered 42 new noncontact ACL injuries, including 12 in previously ACL-injured players. Previous ACL injury (relative risk, 3.8; 95% CI, 2.1-7.1) and medial knee displacement (odds ratio, 1.40; 95% CI, 1.12-1.74 per 1-SD change) were associated with increased risk for injury. However, among the 643 players without previous injury, we found no association with medial knee displacement. A receiver operating characteristic curve analysis of medial knee displacement showed an area under the curve of 0.6, indicating a poor-to-failed combined sensitivity and specificity of the test, even when including previously injured players. Of the 5 risk factors considered, medial knee displacement was the

  8. The anatomy of the ACL and its importance in ACL reconstruction.

    Science.gov (United States)

    Markatos, K; Kaseta, M K; Lallos, S N; Korres, D S; Efstathopoulos, N

    2013-10-01

    The anterior cruciate ligament (ACL) anatomy is very significant if a reconstruction is attempted after its rupture. An anatomic study should have to address, its biomechanical properties, its kinematics, its position and anatomic correlation and its functional properties. In this review, an attempt is made to summarize the most recent and authoritative tendencies as far as the anatomy of the ACL, and its surgical application in its reconstruction are concerned. Also, it is significant to take into account the anatomy as far as the rehabilitation protocol is concerned. Separate placement in the femoral side is known to give better results from transtibial approach. The medial tibial eminence and the intermeniscal ligament may be used as landmarks to guide the correct tunnel placement in anatomic ACL reconstruction. The anatomic centrum of the ACL femoral footprint is 43 % of the proximal-to-distal length of lateral, femoral intercondylar notch wall and femoral socket radius plus 2.5 mm anterior to the posterior articular margin. Some important factors affecting the surgical outcome of ACL reconstruction include graft selection, tunnel placement, initial graft tension, graft fixation, graft tunnel motion and healing. The rehabilitation protocol should come in phases in order to increase range of motion, muscle strength and leg balance, it should protect the graft and weightbearing should come in stages. The cornerstones of such a protocol remain bracing, controlling edema, pain and range of motion. This should be useful and valuable information in achieving full range of motion and stability of the knee postoperatively. In the end, all these advancements will contribute to better patient outcome. Recommendations point toward further experimental work with in vivo and in vitro studies, in order to assist in the development of new surgical procedures that could possibly replicate more closely the natural ACL anatomy and prevent future knee pathology.

  9. Patients with high-grade pivot-shift phenomenon are associated with higher prevalence of anterolateral ligament injury after acute anterior cruciate ligament injuries.

    Science.gov (United States)

    Song, Guan-Yang; Zhang, Hui; Wu, Guan; Zhang, Jin; Liu, Xin; Xue, Zhe; Qian, Yi; Feng, Hua

    2017-04-01

    To compare the prevalence of concomitant anterolateral ligament (ALL) injury between patients with high-grade (grades II and III) pivot-shift and those with low-grade (grades 0 and I) pivot-shift phenomenon after acute anterior cruciate ligament (ACL) injuries. Sixty-eight patients with an acute ACL injury who showed high-grade (grades II and III) pivot-shift phenomenon were enrolled as the study group. They were matched in a 1:1 fashion to another 68 ACL-injured control participants who showed low-grade (grades 0 and I) pivot-shift phenomenon during the same study period. Patients were matched by age, sex, and time from injury to surgery. A standardized pivot-shift test was performed under anesthesia for all the patients. Two blinded musculoskeletal radiologists reviewed the magnetic resonance imaging (MRI) scans for the presence of concomitant ALL injury. The grade of an ALL injury was divided into grade 0 (normal), grade I (sprain), grade II (partial tear), and grade III (complete tear). The prevalence and the grade of concomitant ALL injury were further compared between the study group and the control group. Overall, the prevalence of concomitant ALL injury in the study group (94.1%, 64/68) was significantly higher than that in the control group [60.3%, (41/68), P < 0.05]. Specifically, there were 49 patients (49/64, 76.6%) who showed grade II/III (partial/complete tear) MRI evidence of concomitant ALL injury, which was also significantly higher than that in the control group (12/41, 29.3%). Patients with high-grade pivot-shift phenomenon showed higher prevalence of concomitant ALL injury compared to those with low-grade pivot-shift phenomenon after acute ACL injuries. Careful assessment and proper treatment of this concomitant injury should be considered especially in knees with high-grade pivot-shift phenomenon. III.

  10. Injured coliforms in drinking water.

    OpenAIRE

    McFeters, G A; Kippin, J S; LeChevallier, M W

    1986-01-01

    Coliforms were enumerated by using m-Endo agar LES and m-T7 agar in 102 routine samples of drinking water from three New England community water systems to investigate the occurrence and significance of injured coliforms. Samples included water collected immediately after conventional treatment, during the backwash cycle, at various points in the distribution system, and 1 week after the break and subsequent repair of a distribution main. Injured coliforms in these samples averaged greater th...

  11. The characteristics of EEG power spectra changes after ACL rupture.

    Directory of Open Access Journals (Sweden)

    Xin Miao

    Full Text Available Reestablishing knee stability is the core of the treatment of ACL (Anterior Cruciate Ligament injury. Some patients still have a feeling of instability of the knee after ACL injury treatment. This unstable feeling may be caused by central nervous system changes after ACL rupture.To identify the central changes after ACL rupture, EEG spectra were recorded to compare ACL patients and healthy controls when they were walking, jogging, and landing.There was a significant increase in delta, theta, alpha and beta band power during walking, jogging and landing in ACL patients. We also found an asymmetry phenomenon of EEG only in the ACL patients, mainly in the frontal area and central-parietal area. The asymmetry of beta band power extended to the frontal and the central area during jogging and landing task.There were significant differences in EEG power spectra between the ACL patients and healthy people. ACL patients showed high EEG band power activities and an asymmetry phenomenon. EEG power changes were affected by movements, the asymmetry extended when performing more complicated movements.

  12. ACL Reconstruction With Autografts Weighing Performance Considerations and Postoperative Care.

    Science.gov (United States)

    Grant, John A; Mohtadi, Nicholas G

    2003-04-01

    Anterior cruciate ligament (ACL) reconstruction is the treatment of choice for patients who experience episodes of instability and a decreased quality of life after ACL rupture. The bone-patellar tendon-bone and hamstring autografts are the current standards for ACL reconstruction. Primary care physicians, especially sports medicine clinicians, are the first-line providers of nonoperative care for patients who have ACL injuries. Care providers need to know the biologic and biomechanic properties of these grafts, clinical indications for each graft, and rehabilitation considerations to appropriately counsel their patients.

  13. Anterior cruciate ligament (ACL) loading in a collegiate athlete during sidestep cutting after ACL reconstruction: A case study.

    Science.gov (United States)

    Samaan, Michael A; Ringleb, Stacie I; Bawab, Sebastian Y; Greska, Eric K; Weinhandl, Joshua T

    2016-08-01

    Athletes with anterior cruciate ligament (ACL) injuries usually undergo ACL-reconstruction (ACLR) in order to restore joint stability, so that dynamic maneuvers such as the sidestep cut can be performed. Despite restoration of joint stability after ACLR, many athletes do not return to pre-injury levels and may be at a high risk of a second ACL injury. The purpose of this study was to determine whether or not ACL loading, would increase after ACLR. One female Division I collegiate athlete performed bilateral unanticipated sidestep cuts both before ACL injury and 27months after ACLR. Musculoskeletal simulations were used to calculate ACL loading during the deceleration phase of the sidestep cuts. Twenty-seven months after ACLR, the athlete demonstrated higher total ACL loading in the ipsilateral limb as well as altered joint kinematics, moments, and quadriceps muscle force production. In the contralateral limb, there were no increases in total ACL loading or muscle force production yet altered lower extremity joint kinematics and moments were present after ACLR. Higher total ACL loading in the ipsilateral limb of this athlete may suggest an increased risk of second ACL injury. The results of this study provide an initial step in understanding the effects of ACLR on the risk of second ACL injury in an elite athlete and suggest that it is important to develop a better understanding of this surgical intervention on knee joint loading, in order to reduce the risk of second ACL injury while performing dynamic maneuvers. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Experiences of returning to elite alpine skiing after ACL injury and ACL reconstruction.

    Science.gov (United States)

    Nordahl, Birgitta; Sjöström, Rita; Westin, Maria; Werner, Suzanne; Alricsson, Marie

    2014-01-01

    To explore the experiences of alpine skiing at the elite level after anterior cruciate ligament (ACL) injury and reconstruction. A qualitative approach where semi-structured interviews were conducted, and an analysis of the manifest content was performed. Five ski high school students, two male and three female skiers, who had suffered ACL injuries and undergone ACL reconstructions. Seven categories were identified. The participants described their perceived opportunities with regard to returning to alpine skiing after ACL injury and reconstruction as something positive to do with self-belief, being mentally and physically prepared, regaining confidence in their own ability, being given time and using active strategies. In contrast, perceived barriers to a return to elite alpine skiing gave rise to negative feelings, for example, fear, disheartenment, a total lack of or ambivalent confidence in their own ability and the use of passive strategies. The two male skiers returned to alpine skiing. They reported confidence in their own ability, active strategies and support on all levels, as well as enhanced physical ability. The female skiers did not return to their pre-injury level of competitive alpine skiing. They stated a lack of support on all levels, deterioration in their physical ability and two out of three reported passive strategies and no or ambivalent confidence in their own ability. The most important factors were family support, support on all levels, access to a physiotherapist and time given.

  15. Bit-Blasting ACL2 Theorems

    Directory of Open Access Journals (Sweden)

    Sol Swords

    2011-10-01

    Full Text Available Interactive theorem proving requires a lot of human guidance. Proving a property involves (1 figuring out why it holds, then (2 coaxing the theorem prover into believing it. Both steps can take a long time. We explain how to use GL, a framework for proving finite ACL2 theorems with BDD- or SAT-based reasoning. This approach makes it unnecessary to deeply understand why a property is true, and automates the process of admitting it as a theorem. We use GL at Centaur Technology to verify execution units for x86 integer, MMX, SSE, and floating-point arithmetic.

  16. Knee functional recovery and limb-to-limb symmetry restoration after anterior cruciate ligament (ACL) rupture and ACL reconstruction

    Science.gov (United States)

    Nawasreh, Zakariya Hussein

    perturbation training using mechanical device provides effects similar to manual perturbation training on knee mechanics, knee functional performance, and neuromuscular activation pattern in patients with ACL rupture. The second aim of this study was to measure whether the mechanical perturbation training provides an effect similar to that of manual perturbation training on gait mechanics, knee functional performance, muscle co-contraction, and neuromuscular activation pattern in athletes with an acute ACL rupture who are managed non-surgically. The findings of this work revealed that mechanical perturbation training provides effects similar to the manual perturbation training on knee kinematics and kinetics during walking and performance-based and patient-reported measures. Gait limb-to-limb asymmetries continue persist after the training regardless of the treatment group which may indicate that patients require participating in an extended rehabilitation program. Additionally, Perturbation training attempts to resolve the neuromuscular deficits and restore a balance in muscle activation and strength between knee flexors and extensors to enhance the dynamic stability of the knee joint. There are moderate to strong relationships between time duration of muscles' activities and the muscle co-contraction that may reflect neuromuscular adaptations to provide dynamic knee stability.

  17. Industrial hardware and software verification with ACL2.

    Science.gov (United States)

    Hunt, Warren A; Kaufmann, Matt; Moore, J Strother; Slobodova, Anna

    2017-10-13

    The ACL2 theorem prover has seen sustained industrial use since the mid-1990s. Companies that have used ACL2 regularly include AMD, Centaur Technology, IBM, Intel, Kestrel Institute, Motorola/Freescale, Oracle and Rockwell Collins. This paper introduces ACL2 and focuses on how and why ACL2 is used in industry. ACL2 is well-suited to its industrial application to numerous software and hardware systems, because it is an integrated programming/proof environment supporting a subset of the ANSI standard Common Lisp programming language. As a programming language ACL2 permits the coding of efficient and robust programs; as a prover ACL2 can be fully automatic but provides many features permitting domain-specific human-supplied guidance at various levels of abstraction. ACL2 specifications and models often serve as efficient execution engines for the modelled artefacts while permitting formal analysis and proof of properties. Crucially, ACL2 also provides support for the development and verification of other formal analysis tools. However, ACL2 did not find its way into industrial use merely because of its technical features. The core ACL2 user/development community has a shared vision of making mechanized verification routine when appropriate and has been committed to this vision for the quarter century since the Computational Logic, Inc., Verified Stack. The community has focused on demonstrating the viability of the tool by taking on industrial projects (often at the expense of not being able to publish much).This article is part of the themed issue 'Verified trustworthy software systems'. © 2017 The Author(s).

  18. Multivariate Analysis of the Risk Factors for First-Time Noncontact ACL Injury in High School and College Athletes: A Prospective Cohort Study With a Nested, Matched Case-Control Analysis.

    Science.gov (United States)

    Vacek, Pamela M; Slauterbeck, James R; Tourville, Timothy W; Sturnick, Daniel R; Holterman, Leigh-Ann; Smith, Helen C; Shultz, Sandra J; Johnson, Robert J; Tourville, Kelly J; Beynnon, Bruce D

    2016-06-01

    Multivariate analysis that identifies the combination of risk factors associated with anterior cruciate ligament (ACL) trauma is important because it provides insight into whether a variable has a direct causal effect on risk or an indirect effect that is mediated by other variables. It can also reveal risk factors that might not be evident in univariate analyses; if a variable's effect is moderated by other variables, its association with risk may be apparent only after adjustment for the other variables. Most important, multivariate analyses can identify combinations of risk factors that are more predictive of risk than individual risk factors. A diverse combination of risk factors predispose athletes to first-time noncontact ACL injury, and these relationships are different for male and female athletes. Case-control study; Level of evidence, 3. Athletes competing in organized sports at the high school and college levels participated in this study. Data from injured subjects (109 suffering an ACL injury) and matched controls (227 subjects) from the same athletic team were analyzed with multivariate conditional logistic regression to examine the effects of combinations of variables (demographic characteristics, joint laxity, lower extremity alignment, strength, and personality traits) on the risk of suffering their first ACL injury and to construct risk models. For male athletes, increases in anterior-posterior displacement of the tibia relative to the femur (knee laxity), posterior knee stiffness, navicular drop, and a decrease in standing quadriceps angle were jointly predictive of suffering an ACL injury. For female athletes the combined effects of having a parent who had suffered an ACL injury and increases in anterior-posterior knee laxity and body mass index were predictive of ACL injury. Multivariate models provided more information about ACL injury risk than individual risk factors. Both male and female risk models included increased anterior

  19. The iliotibial band in acute knee trauma: patterns of injury on MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Mansour, Ramy; Yoong, Philip; McKean, David; Teh, James L. [Oxford University Hospitals NHS Trust, Department of Radiology, Nuffield Orthopaedic Centre, Oxford (United Kingdom)

    2014-10-15

    To delineate the spectrum of knee injuries associated with sprains and tears of the distal iliotibial band (ITB). A retrospective review of 200 random MRI scans undertaken for acute knee trauma was performed. Scans were excluded if there was a history of injury over 4 weeks from the time of the scan, septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. In each scan, the ITB was scored as normal, minor sprain (grade 1), severe sprain (grade 2), and torn (grade 3). The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 27.4 years (range, 9-69 years) and 71.5 % (n = 143) of the patients were male. The ITB was injured in 115 cases (57.5 %). The next most common soft tissue structure injured was the anterior cruciate ligament (ACL) in 53.5 % of cases (n = 107). Grade 1 ITB injury was seen in 90 of these 115 cases (45 %), grade 2 injury in 20 cases, and grade 3 injury in only five cases. There is a significant association between ITB injury and ACL rupture (p < 0.05), as well as acute patellar dislocation (p < 0.05). There were ten cases of significant posterolateral corner injury, and all were associated with ITB injury, including four ITB tears. Only two cases of isolated ITB injury were seen (1 %). ITB injury is common in acute knee trauma and is associated with significant internal derangement of the knee, especially cruciate ligament rupture, posterolateral corner injury, and patellar dislocation. (orig.)

  20. ACL-RSI and KOOS Measures Predict Normal Knee Function after ACL-SPORTS Training

    OpenAIRE

    White, Kathleen; Zeni, Joseph; Snyder-Mackler, Lynn

    2014-01-01

    Objectives: After anterior cruciate ligament reconstruction (ACLR) athletes commonly report increased fear of re-injury and below normal knee function. Implementing a post-operative training protocol (ACL-SPORTS Training) to improve patient perceived knee function, may improve short term outcomes after surgery. Identifying pre-training measures that predict normal knee function after training may allow us to determine who may respond to the treatment intervention. The purpose of this study wa...

  1. Clinical outcomes after multiligament injured knees: medial versus lateral reconstructions.

    Science.gov (United States)

    Tardy, N; Boisrenoult, P; Teissier, P; Steltzlen, C; Beaufils, P; Pujol, N

    2017-02-01

    The purpose of this study was to analyse the clinical outcomes of multiligament injured knees with respect to the medial collateral ligament and posteromedial corner (PMC) repair or reconstruction versus the posterolateral corner (PLC) reconstruction in patients operated according to a codified surgical protocol. Patients were divided into two groups depending on whether PMC or PLC was injured. Cruciate ligaments as well as PMC or PLC were reconstructed/repaired in a one-stage procedure. At minimum of 1-year follow-up, objective and subjective International Knee Documentation Committee (IKDC) forms, Lysholm score and sports activity level were recorded. Thirty-nine patients with a median follow-up time of 57 months (range 12-129) were reviewed. No significant difference was found for functional scores between acute PMC and PLC subgroups. In Group PLC, subjective outcomes tend to be better in the acute than in chronic reconstruction subgroup. A one-stage protocol with early surgery rather than delayed reconstruction produced better clinical outcomes whatever the injured collateral ligament, medial or lateral. In the future, early and chronic reconstructions as well as each injury pattern should be considered as separate entities in studies on multiple ligament injured knees to reach a better level of evidence. IV.

  2. Association between Lower Extremity Muscle Strength and Noncontact ACL Injuries.

    Science.gov (United States)

    Steffen, Kathrin; Nilstad, Agnethe; Kristianslund, Eirik Klami; Myklebust, Grethe; Bahr, Roald; Krosshaug, Tron

    2016-11-01

    This study aimed to prospectively investigate the association between isolated and functional lower extremity muscle strength and the risk for noncontact anterior cruciate ligament (ACL) injury in Norwegian female elite handball and football players. From 2007 through 2015, premier league players participated in strength testing and were prospectively followed for ACL injury risk. At baseline, we recorded player demographics, playing and ACL injury history, and measured peak concentric isokinetic quadriceps and hamstring torques (60°·s), hamstring-to-quadriceps ratio, isometric hip abduction strength, and one-repetition maximum in a seated leg press. We followed a predefined statistical protocol where we generated five separate logistic regression models, one for each of the proposed strength risk factors and adjusted for confounding factors. New ACL injury was the outcome, using the leg as the unit of analysis. A total of 57 (6.6%) of 867 players (age = 21 ± 4 yr, height = 170 ± 6 cm, body mass = 66 ± 8 kg) suffered from a noncontact ACL injury after baseline testing (1.8 ± 1.8 yr). The OR of sustaining a new injury among those with an ACL injury history was 3.1 (95% confidence interval = 1.6-6.1). None of the five strength variables selected were statistically associated with an increased risk of ACL rupture when adjusted for sport, dominant leg, ACL injury history, and height. Peak lower extremity strength was not associated with an increased ACL injury risk among female elite handball and football players. Hence, peak strength, as measured in the present study, cannot be used to screen elite female athletes to predict injury risk.

  3. Anterior cruciate ligament- specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial.

    Science.gov (United States)

    White, Kathleen; Di Stasi, Stephanie L; Smith, Angela H; Snyder-Mackler, Lynn

    2013-03-23

    Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk. 80 athletes that have undergone a unilateral ACLR and wish to return to level 1 or 2 activities will be recruited for this study and randomized to one of two treatment groups. A standard care group will receive prevention exercises, quadriceps strengthening and agility exercises, while the perturbation group will receive the same exercise program with the addition of perturbation training. The primary outcomes measures will include gait biomechanics, clinical and functional measures, and knee joint loading. Return to sport rates, return to pre-injury level of activity rates, and second injury rates will be secondary measures. The results of this ACL-Specialized Post-Operative Return To Sports (ACL-SPORTS) Training program will help clinicians to better determine an effective post-operative treatment program that will improve modifiable impairments that influence outcomes after ACLR. Randomized Control Trial NIH 5R01AR048212-07. ClinicalTrials.gov: NCT01773317.

  4. HYSTOMORPHOLOGIC CHANGES IN INJURED MENISCI IN CHILDREN

    Directory of Open Access Journals (Sweden)

    V. B. Bogatov

    2010-01-01

    Full Text Available The purpose of the work was studying histological changes in the injured menisci in children. The histological evaluation of injured menisci received during arthroscopy was performed. The prescription of injury varied from several days till 3 years. It was shown that injured fragment of the meniscus is viable up to 3 months since trauma. It was also obvious that active migration of the meniscus cells occur in the injured fragment and microvessels are seen in 50% of the meniscus tissues.

  5. Case Series: Cyclops lesion - extension loss after ACL reconstruction

    Directory of Open Access Journals (Sweden)

    Dhanda Sunita

    2010-01-01

    Full Text Available Localized anterior arthrofibrosis (cyclops lesion is the second most common cause of extension loss after anterior cruciate ligament (ACL reconstruction. We present and discuss two patients with prior ACL reconstructions, who presented with pain and loss of extension following surgery. MRI and arthroscopy of the knee revealed typical features of a cyclops lesion. The patients showed significant symptomatic improvement following arthroscopic resection of these lesions.

  6. Dynamic intraligamentary stabilization versus conventional ACL reconstruction: A matched study on return to work.

    Science.gov (United States)

    Bieri, Kathrin S; Scholz, Stefan M; Kohl, Sandro; Aghayev, Emin; Staub, Lukas P

    2017-06-01

    The dynamic intraligamentary stabilization (DIS) technique is based on a different treatment approach than ACL reconstruction in that it intends to promote self-healing of the ligament. It is only recommended for acute injuries (work incapacity, revision rates, secondary arthroscopies, and treatment costs during recovery. The study was a post-hoc analysis of prospectively collected data in the Swiss National Accident Insurance Fund (SUVA) database. All registered DIS cases treated until 31 December 2012 were included in the study. ACLR cases were matched to DIS cases using a propensity score approach and analysed in a follow-up period of 2 years after injury. Paired Student's T-test and the Chi-square test were used to compare the outcome measures. All 53 DIS patients were matched to an ACLR pair. The mean time period from injury to surgery was 14days for DIS and 50days for ACLR (pwork incapacity was 13% for DIS and 17% for ACLR resulting in a difference of nearly 1 month of absence from work (p=0.03). The course of postoperative work incapacity was very similar between the groups, while the work incapacity prior to surgery lower in the DIS group. We found no difference in treatment costs, secondary arthroscopies and revision rates. DIS patients benefited from nearly one month shorter absence from work than ACLR patients. This difference is likely related to the early surgical timing that is recommended for DIS. Since no differences were found between DIS and ACLR in terms of treatment costs, secondary arthroscopies and revision rates, the study supports the choice of DIS as an additional treatment option for acute ACL injuries. Further comparative studies are proposed to improve the evidence about optimal timing and best practice in ACL treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Infrared assessment of knee instability in ACL deficient patients.

    Science.gov (United States)

    Matić, Aleksandar; Petrović Savić, Suzana; Ristić, Branko; Stevanović, Vladan B; Devedžić, Goran

    2016-02-01

    Previous clinical studies have shown that anterior cruciate ligament (ACL) ruptures require reconstructive surgery. The main goal of this study is an objective test definition for unstable knee diagnosis based on real measurements by using infrared cameras and adequate software. In the study of gait analysis 35 males with deficient ACL's participated. Pathological parameters for anterior posterior translation (APT) and internal external rotation (IER) and their values of kinematic data were obtained from a gait analysis 3D system. Movement curves were obtained by recording the position of fluorescent markers over time. A machine learning algorithm was developed in order to support decisions on the severity of the ACL injury and its corresponding deficiency. The algorithm was based on logistic regression. The value of APT, designated as exponentiation of the Ө coefficient (Exp (Ө)) of APT, showed that the likelihood of ACL-deficient knee occurrence due to higher values of APT is 1.1758 (95 % CI) times more frequent than that of the patients with lower values of APT. The value of IER, designated as Exp (Ө) of IER, showed that the patients with higher values of IER present 2.2516 (95 % CI) times higher values of ACL-deficient knee frequency than those with lower values. This study showed that the creation of ordered pairs of pathological parameters gives a wider picture of ACL deficiency and that such an algorithm may improve both examination and treatment of patients.

  8. Outcome of ACL Reconstruction and Concomitant Articular Injury Treatment

    Directory of Open Access Journals (Sweden)

    Seyed Mohammad Tahami

    2015-10-01

    Full Text Available Background: Articular cartilage injuries are a common clinical problem at the time of ACL reconstruction with an incidence rate of 16-46%. Good results of ACL reconstruction combined with the treatment of chondral lesions have been published in some studies. Method: After statistical analysis 30 patients were selected and divided in 2 groups. TheFfirst group consisted of 15 patients wite isolated ACL tear without any other concomitant injuries and the second group consisted of 15 patients with ACL tear and concomitant high grade (grade 3 or 4 of outerbridge classification contained articular cartilage injuries during arthroscopy. Group 1 underwent ACL reconstruction and group 2 underwent ACL reconstruction combined with chondroplasty via the drilling and microfracture technique. For each patient the Lysholm knee score questionnaire was completed before surgery, 6 months and 1 year after surgery. Results: The mean Lysholm knee score in both groups improves: 9.6 points after 6 months and 16.06 points after 1 year in group 1 and 23.26 points after 6 months and 30.66 after 1 year in group 2, whict was statistically significant (Pvalue

  9. Stability Outcomes following Computer-Assisted ACL Reconstruction

    Directory of Open Access Journals (Sweden)

    Melissa A. Christino

    2015-01-01

    Full Text Available Purpose. The purpose of this study was to determine whether intraoperative prereconstruction stability measurements and/or patient characteristics were associated with final knee stability after computer-assisted ACL reconstruction. Methods. This was a retrospective review of all patients who underwent computer-assisted single-bundle ACL reconstruction by a single surgeon. Prereconstruction intraoperative stability measurements were correlated with patient characteristics and postreconstruction stability measurements. 143 patients were included (87 male and 56 female. Average age was 29.8 years (SD ± 11.8. Results. Females were found to have significantly more pre- and postreconstruction internal rotation than males (P < 0.001 and P = 0.001, resp.. Patients with additional intra-articular injuries demonstrated more prereconstruction anterior instability than patients with isolated ACL tears (P < 0.001. After reconstruction, these patients also had higher residual anterior translation (P = 0.01. Among all patients with ACL reconstructions, the percent of correction of anterior translation was found to be significantly higher than the percent of correction for internal or external rotation (P < 0.001. Conclusion. Anterior translation was corrected the most using a single-bundle ACL reconstruction. Females had higher pre- and postoperative internal rotation. Patients with additional injuries had greater original anterior translation and less operative correction of anterior translation compared to patients with isolated ACL tears.

  10. Gender dimorphic ACL strain in response to combined dynamic 3D knee joint loading: implications for ACL injury risk.

    Science.gov (United States)

    Mizuno, Kiyonori; Andrish, Jack T; van den Bogert, Antonie J; McLean, Scott G

    2009-12-01

    While gender-based differences in knee joint anatomies/laxities are well documented, the potential for them to precipitate gender-dimorphic ACL loading and resultant injury risk has not been considered. To this end, we generated gender-specific models of ACL strain as a function of any six degrees of freedom (6DOF) knee joint load state via a combined cadaveric and analytical approach. Continuously varying joint forces and torques were applied to five male and five female cadaveric specimens and recorded along with synchronous knee flexion and ACL strain data. All data (approximately 10,000 samples) were submitted to specimen-specific regression analyses, affording ACL strain predictions as a function of the combined 6 DOF knee loads. Following individual model verifications, generalized gender-specific models were generated and subjected to 6 DOF external load scenarios consistent with both a clinical examination and a dynamic sports maneuver. The ensuing model-based strain predictions were subsequently examined for gender-based discrepancies. Male and female specimen-specific models predicted ACL strain within 0.51%+/-0.10% and 0.52%+/-0.07% of the measured data respectively, and explained more than 75% of the associated variance in each case. Predicted female ACL strains were also significantly larger than respective male values for both simulated 6 DOF load scenarios. Outcomes suggest that the female ACL will rupture in response to comparatively smaller external load applications. Future work must address the underlying anatomical/laxity contributions to knee joint mechanical and resultant ACL loading, ultimately affording prevention strategies that may cater to individual joint vulnerabilities.

  11. ACL ideal graft: MRI correlation between ACL and humstrings, PT and QT

    Directory of Open Access Journals (Sweden)

    Fabiano Kupczik

    2013-09-01

    Full Text Available OBJECTIVE: The objective of this study was to measure in MRI scans, the size of the origin, insertion and length of the anterior cruciate ligament and possible graft for reconstruction surgery in case of injury. Besides this, there was a cross between statistical data to test the hypothesis of proportional relationship between these anatomical extent. MATERIALS AND METHODS: 52 MRI examinations performed between 2008 and 2011 were valued at random in a longitudinal retrospective epidemiological study. To measure the width of the ACL was used coronal oblique to the length of the sagittal section, for inserting the tibial coronal femoral insertion and was also used oblique coronal section. RESULTS: The average diameter of the ACL was 4.80 mm (3.1-8.3 mm, with a length of 3.8 cm (2.85-4.5 cm. The origin ranged from 9.7 mm to 15.4 mm. The average insertion on the tibia was 13.3 mm. The average diameter of the semi-tendinous was 4.38 mm and the average diameter was 3.42 mm gracilis. The quadriceps presented diameter of 7.67 mm, a length of 35.34 mm and 4.54 mm patellar tendon diameter and 26.62 mm in average length. CONCLUSION: These data provide important information for the pre-operative surgeon, facilitating preoperative planning and providing viable alternatives and avoiding inadequate grafts.

  12. Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament.

    Science.gov (United States)

    Helito, Camilo Partezani; Helito, Paulo Victor Partezani; Leão, Renata Vidal; Demange, Marco Kawamura; Bordalo-Rodrigues, Marcelo

    2017-04-01

    Few studies have used MRI to identify the ALL. As it was shown that it is not possible to precisely characterize this ligament in all examination, it is important to identify concomitant lesions that can help in diagnosing ALL abnormalities. It is important to characterise this injury due to its association with anterolateral knee instability. Thus, the present study was performed to determine the frequency of ALL injuries in patients with acute ACL rupture and to analyse its associated knee lesions. Patients with acute ACL injuries were evaluated by MRI. Among this population, the ALL was classified as non-visualised, injured or normal. The possible abnormalities of the meniscus, collateral ligaments, popliteus tendon, posterior cruciate ligament, Iliotibial band (ITB), anterolateral capsule and osseus injuries were evaluated. The association of an ALL injury with these other knee structures as well as sex and age was calculated. Among the 228 knees evaluated, the ALL could not be entirely identified in 61 (26.7%). Of the remaining 167, 66 (39.5%) presented an ALL abnormality and only four (6.1%) were Segond fractures. ALL abnormalities were associated with lesions of the lateral collateral ligament, medial collateral ligament, popliteus tendon, ITB, anterolateral capsule and osseous contusions of the femoral condyle and tibial plateau. No correlation was found with medial meniscus, lateral meniscus and posterior cruciate ligament injuries. There was no association between ALL injuries and gender, and older patients were more likely to present an ALL injury. ALL injuries are present in approximately 40% of ACL injuries, and a minority of these are Segond fractures. These injuries are associated with peripheral ligament injuries, anterolateral structures lesions and bone contusions, but there is no association with meniscal injuries. Surgeons must be aware of these associations to consider an ALL lesion even if it is not completely clear in imaging evaluation

  13. The Dutch language anterior cruciate ligament return to sport after injury scale (ACL-RSI) - validity and reliability

    NARCIS (Netherlands)

    Slagers, Anton J.; Reininga, Inge H. F.; van den Akker-Scheek, Inge

    2017-01-01

    The ACL-Return to Sport after Injury scale (ACL-RSI) measures athletes' emotions, confidence in performance, and risk appraisal in relation to return to sport after ACL reconstruction. Aim of this study was to study the validity and reliability of the Dutch version of the ACL-RSI (ACL-RSI (NL)).

  14. Measurement of functional recovery in individuals with acute anterior cruciate ligament rupture.

    Science.gov (United States)

    Button, K; van Deursen, R; Price, P

    2005-11-01

    To measure functional recovery following acute anterior cruciate ligament (ACL) rupture using a simple and reliable clinical movement analysis system. Clinic based methods that simultaneously quantify different aspects of movement over a range of activities and model functional recovery will help guide rehabilitation. A longitudinal study was used to measure gait variables at initial physiotherapy attendance and then at monthly intervals using a digital camcorder and computer for quantitative analysis. Jogging and distance hopping were added during recovery. A sample of 63 ACL deficient subjects entered the study and 48 subjects were measured at least three times. To determine the pattern of recovery, repeated measurements were analysed using a least square fit of the data. Gait variables took between 95 and 130 days post injury to reach the control mean and stabilise shortly after this. Hopping distance for the injured leg took 62 days to recover to within normal limits and 5 months post injury to reach the control mean. Jogging was already within the control limits at 30 days post injury and demonstrated little change with recovery. Functional recovery of multiple variables has been modelled. In the early phase of post injury, gait velocity seems to be the most useful variable to measure improvement. Recovery of more challenging activities appears to take an average of 5 months. Therefore, patients may need to be monitored in physiotherapy until this time and advised not to return to sport until sufficient recovery is demonstrated on activities such as distance hopping.

  15. No difference between mechanical perturbation training with compliant surface and manual perturbation training on knee functional performance after ACL rupture.

    Science.gov (United States)

    Nawasreh, Zakariya; Logerstedt, David; Failla, Mathew; Snyder-Mackler, Lynn

    2017-10-27

    Manual perturbation training improves dynamic knee stability and functional performance after anterior cruciate ligament rupture (ACL-rupture). However, it is limited to static standing position and does not allow time-specific perturbations at different phase of functional activities. The purpose of this study was to investigate whether administering mechanical perturbation training including compliant surface provides effects similar to manual perturbation training on knee functional measures after an acute ACL-rupture. Sixteen level I/II athletes with ACL-ruptures participated in this preliminary study. Eight patients received mechanical (Mechanical) and eight subjects received manual perturbation training (Manual). All patients completed a functional testing (isometric quadriceps strength, single-legged hop tests) and patient-reported measures (Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), Global Rating Score (GRS), International Knee Documentation Committee 2000 (IKDC 2000) at pre- and post-training. 2 × 2 ANOVA was used for data analysis. No significant group-by-time interactions were found for all measures (p > 0.18). Main effects of time were found for single hop (Pre-testing: 85.14% ± 21.07; Post-testing: 92.49% ± 17.55), triple hop (Pre-testing: 84.64% ± 14.17; Post-testing: 96.64% ± 11.14), KOS-ADLS (Pre-testing: 81.13% ± 11.12; Post-testing: 88.63% ± 12.63), GRS (Pre-testing: 68.63% ± 15.73; Post-testing: 78.81% ± 13.85), and IKDC 2000 (Pre-testing: 66.66% ± 9.85; Post-testing: 76.05% ± 14.62) (p training using compliant surfaces induce effects similar to manual perturbation training on knee functional performance after acute ACL-rupture. The clinical significance is both modes of training improve patients' functional-performance and limb-to-limb movement symmetry, and enhancing the patients' self-reported of knee functional measures after ACL rupture. Mechanical

  16. Return to Play and Future ACL Injury Risk Following ACL Reconstruction In Soccer Athletes From the MOON Group

    Science.gov (United States)

    Brophy, Robert H.; Schmitz, Leah; Wright, Rick W.; Dunn, Warren R.; Parker, Richard D.; Andrish, Jack T.; McCarty, Eric C.; Spindler, Kurt P.

    2013-01-01

    Background There is limited information on outcomes and return to play (RTP) after ACL reconstruction (ACLR) in soccer athletes. Hypothesis The purpose of this study was to (i) test the hypotheses that player sex, side of injury and graft choice do not influence RTP, and (ii) define the risk for future ACL injury in soccer players after ACLR. Study design Retrospective cohort study, Level II. Methods Soccer players in a prospective cohort were contacted to determine RTP following ACLR. Information regarding if and when they returned to play, their current playing status, the primary reason they stopped playing soccer (if relevant) and incidence of subsequent ACL surgery was recorded. Results Initially, 72% of 100 soccer athletes (55 male, 45 female) with a mean age of 24.2 years at the time of ACL reconstruction returned to soccer. At average follow up of 7.0 years, 36% were still playing, a significant decrease compared to initial RTP (psoccer athletes had undergone further ACL surgery, including 9 on the contralateral knee and 3 on the ipsilateral knee. In a univariate analysis, females were more likely to have future ACL surgery (20% v. 5.5%, p=0.03). Soccer athletes who underwent ACLR on their non-dominant limb had a higher future rate of contra-lateral ACLR (16%) than soccer athletes who underwent ACLR on their dominant limb (3.5%) (p=0.03). Conclusion Younger and male soccer players are more likely to return to play after ACL reconstruction. Return to soccer following ACLR declines over time. PMID:23002201

  17. Expert medical testimony for your injured patients.

    Science.gov (United States)

    Lang, Gerald J

    2013-10-01

    Many injured patients sustain some type of loss. If someone else is responsible for the injury, the injured patient can pursue compensation for this loss. In the course of treating an injured patient, you may be asked to participate in the legal process to resolve such claims. The basic components of a personal injury claim are reviewed. An overview of the legal process will help clarify your role in the legal process. Enhanced understanding will allow you to provide important medical testimony for your injured patient.

  18. Reconstruction of ACL Ligament rupture: results of 96 operation

    Directory of Open Access Journals (Sweden)

    Tahmasebi MN

    2009-04-01

    Full Text Available "nBackground: Anterior Cruciate Ligament (ACL is one of the main knee stabilizing ligaments. Because of high incidence of ACL tearing especially in young athletes its reconstruction is very important. The aim of this study was to evaluate short-term results of anterior cruciate ligament ruptures using four strand hamstring auto graft and Bone patellar tendon autograph. "nMethods: The study group included 96 patients (3 female and 93 male with ACL teared who had been referred to our center in 5 years period (2002-2007. The subject which were Accessed in this study included meniscal injury concomitant chondral injury, determine the most common cause of ACL tearing, comparision of IKDC and lysholm score in all patients before and after surgery, and limitation of rang of motion of knee post operation. "nResults: Involvement was in the right knee in 38 patients and in the left knee in 58 patients. Mean age of patients was 27.6 years (19-48. Mean surgical delay was 18 month (1-77. The most common cause of tear was playing soccer. Meniscal injury was in 78 patients. (Medial meniscus in 63 patients, lateral meniscus in 29 patients Concommitent chondral injury was in 54 patients (56.25%. 68% of patients returned to preoperative functions sport activity. There was no limitation in extension and there was 6 patients limitation in flexion about 20º. In last visit of patients IKDS in class A and B was 96. "nConclusion: It is seem that arthroscopic reconstruction of ACL is a safe and good method in treatment of Knee stability. Use of IKDC and lysholm score for comparision of patients before and after surgery is helpful. The operation should be done early after injury. Reconstruction of ACL in older patients in the abscense of DJD is effective.

  19. ACL2 Meets the GPU: Formalizing a CUDA-based Parallelizable All-Pairs Shortest Path Algorithm in ACL2

    Directory of Open Access Journals (Sweden)

    David S. Hardin

    2013-04-01

    Full Text Available As Graphics Processing Units (GPUs have gained in capability and GPU development environments have matured, developers are increasingly turning to the GPU to off-load the main host CPU of numerically-intensive, parallelizable computations. Modern GPUs feature hundreds of cores, and offer programming niceties such as double-precision floating point, and even limited recursion. This shift from CPU to GPU, however, raises the question: how do we know that these new GPU-based algorithms are correct? In order to explore this new verification frontier, we formalized a parallelizable all-pairs shortest path (APSP algorithm for weighted graphs, originally coded in NVIDIA's CUDA language, in ACL2. The ACL2 specification is written using a single-threaded object (stobj and tail recursion, as the stobj/tail recursion combination yields the most straightforward translation from imperative programming languages, as well as efficient, scalable executable specifications within ACL2 itself. The ACL2 version of the APSP algorithm can process millions of vertices and edges with little to no garbage generation, and executes at one-sixth the speed of a host-based version of APSP coded in C – a very respectable result for a theorem prover. In addition to formalizing the APSP algorithm (which uses Dijkstra's shortest path algorithm at its core, we have also provided capability that the original APSP code lacked, namely shortest path recovery. Path recovery is accomplished using a secondary ACL2 stobj implementing a LIFO stack, which is proven correct. To conclude the experiment, we ported the ACL2 version of the APSP kernels back to C, resulting in a less than 5% slowdown, and also performed a partial back-port to CUDA, which, surprisingly, yielded a slight performance increase.

  20. Sagittal Plane Knee Biomechanics and Vertical Ground Reaction Forces Are Modified Following ACL Injury Prevention Programs

    OpenAIRE

    Padua, Darin A.; DiStefano, Lindsay J.

    2009-01-01

    Context: Injuries to the anterior cruciate ligament (ACL) occur because of excessive loading on the knee. ACL injury prevention programs can influence sagittal plane ACL loading factors and vertical ground reaction force (VGRF). Objective: To determine the influence of ACL injury prevention programs on sagittal plane knee biomechanics (anterior tibial shear force, knee flexion angle/moments) and VGRF. Data Sources: The PubMed database was searched for studies published between January 1988 an...

  1. Rapid Hamstrings/Quadriceps strength in ACL-reconstructed elite alpine ski racers

    DEFF Research Database (Denmark)

    Jordan, Matthew J; Aagaard, Per; Herzog, Walter

    2015-01-01

    PURPOSE: Due to the importance of hamstrings (HAM) and quadriceps (QUAD) strength for anterior cruciate ligament (ACL) injury prevention, and the high incidence of ACL injury in ski racing, HAM and QUAD maximal and explosive strength was assessed in ski racers with and without ACL reconstruction ...

  2. Higher hamstring-to-quadriceps isokinetic strength ratio during the first post-operative months in patients with quadriceps tendon compared to hamstring tendon graft following ACL reconstruction.

    Science.gov (United States)

    Fischer, Felix; Fink, Christian; Herbst, Elmar; Hoser, Christian; Hepperger, Caroline; Blank, Cornelia; Gföller, Peter

    2018-02-01

    The aim of this study was to compare isokinetic quadriceps and hamstring muscle strength in patients following anterior cruciate ligament (ACL) reconstruction who received either hamstring (HT) or quadriceps (QT) tendon autografts at two time intervals within the first year after surgery. One hundred twenty-four patients, 81 males (age 22.0 ± 6.2 years) and 43 females (age 20.9 ± 8.7 years), participated in this study. ACL reconstruction was performed with either quadriceps tendon autografts (QT; n = 61) or hamstring tendon autografts (HT; n = 63). Two isokinetic muscle strength tests (t1: 5.5 ± 1.2 months; t2: 7.6 ± 1.6 months) were performed at an angular velocity of 60°/s in both the injured and contralateral knees. An independent t test as well as a two-factor analysis of variance with repeated measurements was used. The significance level was set at p ratio in QT patients compared to the HT group at t1 (p ratio in patients with QT grafts within the first months following surgery is possibly of clinical relevance. This may potentially be associated with lower stress on the maturing ACL graft. Furthermore, normal thigh strength can be restored over time. III.

  3. Review of CD Rom: The Virtual Surgeon: ACL Reconstruction ...

    African Journals Online (AJOL)

    THE VIRTUAL SURGEON: ACL RECONSTRUCTION Professor George Bentley ChM FRCS, Russell E LVindsor MD, Mr Andrew Williams FRCS(0rth); 4150 + VAT(UK) The Virtual Surgeon - 3D Anatomy of the Knee 469 + VAT(UK). TVF Multimedia Ltd, 375 City Road, London, EClV lNB, UK ...

  4. ACL graft can replicate the normal ligament's tension curve

    NARCIS (Netherlands)

    Arnold, MP; Verdonschot, N; van Kampen, A

    2005-01-01

    The anatomical femoral insertion of the normal anterior cruciate ligament (ACL) lies on the deep portion of the lateral wall of the intercondylar fossa. Following the deep bone-cartilage border, it stretches from 11 o'clock high in the notch all the way down to its lowest border at 8 o'clock. The

  5. POST-OPERATIVE REHABILITATION PROGRAM AFTER SURGERY ACL RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Zoran Đokić

    2013-07-01

    Full Text Available ACL (anterior cruciate ligament are small ligaments inside the knee capsule that connect the femur tibia, main function is to prevent movement of the femur in front of tibia and to provide stability, it also helps in controlling the movement of the knee, in direction back-forward. Injuries of ACL appear in an increasing number of athletes. Per year, from 100,000 people who have an injury of the knee joint, 30% have the reconstruction surgery of ACL. ACL injury accounts about 40% of all sports injuries. The greatest number of injuries just happens in the most popular sports, such as: basketball, football and handball, often in female athlete. After the injury, about 25% of athletes fail to return to the sport. Recovery time after surgery is usually 6-12 months, depending on individual characteristics, as well as technical and tactical demands of specific sports activities. Choosing an appropriate and efficient rehabilitation protocols, and training is of great importance. The aim of this paper is to present training protocol of 60 days, 3 months after ACL reconstruction surgery, of top handball female athletes. In the first 30 days, a total of 74 training sessions were done, 39 trainings and 21 EMS (Electrical Muscle Stimulation treatments, at the end of each workout. Functional abilities and morphological status were measured at the beginning and end of the treatment program. After the training protocol athlete got individual exercise program of 26 days (30 training sessions. After 20 days began with normal training, the 26th day of the first game played. The applied protocol has proven successful, as the third competition season there is no problem with an injury.

  6. Quantitative comparison of the microscopic anatomy of the human ACL femoral and tibial entheses.

    Science.gov (United States)

    Beaulieu, Mélanie L; Carey, Grace E; Schlecht, Stephen H; Wojtys, Edward M; Ashton-Miller, James A

    2015-12-01

    The femoral enthesis of the human anterior cruciate ligament (ACL) is known to be more susceptible to injury than the tibial enthesis. To determine whether anatomic differences might help explain this difference, we quantified the microscopic appearance of both entheses in 15 unembalmed knee specimens using light microscopy, toluidine blue stain and image analysis. The amount of calcified fibrocartilage and uncalcified fibrocartilage, and the ligament entheseal attachment angle were then compared between the femoral and tibial entheses via linear mixed-effects models. The results showed marked differences in anatomy between the two entheses. The femoral enthesis exhibited a 3.9-fold more acute ligament attachment angle than the tibial enthesis (pResearch Society. Published by Wiley Periodicals, Inc.

  7. MRI Anatomy of the Tibial ACL Attachment and Proximal Epiphysis in a Large Population of Skeletally Immature Knees: Reference Parameters for Planning Anatomic Physeal-Sparing ACL Reconstruction.

    Science.gov (United States)

    Swami, Vimarsha Gopal; Mabee, Myles; Hui, Catherine; Jaremko, Jacob Lester

    2014-07-01

    To aid in performing anatomic physeal-sparing anterior cruciate ligament (ACL) reconstruction, it is important for surgeons to have reference data for the native ACL attachment positions and epiphyseal anatomy in skeletally immature knees. To characterize anatomic parameters of the ACL tibial insertion and proximal tibial epiphysis at magnetic resonance imaging (MRI) in a large population of skeletally immature knees. Cross-sectional study; Level of evidence, 3. The ACL tibial attachment site and proximal epiphysis were examined in 570 skeletally immature knees with an intact ACL (age, 6-15 years) using 1.5-T proton density-weighted sagittal MRI; also measured were the tibial anteroposterior diameter; anterior, central, and posterior ACL attachment positions; vertical height of the epiphysis; and maximum oblique epiphyseal depth extending from the ACL tibial attachment center to the tibial tuberosity. In adolescents (11-15 years of age), the center of the ACL's tibial attachment was 51.5% ± 5.7% of the anteroposterior diameter of the tibia, with no significant differences between sexes or age groups (P > .05 in all cases). Mean vertical epiphyseal height was 15.9 ± 1.7 mm in the adolescent group, with significant differences between 11-year-olds (15.2 ± 1.5 mm) and 15-year-olds (16.6 ± 1.6 mm), P anatomy presented here may be helpful in selecting candidates for surgery and in planning surgical approaches for pediatric ACL reconstruction. © 2014 The Author(s).

  8. Unilateral Stance Strategies of Athletes With ACL Deficiency

    Science.gov (United States)

    Di Stasi, Stephanie L.; Hartigan, Erin H.; Snyder-Mackler, Lynn

    2013-01-01

    Aberrant movement strategies are characteristic of ACL-deficient athletes with recurrent knee instability (non-copers), and may instigate premature or accelerate joint degradation. Biomechanical evaluation of kinematic changes over time may elucidate noncopers’ responses to neuromuscular intervention and ACL reconstruction (ACLR). Forty noncopers were randomized into a perturbation group or a strength training only group. We evaluated the effects of perturbation training, and then gender on knee angle and tibial position during a unilateral standing task before and after ACLR. No statistically significant interactions were found. Before surgery, the strength training only group demonstrated knee angle asymmetry, but 6 months after ACLR, both groups presented with similar knee flexion between limbs. Aberrant and asymmetrical tibial position was found only in females following injury and ACLR. Neither treatment group showed distinct unilateral standing strategies following intervention; however, males and female noncopers appear to respond uniquely to physical therapy and surgery. PMID:22983931

  9. Strength Training Effects on Muscular Regeneration after ACL Reconstruction.

    Science.gov (United States)

    Friedmann-Bette, Birgit; Profit, Francesca; Gwechenberger, Thomas; Weiberg, Nadine; Parstorfer, Mario; Weber, Marc-Andre; Streich, Nikolaus; Barié, Alexander

    2018-01-31

    Protracted quadriceps muscle atrophy is observed after anterior cruciate ligament reconstruction (ACL-R). The aim of this study was to assess if quadriceps strength training with eccentric overload (CON/ECC) is more efficient to induce muscle regeneration after ACL-R than conventional concentric/eccentric (CON/ECC) strength training. Biopsies from the vastus lateralis muscle were obtained from 37 recreational athletes after 12 weeks of regular rehabilitation following ACL-R and again after 12 weeks with twice a week either conventional CON/ECC (n = 16) or CON/ECC (n = 21) one-legged supervised leg-press training. Immunohistochemical analyses were used to determine satellite cell number (SC, Pax7), activated SCs (Pax7/MyoD), fibers expressing myosin heavy chain (MHC) I, II and neonatal, fiber cross sectional area (FCSA). Magnetic resonance imaging was performed to measure quadriceps cross sectional area (MCSA) and isokinetic testing for the measurement of quadriceps strength. CON/ECC induced a significantly (p = 0.002) greater increase in MCSA than CON/ECC. There also was a significant increase in the FCSAs of all fiber types and in quadriceps strength, however, without significant difference between training groups. Only CON/ECC training lead to a significant (p hypertrophy than CON/ECC, however, at the same time inducing a less favorable slower muscle phenotype for strong and fast movements and without the hypothesized enhancing effect on SC activation.

  10. A randomized trial of treatment for acute anterior cruciate ligament tears

    DEFF Research Database (Denmark)

    Frobell, Richard B; Roos, Ewa M; Roos, Harald P

    2010-01-01

    no significant differences between the two treatment groups with respect to secondary outcomes. Adverse events were common in both groups. The results were similar when the data were analyzed according to the treatment actually received. CONCLUSIONS: In young, active adults with acute ACL tears, a strategy......BACKGROUND: The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown. METHODS: We conducted a randomized, controlled trial involving 121 young, active adults with acute ACL injury in which we compared two strategies: structured rehabilitation plus early ACL...... reconstruction and structured rehabilitation with the option of later ACL reconstruction if needed. The primary outcome was the change from baseline to 2 years in the average score on four subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS) - pain, symptoms, function in sports and recreation...

  11. Restriction in hip internal rotation is associated with an increased risk of ACL injury.

    Science.gov (United States)

    Bedi, Asheesh; Warren, Russell F; Wojtys, Edward M; Oh, You Keun; Ashton-Miller, James A; Oltean, Hanna; Kelly, Bryan T

    2016-06-01

    Evidence suggests that femoroacetabular impingement (FAI) in athletes may increase the risk of anterior cruciate ligament (ACL) injury. This study correlates ACL injury with hip range of motion in a consecutive series of elite, contact athletes and tests the hypothesis that a restriction in the available hip axial rotation in a dynamic in silico model of a simulated pivot landing would increase ACL strain and the risk of ACL rupture. Three hundred and twenty-four football athletes attending the 2012 NFL National Invitational Camp were examined. Hip range of internal rotation was measured and correlated with a history of ACL injury and surgical repair. An in silico biomechanical model was used to study the effect of FAI on the peak relative ACL strain developed during a simulated pivot landing. The in vivo results demonstrated that a reduction in internal rotation of the left hip was associated with a statistically significant increased odds of ACL injury in the ipsilateral or contralateral knee (OR 0.95, p = 0.0001 and p < 0.0001, respectively). A post-estimation calculation of odds ratio for ACL injury based on deficiency in hip internal rotation demonstrated that a 30-degree reduction in left hip internal rotation was associated with 4.06 and 5.29 times greater odds of ACL injury in the ipsilateral and contralateral limbs, respectively. The in silico model demonstrated that FAI systematically increased the peak ACL strain predicted during the pivot landing. FAI may be associated with ACL injury because of the increased resistance to femoral internal axial rotation during a dynamic maneuver such as a pivot landing. This insight may lead to better interventions to prevent ACL injury and improved understanding of ACL reconstruction failure. Cohort study, Level IV.

  12. Knee kinematics and kinetics in former soccer players with a 16-year-old ACL injury – the effects of twelve weeks of knee-specific training

    Directory of Open Access Journals (Sweden)

    Holmström Eva

    2007-04-01

    Full Text Available Abstract Background Training of neuromuscular control has become increasingly important and plays a major role in rehabilitation of subjects with an injury to the anterior cruciate ligament (ACL. Little is known, however, of the influence of this training on knee stiffness during loading. Increased knee stiffness occurs as a loading strategy of ACL-injured subjects and is associated with increased joint contact forces. Increased or altered joint loads contribute to the development of osteoarthritis. The aim of the study was to determine if knee stiffness, defined by changes in knee kinetics and kinematics of gait, step activity and cross-over hop could be reduced through a knee-specific 12-week training programme. Methods A 3-dimensional motion analysis system (VICON and a force plate (AMTI were used to calculate knee kinetics and kinematics before and after 12 weeks of knee-specific training in 12 males recruited from a cohort with ACL injury 16 years earlier. Twelve uninjured males matched for age, sex, BMI and activity level served as a reference group. Self-reported patient-relevant data were obtained by the KOOS questionnaire. Results There were no significant changes in knee stiffness during gait and step activity after training. For the cross-over hop, increased peak knee flexion during landing (from 44 to 48 degrees, p = 0.031 and increased internal knee extensor moment (1.28 to 1.55 Nm/kg, p = 0.017 were seen after training, indicating reduced knee stiffness. The KOOS sport and recreation score improved from 70 to 77 (p = 0.005 and was significantly correlated with the changes in knee flexion during landing for the cross-over hop (r = 0.6, p = 0.039. Conclusion Knee-specific training improved lower extremity kinetics and kinematics, indicating reduced knee stiffness during demanding hop activity. Self-reported sport and recreational function correlated positively with the biomechanical changes supporting a clinical importance of the

  13. The experience of being a partner to a spinal cord injured person

    DEFF Research Database (Denmark)

    Angel, Sanne; Buus, Niels

    2011-01-01

    This qualitative focuses on the personal experiences of partners to a spinal cord injured person. Using a Ricoeurian phenomenological-hermeneutic approach, we analysed seven partners' narratives 1 and 2 years after their partner's injury. The study revealed how the injury was experienced from...... the partners' perspective through the aftermath. In the acute phase after the injury, partners also felt harmed, and support was needed in relation to their own daily activities, eating, resting, and managing distress. During the institutionalized rehabilitation, partners felt torn between supporting...... the injured partner and the demanding tasks of everyday life outside the institution. After discharge, partners struggled for the injured partner to regain a well-functioning everyday life and for reestablishing life as a couple. The partner struggled to manage the overwhelming amount of everyday tasks. Some...

  14. Dimensionality of the Knee Numeric-Entity Evaluation Score (KNEES-ACL)

    DEFF Research Database (Denmark)

    Comins, J D; Krogsgaard, M R; Kreiner, Svend

    2013-01-01

    The benefit of anterior cruciate ligament (ACL) reconstruction has been questioned based on patient-reported outcome measures (PROMs). Valid interpretation of such results requires confirmation of the psychometric properties of the PROM. Rasch analysis is the gold standard for validation of PROMs......, yet PROMs used for ACL reconstruction have not been validated using Rasch analysis. We used Rasch analysis to investigate the psychometric properties of the Knee Numeric-Entity Evaluation Score (KNEES-ACL), a newly developed PROM for patients treated for ACL deficiency. Two-hundred forty-two patients...

  15. Rapid hamstrings/quadriceps strength in ACL-reconstructed elite Alpine ski racers.

    Science.gov (United States)

    Jordan, Matthew J; Aagaard, Per; Herzog, Walter

    2015-01-01

    Because of the importance of hamstrings (HAM) and quadriceps (QUAD) strength for anterior cruciate ligament (ACL) injury prevention and the high incidence of ACL injury in ski racing, HAM and QUAD maximal and explosive strength were assessed in ski racers with and without ACL reconstruction (ACL-R). Uninjured (n = 13 males, n = 8 females) and ACL-R (n = 3 males, n = 5 females, 25.0 ± 11.3 months after operation) elite ski racers performed maximal voluntary isometric HAM and QUAD contractions to obtain maximal torque (MVC) and rate of torque development (RTD) at 0-50, 0-100, 0-150, and 0-200 ms. MVC and RTD (per kilogram body mass) were calculated for the uninjured group to compare between sexes and to compare the control group with the ACL-R limb and unaffected limb of the ACL-R skiers. HAM/QUAD MVC and RTD strength ratios (H/Q ratios) were also compared. The ACL-R limb demonstrated significant HAM and QUAD deficits compared with the contralateral limb for MVC and late-phase RTD (P ski racing, our results suggest the importance of including HAM and QUAD strength assessments in the physical evaluation of uninjured skiers. Furthermore, HAM and QUAD strength should be assessed over a long-term period after surgery to identify chronic strength deficits in ACL-R ski racers.

  16. The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotary stability

    DEFF Research Database (Denmark)

    Tavlo, Mette; Eljaja, S; Tranum-Jensen, Jørgen

    2016-01-01

    with a rolimeter. Rotation with a torque of 8.85 Nm was measured photographically. The ALL was well defined in 78% of knees. ACL reconstruction had a significant effect on anterior-posterior stability. Detaching the ALL had a significant effect on internal rotatory stability and on anterior-posterior stability...... in ACL-insufficient knees. Reconstruction of ACL and ALL reestablished knee stability. The appearance of the ALL was not uniform. The ALL was an internal rotational stabilizer. Anatomical ALL reconstruction in combination with ACL reconstruction could reestablish stability. ALL reconstruction might...

  17. ATP released by injured neurons activates Schwann cells

    Directory of Open Access Journals (Sweden)

    Samuele eNegro

    2016-05-01

    Full Text Available Injured nerve terminals of neuromuscular junctions (NMJs can regenerate. This remarkable and complex response is governed by molecular signals that are exchanged among the cellular components of this synapse: motor axon nerve terminal (MAT, perisynaptic Schwann cells (PSCs, and muscle fibre. The nature of signals that govern MAT regeneration is ill-known. In the present study the spider toxin α-Latrotoxin has been used as tool to investigate the mechanisms underlying peripheral neuroregeneration. Indeed this neurotoxin induces an acute, specific, localized and fully reversible damage of the presynaptic nerve terminal, and its action mimics the cascade of events that leads to nerve terminal degeneration in injured patients and in many neurodegenerative conditions. Here we provide evidence of an early release by degenerating neurons of ATP as alarm messenger, that contributes to the activation of a series of intracellular pathways within SCs that are crucial for nerve regeneration: Ca2+, cAMP, ERK1/2, and CREB. These results contribute to define the cross-talk taking place among degenerating nerve terminals and PSCs, involved in the functional recovery of the NMJ.

  18. Modeling Algorithms in SystemC and ACL2

    Directory of Open Access Journals (Sweden)

    John W. O'Leary

    2014-06-01

    Full Text Available We describe the formal language MASC, based on a subset of SystemC and intended for modeling algorithms to be implemented in hardware. By means of a special-purpose parser, an algorithm coded in SystemC is converted to a MASC model for the purpose of documentation, which in turn is translated to ACL2 for formal verification. The parser also generates a SystemC variant that is suitable as input to a high-level synthesis tool. As an illustration of this methodology, we describe a proof of correctness of a simple 32-bit radix-4 multiplier.

  19. Treatment and outcome of the severely head injured child.

    Science.gov (United States)

    Pfenninger, J; Kaiser, G; Lütschg, J; Sutter, M

    1983-01-01

    Twenty-four children (aged 3 months to 14 years) with severe head injuries were treated by means of invasive neurointensive care for normalizing intracranial pressure (ICP) involving hyperventilation, control of body temperature, dexamethasone, barbiturates and continuous intracranial and arterial pressure monitoring. The Glasgow Coma Scale before initiation of treatment was 3-4 in 8, 5-6 in 9 and 7 in 7 patients. Moderately to severely elevated ICP was observed in 20 patients. Seven developed acute and subacute space occupying intracranial hematomas. Nineteen children (79%) survived, most often with good recovery and 5 (21%) died. Severely elevated ICP, presence of severe consumption coagulopathy and loss of components in brain auditory evoked potentials were significantly more frequent in the fatal group. We conclude that the prognosis of the severely head injured child can be improved by prompt resuscitation and aggressive neurointensive care but probably not, however, to the extent postulated in recent literature.

  20. Nursing care of the thermally injured patient.

    Science.gov (United States)

    Elfving, U

    1980-01-01

    Team work is required in the treatment of the thermally injured patient--nursing staff being part of the team. The nurses are with the patient for 24 hours a day and they have to understand the objectives of all other members of the team involved in the treatment as well as thoroughly mastering their own work. For the nursing staff the care of the thermally injured patient is a challenge. The work demands strong motivation and interest--it includes at times painful treatment, isolation and also constant alertness. It is important that the nursing staff is given continuous training so that they are able to give the required care efficiently and to keep up active interest. Practical work is the best way of getting aquainted with the complex forms of treatment of the thermally injured patient. It also lessens the fear of a badly burned patient. Nursing care of the thermally injured patient consists of good basic care, local attention and active observation. The basic care consists of basic hygiene, diet, observation of the patient's psychological condition, giving emotional support, encouraging initiative physiotherapy and postural treatment.

  1. Helping brain injured children and their families.

    Science.gov (United States)

    Wood, S J

    1998-01-01

    For many brain injured children, whether the injury is congenital or the result of subsequent illness or accident, there is little to be done to put right the underlying problem. Treatment programmes, however, can encourage better motor and cognitive function and better nutrition. NHS continuing care for brain injured children is under-resourced, often amounting to only half an hour of physiotherapy fortnightly or even monthly. The British Institute for Brain Injured Children (BIBIC) is a registered charity which exists to help families with a brain injured child to learn to apply simple, practical, inexpensive treatment programmes themselves, in their own homes. Initial assessments and training take place at the BIBIC Centre in Somerset. Families are asked to contribute towards costs if they are in a position to, but treatment does not depend on ability to pay. Treatment sessions often last about 30 minutes and families may be advised to carry out two or more sessions every day. Telephone help and continuing support is available from BIBIC, and families are encouraged to retain contact with their GP and hospital consultants, and local services.

  2. Thromboembolic Complications in Thermally Injured Patients,

    Science.gov (United States)

    1992-12-01

    utilisation systdmatique chez le brOld sauf chez les patients A bolism: A clinico -pathological study in injured and burned patients. thromoemblie.Br. J...fueron identificados como casos de tromboembolismo, complications in the surgical patient. Ann. Surg. 186:669, 1977 pulmonar significativo. En s6lo tres

  3. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study.

    Science.gov (United States)

    Grindem, Hege; Snyder-Mackler, Lynn; Moksnes, Håvard; Engebretsen, Lars; Risberg, May Arna

    2016-07-01

    Knee reinjury after ACL reconstruction is common and increases the risk of osteoarthritis. There is sparse evidence to guide return to sport (RTS) decisions in this population. To assess the relationship between knee reinjury after ACL reconstruction and (1) return to level I sports, (2) timing of RTS and (3) knee function prior to return. 106 patients who participated in pivoting sports participated in this prospective 2-year cohort study. Sports participation and knee reinjury were recorded monthly. Knee function was assessed with the Knee Outcome Survey-Activities of Daily Living Scale, global rating scale of function, and quadriceps strength and hop test symmetry. Pass RTS criteria were defined as scores >90 on all tests, failure as failing any. Patients who returned to level I sports had a 4.32 (p=0.048) times higher reinjury rate than those who did not. The reinjury rate was significantly reduced by 51% for each month RTS was delayed until 9 months after surgery, after which no further risk reduction was observed. 38.2% of those who failed RTS criteria suffered reinjuries versus 5.6% of those who passed (HR 0.16, p=0.075). More symmetrical quadriceps strength prior to return significantly reduced the knee reinjury rate. Returning to level I sports after ACL reconstruction leads to a more than 4-fold increase in reinjury rates over 2 years. RTS 9 months or later after surgery and more symmetrical quadriceps strength prior to return substantially reduce the reinjury rate. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    McKean, D.; Thomee, E.; Grant, D.; Teh, J.L.; Mansour, R. [Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Headington, Oxford (United Kingdom); Yoong, P. [Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, Reading (United Kingdom); Yanny, S. [Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Aylesbury (United Kingdom)

    2015-10-15

    To describe the patterns of injury associated with injury to the popliteofibular ligament injury. A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 25.7 years (range, 9-65 years) and 72.2 % (n = 130) patients were male. The PFL was injured in 36 cases (20 %). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25 %) were associated with further injuries of posterolateral corner structures and in 27 cases (75 %) the PFL was the only posterolateral corner structure torn. PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner. (orig.)

  5. The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging.

    Science.gov (United States)

    McKean, D; Yoong, P; Yanny, S; Thomee, E; Grant, D; Teh, J L; Mansour, R

    2015-10-01

    To describe the patterns of injury associated with injury to the popliteofibular ligament injury. A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 25.7 years (range, 9-65 years) and 72.2% (n = 130) patients were male. The PFL was injured in 36 cases (20%). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25%) were associated with further injuries of posterolateral corner structures and in 27 cases (75%) the PFL was the only posterolateral corner structure torn. PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner.

  6. Stress During ACLS Courses: Is it Important for Learning Skills?

    Directory of Open Access Journals (Sweden)

    Emilton Lima Júnior

    2002-12-01

    Full Text Available OBJECTIVE: To determine the influence of stress on teaching medical emergencies in an Advanced Cardiac Life Support (ACLS course and to verify this influence on learning, and the efficiency of emergency care training. METHODS: Seventeen physicians signed up for an ACLS course. Their pulses were taken and blood pressure (BP verified on the first day, before the beginning of the course, and on the second day, during the theoretical and practical test (TPT. Variations in pulse rates and BP were compared with students' test grades. Then, students answered a questionnaire of variables (QV about the amount of sleep they had during the course, the quantity of study material and the time spent studying for the course, and a stress scale graphic. RESULTS: Seven students had a pulse variation less than 10% between the 2 periods and 10 had a 10% or more variation. Grades on TPT were, respectively, 91.4±2.4 and 87.3±5.2 (p<0.05. Six students had a BP variation less than 20 mmHg, and in 11 it varied more than 21 mmHg. Grades on the TPT were 92.3±3.3 and 86.2± 8.1, respectively (p<0.05. The QV dates did not significantly influence grades. CONCLUSION: Stress, as an isolated variable, had a negative influence on the learning process and on the efficiency of emergency training in this situation.

  7. Initial Experiments with TPTP-style Automated Theorem Provers on ACL2 Problems

    Directory of Open Access Journals (Sweden)

    Sebastiaan Joosten

    2014-06-01

    Full Text Available This paper reports our initial experiments with using external ATP on some corpora built with the ACL2 system. This is intended to provide the first estimate about the usefulness of such external reasoning and AI systems for solving ACL2 problems.

  8. Social psychological aspects of ACL injury prevention and rehabilitation: An integrated model for behavioral adherence.

    Science.gov (United States)

    Chan, Derwin King Chung; Lee, Alfred Sing Yeung; Hagger, Martin S; Mok, Kam-Ming; Yung, Patrick Shu-Hang

    2017-10-01

    Managing rehabilitation for ACL injury is dependent on uptake of, and compliance with, medical and safety recommendations. In this paper, we propose a multi-theory model that integrates self-determination theory and the theory of planned behavior to identify the motivational determinants ACL injury prevention and management behaviors and the processes involved.

  9. Social psychological aspects of ACL injury prevention and rehabilitation: An integrated model for behavioral adherence

    OpenAIRE

    Derwin King Chung Chan; Alfred Sing Yeung Lee; Martin S. Hagger; Kam-Ming Mok; Patrick Shu-Hang Yung

    2017-01-01

    Managing rehabilitation for ACL injury is dependent on uptake of, and compliance with, medical and safety recommendations. In this paper, we propose a multi-theory model that integrates self-determination theory and the theory of planned behavior to identify the motivational determinants ACL injury prevention and management behaviors and the processes involved.

  10. Evaluating ACLS Algorithms for the International Space Station (ISS) - A Paradigm Revisited

    Science.gov (United States)

    Alexander, Dave; Brandt, Keith; Locke, James; Hurst, Victor, IV; Mack, Michael D.; Pettys, Marianne; Smart, Kieran

    2007-01-01

    The ISS may have communication gaps of up to 45 minutes during each orbit and therefore it is imperative to have medical protocols, including an effective ACLS algorithm, that can be reliably autonomously executed during flight. The aim of this project was to compare the effectiveness of the current ACLS algorithm with an improved algorithm having a new navigation format.

  11. Social psychological aspects of ACL injury prevention and rehabilitation: An integrated model for behavioral adherence

    Directory of Open Access Journals (Sweden)

    Derwin King Chung Chan

    2017-10-01

    Full Text Available Managing rehabilitation for ACL injury is dependent on uptake of, and compliance with, medical and safety recommendations. In this paper, we propose a multi-theory model that integrates self-determination theory and the theory of planned behavior to identify the motivational determinants ACL injury prevention and management behaviors and the processes involved.

  12. ACL rupture is a single leg injury but a double leg problem

    DEFF Research Database (Denmark)

    Benjaminse, Anne; Holden, Sinead; Myer, Gregory D.

    2018-01-01

    The authors present their thoughts on the focus on targeting asymmetry in rehabilitation after ACL reconstruction, which they think may not be rich enough to identify deficits.......The authors present their thoughts on the focus on targeting asymmetry in rehabilitation after ACL reconstruction, which they think may not be rich enough to identify deficits....

  13. Lower extremity performance following ACL rehabilitation in the KANON-trial

    DEFF Research Database (Denmark)

    Ericsson, Ylva B; Roos, Ewa M.; Frobell, Richard B

    2013-01-01

    The additional effect of anterior cruciate ligament (ACL) reconstruction on muscle strength and physical performance after a structured exercise programme is not well understood.......The additional effect of anterior cruciate ligament (ACL) reconstruction on muscle strength and physical performance after a structured exercise programme is not well understood....

  14. No economic benefit of early knee reconstruction over optional delayed reconstruction for ACL tears

    DEFF Research Database (Denmark)

    Kiadaliri, Aliasghar A; Englund, Martin; Stefan Lohmander, L.

    2016-01-01

    discounted at 3%. Full-analysis set (based on study randomisation) and as-treated analysis (according to actual treatment over 5 years) principles were applied. Results Mean cost of early ACL reconstruction was €4695 higher than optional delayed ACL reconstruction (p=0.19) and provided an additional 0...

  15. MRI diagnosis of ACL bundle tears: value of oblique axial imaging

    Energy Technology Data Exchange (ETDEWEB)

    Ng, Alex W.H.; Griffith, James F.; Hung, Esther H.Y. [Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR (China); Law, Kan Yip; Yung, Patrick S.H. [Chinese University of Hong Kong, Department of Orthopedics and Traumatology, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR (China)

    2013-02-15

    To investigate the diagnostic accuracy of oblique axial intermediate weighting MR imaging in detecting partial thickness anterior cruciate ligament (ACL) bundle tears. The study protocol was approved by the institutional ethics committee. Sixty-one subjects (43 male, 18 female; mean age 27.4 years; range 9 to 57 years) with clinically suspected ACL tear or meniscal tear between September 2009 and January 2011 were studied with MRI and arthroscopy. Detection of partial tear for the ACL as a whole and for each ACL bundle by protocol A (standard orthogonal sequences) and protocol B (standard orthogonal sequences plus oblique axial intermediate weighted imaging) was compared in a blinded fashion. Performance characteristics for protocol A and protocol B were compared using sensitivity, specificity, accuracy and ROC curves. A two-tailed p value of <0.05 indicated statistical significance. Fifteen (24.6%) normal, 15 (24.6%) partial and 31 complete tears were diagnosed by arthroscopy. Sensitivity, specificity and accuracy of protocol A for the diagnosis of partial tear of the ACL was 33%, 87% and 74%, while for protocol B the values were 87%, 87% and 87% respectively. The area under the curve (AUC) for the diagnosis of partial ACL tear and individual bundle tear was higher for protocol B, although this difference did not reach statistical significance (p > 0.05). The addition of oblique axial imaging to standard MR imaging improves diagnostic accuracy for detecting partial tears of the ACL as well as individual bundle tears of the ACL. (orig.)

  16. A Retrospective Analysis of Concurrent Pathology in ACL-Reconstructed Knees of Elite Alpine Ski Racers

    DEFF Research Database (Denmark)

    Jordan, Matthew J; Doyle-Baker, Patricia; Heard, Mark

    2017-01-01

    BACKGROUND: Anterior cruciate ligament (ACL) tear is the most frequent injury in alpine ski racing, and there is a high prevalence of ACL reinjury. Limited data exist on the concurrent pathology with primary ACL tears in elite alpine ski racers and the magnitude of injury progression after primary...... ACL reconstruction (ACLR). PURPOSE: To evaluate (1) the involvement of intra-articular and multiligament pathologies at the time of primary ACLR, (2) the subsequent progression in meniscal/chondral injuries, and (3) the occurrence of ACL reinjury in elite alpine ski racers. STUDY DESIGN: Case series......; Level of evidence, 4. METHODS: Primary ACLR operative reports (n = 28) were obtained for 32 elite alpine ski racers along with the reports of 20 operative procedures that occurred subsequent to primary ACLR. Operative reports were evaluated to identify the presence/location of multiligament injury...

  17. Musculoskeletal Modeling of a Forward Lunge Movement:Implications for ACL Loading

    DEFF Research Database (Denmark)

    Alkjaer, T; Wieland, MR; Andersen, MS

    2010-01-01

    Context: The forward lunge is widely used among athletes for training and rehabilitation purposes. The forward lunge movement has also been suggested as a model to study functional adaptation to ACL rupture. Previous investigations indicate that the absence of the ACL influences the movement...... pattern of many patients during a forward lunge, while direct measurements of ACL strain show that except for cases close to full extension, quadriceps activity does not seem to influence the ACL strain. The question is whether there are other external forces present in the lunge movement that may cause...... an anterior force on the tibia, requiring the ACL to be intact to stabilize the knee? Objective: To establish a musculoskeletal model of the forward lunge to computationally investigate the force equilibrium in the knee during forward lunge and answer the following questions: 1) Which structures in the knee...

  18. Do general medical practitioners examine injured runners?

    DEFF Research Database (Denmark)

    Andersen, Solvej Videbæk; Jensen, A V; Rasmussen, Sten

    2017-01-01

    BACKGROUND: General Medical Practitioners (GMP) in Denmark perform clinical examinations of patients with musculoskeletal pain. However, the prevalence proportion of examinations caused by running-related injuries remains unknown. PURPOSE: The primary purpose of the present study was to estimate ...... response-proportion highlights the challenges recruiting GMPs willing to respond to questionnaires on running-related injuries. It is plausible to assume that the estimates reported in the present study are overestimated owing to selection bias. LEVEL OF EVIDENCE: 3........43%]. Ten (37%) GMPs reported to refer between 0-24% of the injured runners to additional examination or treatment, whereas thirteen (48%) of GMPs referred between 25-49% and four (15%) referred 50-74% of injured runners. CONCLUSION: Although a very small part (

  19. Accident characteristics of injured motorcyclists in Malaysia.

    Science.gov (United States)

    Pang, T Y; Umar, R S; Azhar, A A; Ahmad, M M; Nasir, M T; Harwant, S

    2000-03-01

    This study examines the accident characteristics of injured motorcyclists in Malaysia. The aim of this study is to identify the characteristics of motorcyclists who are at higher fatality risk and subsequently be the targeted group for the fatality-reduction countermeasures. A total of 412 motorcycle crash victims with serious or fatal injuries were analysed. The results showed that the injured motorcyclists were predominant young, novice riders of less than 3 years licensure and male. A fatal outcome was more likely to be associated with a larger engine capacity motorcycle, collision with a heavy vehicle, head on collision, and collision at a non-junction road. In contrast, a non-fatal outcome was more likely to be associated with a small engine capacity motorcycle, collision with another motorcycle or passenger car, junction accidents, and side or rear collisions.

  20. Neuromuscular coordination deficit persists 12 months after ACL reconstruction but can be modulated by 6 weeks of kettlebell training

    DEFF Research Database (Denmark)

    Zebis, Mette K.; Andersen, Christoffer H.; Bencke, Jesper

    2017-01-01

    The aim of the present single-case study was to investigate the effect of 6 weeks' kettlebell training on the neuromuscular risk profile for ACL injury in a high-risk athlete returning to sport after ACL reconstruction. A female elite soccer player (age 21 years) with no previous history of ACL i...

  1. Neuromuscular Coordination Deficit Persists 12 Months after ACL Reconstruction But Can Be Modulated by 6 Weeks of Kettlebell Training

    DEFF Research Database (Denmark)

    Zebis, Mette K; Andersen, Christoffer H; Bencke, Jesper

    2017-01-01

    The aim of the present single-case study was to investigate the effect of 6 weeks' kettlebell training on the neuromuscular risk profile for ACL injury in a high-risk athlete returning to sport after ACL reconstruction. A female elite soccer player (age 21 years) with no previous history of ACL i...

  2. Reconstructive Surgery in the Thermally Injured Patient

    Science.gov (United States)

    2012-01-01

    the same or Conflicts of interest: The authors disclose no conflicts. a Division of Oral and Maxillofacial Surgery , Dental and Trauma Research...Reconstructive Surgery in the Thermally Injured Patient Davin Mellus, DMDa,* Rodney K. Chan, MDb KEYWORDS • Microvascular free-tissue transfer...Pedicle flaps • Reconstructive Surgery • Thermal injury • Z-plasties • Skin grafting AN INCREASED NEED FOR RECONSTRUCTIVE SURGERY Reconstruction is a

  3. Outcomes of ACL Reconstruction in Patients with Diabetes

    Science.gov (United States)

    Brophy, Robert H.; Huston, Laura J.; Wright, Rick W.; Nwosu, Samuel K.; Kaeding, Christopher C.; Parker, Richard D.; Andrish, Jack T.; Marx, Robert G.; McCarty, Eric C.; Amendola, Annunziato; Wolf, Brian R.; Dunn, Warren R.; Wolcott, Michelle L.; Spindler, Kurt P.

    2016-01-01

    Purpose Diabetes has been associated with adverse outcomes following various types of surgery. There is no previously published data regarding the impact of diabetes on outcomes from anterior cruciate ligament (ACL) reconstruction (ACLR). The purpose of this study was to test the hypotheses that diabetes is associated with worse clinical outcomes and a higher prevalence of subsequent surgeries following ACLR. Methods ACL deficient patients (n=2198) undergoing unilateral ACLR from a multicenter prospective study were included. Patients who self-reported diabetes based on comorbidity questions prior to surgery were identified from the database. They were compared with the remainder of the cohort who did not self-report diabetes. All patients were followed up for a minimum of 2 years following their index surgery. Minimum 2 year follow-up was attained on 1905/2198 (87%) via completed outcome questionnaires and 2096/2198 (95%) regarding subsequent surgery. The primary outcome measures were three validated outcome instruments. Secondary outcome measure was the incidence of additional surgery on the ipsilateral and contralateral knees. Results Patients with diabetes had significantly higher activity level at 2 years (OR=2.96; 95% CI=1.30–6.77; p=0.01), but otherwise slightly worse clinical outcomes, compared to patients without diabetes (OR range = 0.42–0.59). The prevalence of subsequent surgeries in patients with diabetes was not significantly different from the prevalence in patients without diabetes. Conclusions Patients with diabetes maintain a higher activity level after ACLR despite slightly lower patient reported outcomes scores compared to patients without diabetes and do not have a higher rate of subsequent surgery. PMID:26765634

  4. [Psychometric properties of the Autism-Checklist (ACL) in adults with intellectual disability].

    Science.gov (United States)

    Sappok, Tanja; Heinrich, Manuel; Diefenbacher, Albert

    2014-01-01

    To determine the validity of the Autism-Checklist (ACL) in adults with intellectual disability (ID) who are suspected of having autism spectrum disorder. In 154 adults with ID the results of the ACL were compared to the results of the final diagnostic classification obtained by a multiprofessional case conference for autism. Psychometric properties of the ACL were evaluated. The internal consistency as indicated by Cronbach's alpha was 0.81. The ACL sum score highly correlated with established screening measures such as the Social Communication Questionnaire (SCQ: Spearman's rho = 0.620) and the Pervasive Developmental Disorder in Mental Retardation Scale (PDD-MRS: Spearman's rho = 0.490). ROC Analysis revealed an area under the curve of 0.859. The ACL classification complied with the final diagnostic classification in 80.5 % and Cohen's kappa revealed a moderate agreement of 0.596. Sensitivity/specificity of the ACL were 90.7 %/67.6 %, respectively. Interrater-intertime reliability was good (Cohen's kappa = 0.702; Spearman = 0.549; n = 53). In 19 patients (22 %) a diagnosis of ASD had been given prior to referral. The ACL is a suitable measure for adults with ID and suspicion of autism spectrum disorders. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Lateral Intercondylar Ridge: Is it a reliable landmark for femoral ACL insertion?: An anatomical study.

    Science.gov (United States)

    Bhattacharyya, Rahul; Ker, Andrew; Fogg, Quentin; Spencer, Simon J; Joseph, Jibu

    2018-02-01

    Incorrect femoral tunnel placement is the most common cause of graft failure during Anterior Cruciate Ligament (ACL) Reconstruction. A reliable landmark can minimize errors. To identify whether the Lateral Intercondylar Ridge (LIR) is a consistent anatomical structure and define its relationship with the femoral ACL insertion. Phase 1: we studied 23 femoral dry bone specimens macroscopically. Using a digital microscribe, the medial surface of the lateral femoral condyle was reconstructed (3D) to evaluate whether there was an identifiable bony ridge. Phase 2: 7 cadaveric specimens with intact soft tissues were dissected to identify the femoral ACL insertion. A 3D reconstruction of the femoral ACL insertion and the surface allowed us to define the relationship between the LIR and the ACL insertion. All specimens had a defined LIR on the medial surface of the lateral femoral condyle. The ridge was consistently located just anterior to the femoral ACL insertion. The ACL footprint was present in the depression between the ridge and the Inferior Articular Cartilage Margin (IACM). The mean distance from the midpoint of the IACM to the LIR was 10.1 mm. This is the first study to use the microscribe to digitally reconstruct the medial surface of the lateral femoral condyle. It shows that the LIR is a consistent anatomical structure that defines the anterior margin of the femoral ACL insertion, which guides femoral tunnel placement. Our findings support the ruler technique, which is a commonly used method for anatomic single bundle ACL reconstruction. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  6. Mechanisms, Prediction, and Prevention of ACL Injuries: Cut Risk With Three Sharpened and Validated Tools

    Science.gov (United States)

    Hewett, Timothy E.; Myer, Gregory D.; Ford, Kevin R.; Paterno, Mark V.; Quatman, Carmen E.

    2017-01-01

    Economic and societal pressures influence modern medical practice to develop and implement prevention strategies. Anterior cruciate ligament (ACL) injury devastates the knee joint leading to short term disability and long term sequelae. Due to the high risk of long term osteoarthritis in all treatment populations following ACL injury, prevention is the only effective intervention for this life-altering disruption in knee health. The “Sequence of Prevention” Model provides a framework to monitor progress towards the ultimate goal of preventing ACL injuries. Utilizing this model, our multidisciplinary collaborative research team has spent the last decade working to delineate injury mechanisms, identify injury risk factors, predict which athletes are at-risk for injury, and develop ACL injury prevention programs. Within this model of injury prevention, modifiable factors (biomechanical and neuromuscular) related to injury mechanisms likely provide the best opportunity for intervention strategies aimed to decrease the risk of ACL injury, particularly in female athletes. Knowledge advancements have led to the development of potential solutions that allow athletes to compete with lowered risk of ACL injury. Design and integration of personalized clinical assessment tools and targeted prevention strategies for athletes at high risk for ACL injury may transform current prevention practices and ultimately significantly reduce ACL injury incidence. This 2016 OREF Clinical Research Award focuses on the authors' work and contributions to the field. The author's acknowledge the many research groups who have contributed to the current state of knowledge in the fields of ACL injury mechanisms, injury risk screening and injury prevention strategies. PMID:27612195

  7. Traumatically injured astrocytes release a proteomic signature modulated by STAT3 dependent cell survival

    Science.gov (United States)

    Levine, Jaclynn; Kwon, Eunice; Paez, Pablo; Yan, Weihong; Czerwieniec, Gregg; Loo, Joseph A.; Sofroniew, Michael V.; Wanner, Ina-Beate

    2015-01-01

    Molecular markers associated with CNS injury are of diagnostic interest. Mechanical trauma generates cellular deformation associated with membrane permeability with unknown molecular consequences. We used an in vitro model of stretch-injury and proteomic analyses to determine protein changes in murine astrocytes and their surrounding fluids. Abrupt pressure-pulse stretching resulted in the rapid release of 59 astrocytic proteins with profiles reflecting cell injury and cell death, i.e. mechanoporation and cell lysis. This acute trauma-release proteome was overrepresented with metabolic proteins compared to the uninjured cellular proteome, bearing relevance for post-traumatic metabolic depression. Astrocyte-specific deletion of signal transducer and activator of transcription 3 (STAT3-CKO) resulted in reduced stretch-injury tolerance, elevated necrosis and increased protein release. Consistent with more lysed cells, more protein complexes, nuclear and transport proteins were released from STAT3-CKO versus non-transgenic astrocytes. STAT3-CKO astrocytes had reduced basal expression of GFAP, lactate dehydrogenase B (LDHB), aldolase C (ALDOC) and astrocytic phosphoprotein 15 (PEA15), and elevated levels of tropomyosin (TPM4) and α actinin 4 (ACTN4). Stretching caused STAT3 dependent cellular depletion of PEA15 and GFAP, and its filament disassembly in subpopulations of injured astrocytes. PEA15 and ALDOC signals were low in injured astrocytes acutely after mouse spinal cord crush injury and robustly expressed in reactive astrocytes one day post-injury. In contrast, α crystallin (CRYAB) was present in acutely injured astrocytes, and absent from uninjured and reactive astrocytes, demonstrating novel marker differences among post-injury astrocytes. These findings reveal a proteomic signature of traumatically-injured astrocytes reflecting STAT3-dependent cellular survival with potential diagnostic value. PMID:26683444

  8. Magnetic resonance imaging of the normal and chronically injured adult rat spinal cord in vivo

    Energy Technology Data Exchange (ETDEWEB)

    Guizar-Sahagun, G. (Centro de Investigacion del Proyecto Camina, Mexico City (Mexico) Dept. of Clinical Research in Neurology and Neurosurgery, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Inst. Mexicano del Seguro Social, Mexico City (Mexico)); Rivera, F. (Centro de Investigacion del Proyecto Camina, Mexico City (Mexico)); Babinski, E. (Centro de Investigacion del Proyecto Camina, Mexico City (Mexico)); Berlanga, E. (Dept. of Magnetic Resonance Imaging, Hospital Angeles del Pedregal, Mexico City (Mexico)); Madrazo, M. (Dept. of Magnetic Resonance Imaging, Hospital Angeles del Pedregal, Mexico City (Mexico)); Franco-Bourland, R. (Centro de Investigacion del Proyecto Camina, Mexico City (Mexico) Dept. of Biochemistry, Inst. Nacional de la Nutricion, Mexico City (Mexico)); Grijalva, I. (Centro de Investigacion del Proyecto Camina, Mexico City (Mexico) Dept. of Clinical Research in Neurology and Neurosurgery, Hospital de Especialidades, Centro Medico Nacional Siglo

    1994-08-01

    We assessed the capacity of MRI to show and characterise the spinal cord (SC) in vivo in normal and chronically injured adult rats. In the chronically injured animals the SC was studied by MRI and histological examination. MRI was performed at 1.5 T, using gradient-echo and spin-echo (SE) sequences, the latter with and without gadolinium-DTPA (Gd-DTPA). Several positions were tried for good alignment and to diminish interference by respiratory movements. Images of the SC were obtained in sagittal, coronal, and axial planes. Normal SC was observed as a continuous intensity in both sequences, although contrast resolution was better using SE; it was not possible to differentiate the grey and white matter. Low signal was seen in the damaged area in chronically injured rats, which corresponded to cysts, trabeculae, mononuclear infiltrate, and fibroglial wall on histological examination. Gd-DTPA failed to enhance the SC in normal or chronically injured rats. It did, however, cause enhancement of the lesion after acute SC injury. (orig.)

  9. Magnetic resonance imaging of the normal and chronically injured adult rat spinal cord in vivo

    International Nuclear Information System (INIS)

    Guizar-Sahagun, G.; Rivera, F.; Babinski, E.; Berlanga, E.; Madrazo, M.; Franco-Bourland, R.; Grijalva, I.; Gonzalez, J.; Contreras, B.; Madrazo, I.

    1994-01-01

    We assessed the capacity of MRI to show and characterise the spinal cord (SC) in vivo in normal and chronically injured adult rats. In the chronically injured animals the SC was studied by MRI and histological examination. MRI was performed at 1.5 T, using gradient-echo and spin-echo (SE) sequences, the latter with and without gadolinium-DTPA (Gd-DTPA). Several positions were tried for good alignment and to diminish interference by respiratory movements. Images of the SC were obtained in sagittal, coronal, and axial planes. Normal SC was observed as a continuous intensity in both sequences, although contrast resolution was better using SE; it was not possible to differentiate the grey and white matter. Low signal was seen in the damaged area in chronically injured rats, which corresponded to cysts, trabeculae, mononuclear infiltrate, and fibroglial wall on histological examination. Gd-DTPA failed to enhance the SC in normal or chronically injured rats. It did, however, cause enhancement of the lesion after acute SC injury. (orig.)

  10. Muscle function is associated with future patient-reported outcomes in young adults with ACL injury

    DEFF Research Database (Denmark)

    Flosadottir, Vala; Roos, Ewa M; Ageberg, Eva

    2016-01-01

    extremity muscle function and PROs after ACL injury. METHODS: Fifty-four participants (15 women, mean 30 years) with ACL injury or reconstruction, from the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) trial (ISRCTN84752559), were assessed with hop performance, muscle power...... and postural orientation 3 years (SD 0.85) after ACL injury. PROs at 3 and 5 years after injury included Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales Function in sport and recreation (KOOS Sport/rec) and Knee-related Quality of life (KOOS QoL), KOOS item Q3 (KOOS Q3), Tegner Activity Scale...

  11. Prevalens av kneartrose hos fotballspillere, og relasjonen til ACL-skade

    OpenAIRE

    Hillesund, Svein Egil Bakkevig

    2012-01-01

    Objectives: Football is the world biggest sport (7), and the estimates for ACL(Anterior Cruciate Ligament)-injuries varies; 0,06-3,7 for each 1000 playing-hours. (5,44) In Scandinavia football is the most common activity that leads to ACL-injury. (35) The objectives for this article are to investigate the radiological prevalence of osteoarthritis among former footballplayers, and the relation to ACL-injury. Methods: The data and material are mainly from unsystematic searches in PubMed and...

  12. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement

    DEFF Research Database (Denmark)

    Renstrom, P; Ljungqvist, A; Arendt, E

    2008-01-01

    The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert...... and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus...

  13. DO GENERAL MEDICAL PRACTITIONERS EXAMINE INJURED RUNNERS?

    DEFF Research Database (Denmark)

    Videbæk, Solvej; Jensen, A V; Rasmussen, S

    2017-01-01

    BACKGROUND: General Medical Practitioners (GMP) in Denmark perform clinical examinations of patients with musculoskeletal pain. However, the prevalence proportion of examinations caused by running-related injuries remains unknown. PURPOSE: The primary purpose of the present study was to estimate...... the prevalence proportion of consultations in general medical practice caused by running-related injuries. The secondary purpose was to estimate the prevalence proportion of injured runners, who consult their GMP, that are referred to additional examinations or treatments. STUDY DESIGN: A survey-based study...

  14. [Optimization of surgical and reanimation tactic in injured persons with dominating damage of the abdominal cavity organs in polytrauma].

    Science.gov (United States)

    Zamiatin, P N

    2004-07-01

    Results of surgical treatment of 148 injured persons with polytrauma in dominating damage of the abdominal cavity organs and concurrent damage of various anatomic-functional regions were analyzed. Taking into account the delineated reanimation-operative period there were presented surgical and reanimation tactic, intensive infusion-transfusion therapy in an acute massive blood loss, which was conducted in conditions of artificial pulmonary ventilation and general multicomponent anesthesy performed. Introduction of the tactic elaborated into the clinical practice had promoted significant improvement of the treatment results in injured persons with polytrauma.

  15. A cost analysis of conservative management of spinal cord-injured patients in Nigeria.

    Science.gov (United States)

    Kawu, A A; Olawepo, A; Salami, A O O; Kuranga, S A; Abdulhameed, S; Esenwah, V C

    2011-11-01

    A prospective study. To determine the cost of acute phase of injury (ASCI) among spinal cord-injured patients managed conservatively in Nigeria. Gwagwalada, Abuja. Over a 1-year period (1 January 2009 to 31 December 2009), the cost of ASCI of consecutive spinal cord-injured patients, gainfully employed preinjury, who paid the hospital bill directly from their purses and could estimate their daily income, and who were managed conservatively for 6 weeks before discharge to rehabilitation, was prospectively examined. A total of 34 cases of spinal cord-injured patients with a mean age of 35.4 ± 12.8 years were included in this study. The mean cost of ASCI over 6 weeks was $1598.29, an average of 6.4-232.8% of patients' annual income where >50% of the people live on less than a dollar a day. The mean cost of hospitalization was 14.9% of the total cost of ASCI in this study. It was significantly more expensive to treat tetraplegics compared with paraplegics. This study identified the cost of acute phase of spinal cord injury in Nigeria to assist clinicians in planning treatment that could reduce financial burden on the patients but optimize patients' care.

  16. [Automation in the modern coagulation laboratory. Exemplified by the integration of the Microanalyser ACL 300].

    Science.gov (United States)

    Haushofer, A; Halbmayer, W M; Fischer, M

    1991-01-01

    We report on the organisation of our coagulation laboratory which had to meet the requirements of both, the large routine operations and those of a special laboratory for specific blood coagulation problems. A valuable support for the routine activities of our coagulation laboratory was the installation of 2 automated coagulation analysers, type ACL 300. Due to the selective (diagnosis/therapy) patient-related allotment of samples and the establishment of a final diagnosis according to a step-wise method it was possible to integrate the 2 ACL 300 analysers into our existing system and consequently to take full advantage of the savings in staff time. Moreover we report on the evaluation of the 1st ACL 300 (810) analyser and the specific characteristics of the ACL series.

  17. Relationship jump-landing technique and neuropsychological characteristics, implications for acl injury prevention

    NARCIS (Netherlands)

    Benjaminse, A.; Meijer, M.; Cortes, N.; Gokeler, A.

    2014-01-01

    BACKGROUND: Neuropsychological capabilities in athletes may be associated with a predisposition to anterior cruciate ligament (ACL) injuries. OBJECTIVE: Assess differences between male and female athletes in jump-landing technique in relation to their neuropsychological capabilities. DESIGN:

  18. Different knee joint loading patterns in ACL deficient copers and non-copers during walking

    DEFF Research Database (Denmark)

    Alkjaer, Tine; Henriksen, Marius; Simonsen, Erik B

    2011-01-01

    Rupture of the anterior cruciate ligament (ACL) causes changes in the walking pattern. ACL deficient subjects classified as copers and non-copers have been observed to adopt different post-injury walking patterns. How these different patterns affect the knee compression and shear forces is unreso......Rupture of the anterior cruciate ligament (ACL) causes changes in the walking pattern. ACL deficient subjects classified as copers and non-copers have been observed to adopt different post-injury walking patterns. How these different patterns affect the knee compression and shear forces...... is unresolved. Thus, the aim of the present study was to investigate how different walking patterns observed between copers, non-copers, and controls affect the knee compression and shear forces during walking....

  19. Relationship jump-landing technique and neuropsychological characteristics, implications for ACL injury prevention

    NARCIS (Netherlands)

    A. Gokeler; Anne Benjaminse; N. Cortes; M. Meier

    2014-01-01

    Abstract from the IOC World Conference on Prevention of Injury & Illness in Sport, Monaco 2014 Background: Neuropsychological capabilities in athletes may be associated with a predisposition to anterior cruciate ligament (ACL) injuries. Objective: Assess differences between male and female athletes

  20. Quadriceps Function and Knee Joint Ultrasonography after ACL Reconstruction.

    Science.gov (United States)

    Pamukoff, Derek N; Montgomery, Melissa M; Moffit, Tyler J; Vakula, Michael N

    2018-02-01

    Individuals with anterior cruciate ligament reconstruction (ACLR) are at greater risk for knee osteoarthritis, partially because of chronic quadriceps dysfunction. Articular cartilage is commonly assessed using magnetic resonance imaging and radiography, but these methods are expensive and lack portability. Ultrasound imaging may provide a cost-effective and portable alternative for imaging the femoral cartilage. The purpose of this study was to compare ultrasonography of the femoral cartilage between the injured and uninjured limbs of individuals with unilateral ACLR, and to examine the association between quadriceps function and ultrasonographic measures of femoral cartilage. Bilateral femoral cartilage thickness and quadriceps function were assessed in 44 individuals with unilateral ACLR. Quadriceps function was assessed using peak isometric strength, and early (RTD100) and late (RTD200) rate of torque development. Cartilage thickness at the medial femoral condyle (P < 0.001) and femoral cartilage cross-sectional area (P = 0.007) were smaller in the injured compared with the uninjured limb. After accounting for time since ACLR, quadriceps peak isometric strength was associated with cartilage thickness at the medial femoral condyle (r = 0.35, P = 0.02) and femoral cartilage cross-sectional area (r = 0.28, P = 0.04). RTD100 and RTD200 were not associated with femoral cartilage thickness or cross-sectional area. Individuals with ACLR have thinner cartilage in their injured limb compared with uninjured limb, and cartilage thickness is associated with quadriceps function. These results indicate that ultrasonography may be useful for monitoring cartilage health and osteoarthritis progression after ACLR.

  1. TRANSTIBIAL VERSUS ANTEROMEDIAL PORTAL TECHNIQUES IN ACL RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Luiz Gabriel Betoni Guglielmetti

    Full Text Available Abstract Introduction: Although the results of anterior cruciate ligament (ACL reconstruction are well documented in many studies, with good to excellent outcomes in most cases, some issues like tunnel positioning are still discussed and studied. Objective: To compare the objective and subjective clinical outcomes of ACL reconstruction using the transtibial and anteromedial portal techniques. Methods: Prospective randomized study of 80 patients undergoing anterior cruciate ligament reconstruction by the same surgeon, with 40 patients operated by the transtibial technique and 40 by anteromedial portal technique. The patients, 34 in the transtibial group and 37 in the anteromedial portal group (nine dropouts, were reassessed during a 2-year follow-up period. The clinical assessment consisted of physical examination, KT-1000TM evaluation, Lysholm score, and objective and subjective International Knee Documentation Committee - IKDC scores. Results: Regarding the Lachman and pivot shift tests, we observed more cases of instability in the transtibial group, but with no statistical significance (p=0.300 and p=0.634, respectively. Regarding the anterior drawer test, the groups presented similar results (p=0.977. Regarding KT-1000TM evaluation, the mean results were 1.44 for the transtibial group and 1.23 for the anteromedial portal group, with no statistical significance (p=0.548. We separated the objective IKDC scores into two groups: Group 1, IKDC A, and Group 2, IKDC B, C, or D, with no statistical significance (p=0.208. Concerning the Lysholm score, the transtibial group had a mean score of 91.32, and the anteromedial portal group had a mean score of 92.81. The mean subjective IKDC scores were 90.65 for the transtibial group and 92.65 for the anteromedial portal group. Three re-ruptures were encountered in the transtibial group and three in the anteromedial portal group. Conclusions: There were no significant differences in the subjective and

  2. Current use of navigation system in ACL surgery: a historical review.

    Science.gov (United States)

    Zaffagnini, S; Urrizola, F; Signorelli, C; Grassi, A; Di Sarsina, T Roberti; Lucidi, G A; Marcheggiani Muccioli, G M; Bonanzinga, T; Marcacci, M

    2016-11-01

    The present review aims to analyse the available literature regarding the use of navigation systems in ACL reconstructive surgery underling the evolution during the years. A research of indexed scientific papers was performed on PubMed and Cochrane Library database. The research was performed in December 2015 with no publication year restriction. Only English-written papers and related to the terms ACL, NAVIGATION, CAOS and CAS were considered. Two reviewers independently selected only those manuscripts that presented at least the application of navigation system for ACL reconstructive surgery. One hundred and forty-six of 394 articles were finally selected. In this analysis, it was possible to review the main uses of navigation system in ACL surgery including tunnel positioning for primary and revision surgery and kinematic assessment of knee laxity before and after different surgical procedures. In the early years, until 2006, navigation system was mainly used to improve tunnel positioning, but since the last decade, this tool has been principally used for kinematics evaluation. Increased accuracy of tunnel placement was observed using navigation surgery, especially, regarding femoral, 42 of 146 articles used navigation to guide tunnel positioning. During the following years, 82 of 146 articles have used navigation system to evaluate intraoperative knee kinematic. In particular, the importance of controlling rotatory laxity to achieve better surgical outcomes has been underlined. Several applications have been described and despite the contribution of navigation systems, its potential uses and theoretical advantages, there are still controversies about its clinical benefit. The present papers summarize the most relevant studies that have used navigation system in ACL reconstruction. In particular, the analysis identified four main applications of the navigation systems during ACL reconstructive surgery have been identified: (1) technical assistance for tunnel

  3. Is current training in basic and advanced cardiac life support (BLS & ACLS) effective? A study of BLS & ACLS knowledge amongst healthcare professionals of North-Kerala.

    Science.gov (United States)

    Nambiar, Madavan; Nedungalaparambil, Nisanth Menon; Aslesh, Ottapura Prabhakaran

    2016-01-01

    Healthcare professionals are expected to have knowledge of current basic and advanced cardiac life support (BLS/ACLS) guidelines to revive unresponsive patients. A cross-sectional study was conducted to evaluate the current practices and knowledge of BLS/ACLS principles among healthcare professionals of North-Kerala using pretested self-administered structured questionnaire. Answers were validated in accordance with American Heart Association's BLS/ACLS teaching manual and the results were analysed. Among 461 healthcare professionals, 141 (30.6%) were practicing physicians, 268 (58.1%) were nurses and 52 (11.3%) supporting staff. The maximum achievable score was 20 (BLS 15/ACLS 5). The mean score amongst all healthcare professionals was 8.9±4.7. The mean score among physicians, nurses and support staff were 8.6±3.4, 9±3.6 and 9±3.3 respectively. The majority of healthcare professionals scored ≤50% (237, 51.4%); 204 (44.3%) scored 51%-80% and 20 (4.34%) scored >80%. Mean scores decreased with age, male sex and across occupation. Nurses who underwent BLS/ACLS training previously had significantly higher mean scores (10.2±3.4) than untrained (8.2±3.6, P =0.001). Physicians with <5 years experience ( P =0.002) and nurses in the private sector ( P =0.003) had significantly higher scores. One hundred and sixty three (35.3%) healthcare professionals knew the correct airway opening manoeuvres like head tilt, chin lift and jaw thrust. Only 54 (11.7%) respondents were aware that atropine is not used in ACLS for cardiac arrest resuscitation and 79 (17.1%) correctly opted ventricular fibrillation and pulseless ventricular tachycardia as shockable rhythms. The majority of healthcare professionals (356, 77.2%) suggested that BLS/ACLS be included in academic curriculum. Inadequate knowledge of BLS/ACLS principles amongst healthcare professionals, especially physicians, illuminate lacunae in existing training systems and merit urgent redressal.

  4. A novel first aid stretcher for immobilization and transportation of spine injured patients.

    Science.gov (United States)

    Liu, Yan-Sheng; Feng, Ya-Ping; Xie, Jia-Xin; Luo, Zhuo-Jing; Shen, Cai-Hong; Niu, Fang; Zou, Jian; Tang, Shao-Feng; Hao, Jiang; Xu, Jia-Xiang; Xiao, Li-Ping; Xu, Xiao-Ming; Zhu, Hui

    2012-01-01

    Effective immobilization and transportation are vital to the life-saving acute medical care needed when treating critically injured people. However, the most common types of stretchers used today are wrought with problems that can lead to further medical complications, difficulty in employment and rescue, and ineffective transitions to hospital treatment. Here we report a novel first aid stretcher called the "emergency carpet", which solves these problems with a unique design for spine injured patients. Polyurethane composite material, obtained by a novel process of manually mixing isocyanate and additives, can be poured into a specially designed fabric bag and allowed to harden to form a rigid human-shaped stretcher. The effectiveness of the emergency carpet was examined in the pre-hospital management of victims with spinal fractures. Additionally, it was tested on flat ground and complex terrain as well as in the sea and air. We demonstrated that the emergency carpet can be assembled and solidified on the scene in 5 minutes, providing effective immobilization to the entire injured body. With the protection of the emergency carpet, none of the 20 patients, who were finally confirmed to have spinal column fracture or dislocation, had any neurological deterioration during transportation. Furthermore, the carpet can be handled and transported by multiple means under differing conditions, without compromising immobilization. Finally, the emergency carpet allows the critically injured patient to receive multiple examinations such as X-ray, CT, and MRI without being removed from the carpet. Our results demonstrate that the emergency carpet has ideal capabilities for immobilization, extrication, and transportation of the spine injured patients. Compared with other stretchers, it allows for better mobility, effective immobilization, remarkable conformity to the body, and various means for transportation. The emergency carpet is promising for its intrinsic advantages in

  5. A novel first aid stretcher for immobilization and transportation of spine injured patients.

    Directory of Open Access Journals (Sweden)

    Yan-Sheng Liu

    Full Text Available Effective immobilization and transportation are vital to the life-saving acute medical care needed when treating critically injured people. However, the most common types of stretchers used today are wrought with problems that can lead to further medical complications, difficulty in employment and rescue, and ineffective transitions to hospital treatment. Here we report a novel first aid stretcher called the "emergency carpet", which solves these problems with a unique design for spine injured patients. Polyurethane composite material, obtained by a novel process of manually mixing isocyanate and additives, can be poured into a specially designed fabric bag and allowed to harden to form a rigid human-shaped stretcher. The effectiveness of the emergency carpet was examined in the pre-hospital management of victims with spinal fractures. Additionally, it was tested on flat ground and complex terrain as well as in the sea and air. We demonstrated that the emergency carpet can be assembled and solidified on the scene in 5 minutes, providing effective immobilization to the entire injured body. With the protection of the emergency carpet, none of the 20 patients, who were finally confirmed to have spinal column fracture or dislocation, had any neurological deterioration during transportation. Furthermore, the carpet can be handled and transported by multiple means under differing conditions, without compromising immobilization. Finally, the emergency carpet allows the critically injured patient to receive multiple examinations such as X-ray, CT, and MRI without being removed from the carpet. Our results demonstrate that the emergency carpet has ideal capabilities for immobilization, extrication, and transportation of the spine injured patients. Compared with other stretchers, it allows for better mobility, effective immobilization, remarkable conformity to the body, and various means for transportation. The emergency carpet is promising for its

  6. Torn ACL: A New Bioengineered Substitute Brought from the Laboratory to the Knee Joint

    Directory of Open Access Journals (Sweden)

    Francine Goulet

    2004-01-01

    Full Text Available Anterior cruciate ligament (ACL injuries occur at an annual rate of 120 000 in the USA, and many need reconstructive surgery. We report successful results at 1–13 months following implantation of bioengineered ACL (bACL in goats. A bACL has been developed using autologous ACL cells, a collagen matrix and bone plugs. The extremities of the bACL were fully integrated into the femur and tibia of the host. Vascularisation of the grafts was extensive 1 month post-surgery and improved with time. At 6 months post-grafting, histological and ultrastructural observations demonstrated a highly organised ligamentous structure, rich in type I collagen fibres and fibroblasts. At the implants' insertion sites, characteristic fibrocartilage was observed having well aligned chondrocytes and collagen fibrils. After a year, mechanical rupture of the grafts demonstrated a major gain in strength. Eventual applications of this new technology in humans include multiple uses in orthopaedic, dental and reconstructive surgeries.

  7. Inter-segmental postural coordination measures differentiate athletes with ACL reconstruction from uninjured athletes.

    Science.gov (United States)

    Kiefer, Adam W; Ford, Kevin R; Paterno, Mark V; Schmitt, Laura C; Myer, Gregory D; Riley, Michael A; Shockley, Kevin; Hewett, Timothy E

    2013-02-01

    Athletes who sustain non-contact anterior cruciate ligament (ACL) injuries and undergo surgical reconstruction exhibit deficits in sensorimotor control, which often impairs lower-limb movement coordination. The purpose of this experiment was to measure the influence of sensorimotor deficits on the ankle-hip coordination of a postural coordination task in athletes following ACL reconstruction. Twenty-two female athletes who were cleared to return to sports participation following ACL reconstruction and 22 uninjured female athletes performed a unilateral dynamic postural rhythmic coordination task at two movement frequencies (0.2 and 0.7 Hz). Athletes with ACL-reconstruction exhibited greater ankle-hip relative phase variability and reduced regularity of coupling than uninjured athletes, especially during the 0.2 Hz condition. The results of this study show altered lower extremity coordination patterns in athletes following ACL reconstruction and return to sports participation. The results also indicate that dynamical coordination measures may provide objective measures of sensorimotor deficits following ACL reconstruction and can potentially guide rehabilitation interventions following reconstruction. Copyright © 2012 Elsevier B.V. All rights reserved.

  8. Changing injury pattern of acute anterior cruciate ligament tears treated at Tampere University Hospital in the 1980s.

    Science.gov (United States)

    Natri, A; Järvinen, M; Kannus, P; Niittymäki, S; Aarnio, J; Lindholm, T S

    1995-04-01

    During the years 1980-1989, 450 patients with an acute anterior cruciate ligament (ACL) rupture were treated at the University Hospital of Tampere, Finland. ACL ruptures were diagnosed by arthroscopy or open surgery. The data were analyzed in terms of patient age, sex, injury etiology, injury type and sports activity to determine the trends in the 1980s. The number of ACL tears seen in the Hospital increased by 247% over this period. Sixty-three percent of the patients were male (mean age 33 years) and 37% female (mean age 39 years), and there were no changes in the sex and age distribution in 1980s. The most common injury type was the isolated ACL rupture (51%), followed by a combination injury of the ACL and medial collateral ligament (38%). Isolated ACL ruptures in the 1980s increased 6.5 times. Sports accounted for 54% of all injuries without any sign of change in their relative proportion in 1980s. The most common sports causing the rupture were soccer (29%), downhill skiing (20%), cross-country skiing (12%) and volleyball (12%). From 1980 to 1989, there was a decrease (2 times) in ACL injuries sustained in cross-country skiing and a substantial (30 times) increase in ACL injuries sustained in downhill skiing.

  9. Unit Testing for the Application Control Language (ACL) Software

    Science.gov (United States)

    Heinich, Christina Marie

    2014-01-01

    In the software development process, code needs to be tested before it can be packaged for release in order to make sure the program actually does what it says is supposed to happen as well as to check how the program deals with errors and edge cases (such as negative or very large numbers). One of the major parts of the testing process is unit testing, where you test specific units of the code to make sure each individual part of the code works. This project is about unit testing many different components of the ACL software and fixing any errors encountered. To do this, mocks of other objects need to be created and every line of code needs to be exercised to make sure every case is accounted for. Mocks are important to make because it gives direct control of the environment the unit lives in instead of attempting to work with the entire program. This makes it easier to achieve the second goal of exercising every line of code.

  10. Primary repair plus intra-articular iliotibial band augmentation in the treatment of an acute anterior cruciate ligament rupture. A follow-up study of 70 patients.

    Science.gov (United States)

    Natri, A; Järvinen, M; Kannus, P

    1996-01-01

    Between September 1987 and November 1989, we treated 90 consecutive patients with an acute anterior cruciate ligament (ACL) rupture with the multiple suture technique and iliotibial band augmentation. Seventy of these patients were re-examined 2 to 5 years after the operation (mean 3.5 years), the examination consisting of a questionnaire, clinical examination, laxity tests with the KSS machine (Acufex), radiological examination and isokinetic muscle strength testing (Cybex 6000). There were 32 men and 38 women (mean age 34 years). The injury was sustained in sports in 44 (63%) cases, and the sports most frequently involved were downhill skiing (18 cases), soccer (9 cases) and volleyball (5 cases). Of the injuries, 38 were isolated ACL ruptures and 31, ACL ruptures combined with a medial CL rupture. In 9 cases, an additional meniscus injury and in one case an additional posterior CL - lateral CL rupture was found. At the follow-up, 55 patients (79%) were satisfied with the end result, and according to our objective functional criteria 55 (79%) had an excellent or good outcome. According to the Lysholm score, 53 (76%) patients were excellent or good (> or = 82 points). In the Lachman test, 29 knees (41%) were completely stable. The Lachman test was mildy positive in 40 knees (57%) (36 had 1+ laxity and 4, 2+ laxity), and one patient had 3+ laxity with a hard end-point. Similarly, the anterior drawer test was negative in 53 knees (76%), and the other 17 (24%) had mild laxity (16 had 1+ laxity and 1, 2+ laxity). The total anterior-posterior laxity measured with the KSS averaged 9.7 +/- 3.5 mm in the injured knee and 7.3 + 3.0 mm in the uninjured knee (the laxity measured at a knee angle of 20 degrees of flexion). Corresponding values at a knee angle of 90 degrees of flexion were 6.1 +/- 2.4 mm and 4.7 +/- 1.9 mm, respectively. The pivot shift test was negative in 62 patients (89%) and 1+ positive in the remaining 8 patients (11%). Fifty-eight patients (83%) had full

  11. Dynamic augmentation restores anterior tibial translation in ACL suture repair: a biomechanical comparison of non-, static and dynamic augmentation techniques.

    Science.gov (United States)

    Hoogeslag, Roy A G; Brouwer, Reinoud W; Huis In 't Veld, Rianne; Stephen, Joanna M; Amis, Andrew A

    2018-02-03

    There is a lack of objective evidence investigating how previous non-augmented ACL suture repair techniques and contemporary augmentation techniques in ACL suture repair restrain anterior tibial translation (ATT) across the arc of flexion, and after cyclic loading of the knee. The purpose of this work was to test the null hypotheses that there would be no statistically significant difference in ATT after non-, static- and dynamic-augmented ACL suture repair, and they will not restore ATT to normal values across the arc of flexion of the knee after cyclic loading. Eleven human cadaveric knees were mounted in a test rig, and knee kinematics from 0° to 90° of flexion were recorded by use of an optical tracking system. Measurements were recorded without load and with 89-N tibial anterior force. The knees were tested in the following states: ACL-intact, ACL-deficient, non-augmented suture repair, static tape augmentation and dynamic augmentation after 10 and 300 loading cycles. Only static tape augmentation and dynamic augmentation restored ATT to values similar to the ACL-intact state directly postoperation, and maintained this after cyclic loading. However, contrary to dynamic augmentation, the ATT after static tape augmentation failed to remain statistically less than for the ACL-deficient state after cyclic loading. Moreover, after cyclic loading, ATT was significantly less with dynamic augmentation when compared to static tape augmentation. In contrast to non-augmented ACL suture repair and static tape augmentation, only dynamic augmentation resulted in restoration of ATT values similar to the ACL-intact knee and decreased ATT values when compared to the ACL-deficient knee immediately post-operation and also after cyclic loading, across the arc of flexion, thus allowing the null hypotheses to be rejected. This may assist healing of the ruptured ACL. Therefore, this study would support further clinical evaluation of dynamic augmentation of ACL repair.

  12. ACL Injury Prevention Training Results in Modification of Hip and Knee Mechanics During a Drop-Landing Task

    OpenAIRE

    Pollard, Christine D.; Sigward, Susan M.; Powers, Christopher M.

    2017-01-01

    Background: Injury prevention training has been shown to be effective in reducing the incidence of noncontact anterior cruciate ligament (ACL) injury; however, the underlying reason for the success of these training programs is unclear. Purpose: To investigate whether an ACL injury prevention program that has been shown to reduce the incidence of ACL injury alters sagittal plane hip and knee biomechanics during a drop-landing task. Study Design: Descriptive laboratory study. Methods: Thirty f...

  13. ACL status in arthroplasty patients, why not to preserve?

    Directory of Open Access Journals (Sweden)

    Abdelbadie Ahmed

    2018-01-01

    Full Text Available Introduction: Only 70–85% of patients that had total knee arthroplasty (TKA are satisfied with their knees. The need for a near to normal knee kinematics is crucial and maybe the solution to their needs. Addressing the cruciate ligaments during surgery along with the extent of arthrosis may give a solution to this problem. Material and methods: One hundred consecutive patients in whom a total knee arthroplasty was indicated and performed were prospectively documented. During the knee replacement surgery, the condition of the anterior and posterior cruciate ligaments and the degree of osteoarthritis (OA in the medial and lateral compartments as well as in the patello-femoral joint were documented using the Outerbridge classification. The patients’ average age was 72.3 years, with the majority being female. In all patients, a total bi-compartmental knee replacement was indicated. Results: Our results showed that in 78% of all patients the anterior, and in 98% the posterior cruciate ligament was still intact. Seventy-one percent of cases suffered from grade 4 medial osteoarthritis, 19% from grade 3 and 10% from grade 2. Thirty-six of patients suffered from grade 4 lateral osteoarthritis, 36% from grade 3, 24% from grade 2 and 4% from grade 1. Grade 4 patello-femoral osteoarthritis was present in 32% of all patients, grade 3 in 60% and grade 2 in 8% of all patients. Discussion: The goal of arthroplasty is to approximate the function of a normal knee. The retention of the anterior cruciate ligament (ACL allows for better knee, kinematics, improved proprioception, increased flexion and an overall improvement in knee function. The decreased constraint that is possible with retention of both cruciates may decrease implant stresses and improve the implant survivorship. The distribution of OA shows that the medial and patello-femoral compartments of the joint are primarily affected. This could also allow for a more conservative and patient

  14. Injured pedestrians in Cape Town - the role of alcohol

    African Journals Online (AJOL)

    alcohol. Margaret M. Peden, John D. Knotlenbelt,. Johan van der Spuy, Ravi Oodit, Hendrik J. Scholtz,. J. Morris Stokol. Objective. To establish a profile of injured adult pedestrians and attempt to define the role which alcohol plays in this regard. Design. Prospective survey of injured pedestrians who presented consecutively ...

  15. Lessons learned from the last 20 years of ACL-related in vivo-biomechanics research of the knee joint.

    Science.gov (United States)

    Pappas, Evangelos; Zampeli, Franceska; Xergia, Sofia A; Georgoulis, Anastasios D

    2013-04-01

    Technological advances in recent years have allowed the easy and accurate assessment of knee motion during athletic activities. Subsequently, thousands of studies have been published that greatly improved our understanding of the aetiology, surgical reconstruction techniques and prevention of anterior cruciate ligament (ACL) injuries. The purpose of this review is to summarize the evidence from biomechanical studies on ACL-related research. High-impact articles that enhanced understanding of ACL injury aetiology, rehabilitation, prevention and adaptations after reconstruction were selected. The importance of restoring internal tibial rotation after ACL reconstruction has emerged in several studies. Criteria-based, individualized rehabilitation protocols have replaced the traditional time-based protocols. Excessive knee valgus, poor trunk control, excessive quadriceps forces and leg asymmetries have been identified as potential high risk biomechanical factors for ACL tear. Injury prevention programmes have emerged as low cost and effective means of preventing ACL injuries, particularly in female athletes. As a result of biomechanical research, clinicians have a better understanding of ACL injury aetiology, prevention and rehabilitation. Athletes exhibiting neuromuscular deficits predisposing them to ACL injury can be identified and enrolled into prevention programmes. Clinicians should assess ACL-reconstructed patients for excessive internal tibial rotation that may lead to poor outcomes.

  16. Case study: Muscle atrophy and hypertrophy in a premier league soccer player during rehabilitation from ACL injury.

    Science.gov (United States)

    Milsom, Jordan; Barreira, Paulo; Burgess, Darren J; Iqbal, Zafar; Morton, James P

    2014-10-01

    The onset of injury and subsequent period of immobilization and disuse present major challenges to maintenance of skeletal muscle mass and function. Although the characteristics of immobilization-induced muscle atrophy are well documented in laboratory studies, comparable data from elite athletes in free-living conditions are not readily available. We present a 6-month case-study account from a professional soccer player of the English Premier League characterizing rates of muscle atrophy and hypertrophy (as assessed by DXA) during immobilization and rehabilitation after ACL injury. During 8 weeks of inactivity and immobilization, where the athlete adhered to a low carbohydrate-high protein diet, total body mass decreased by 5 kg attributable to 5.8 kg loss and 0.8 kg gain in lean and fat mass, respectively. Changes in whole-body lean mass was attributable to comparable relative decreases in the trunk (12%, 3.8 kg) and immobilized limb (13%, 1.4 kg) whereas the nonimmobilized limb exhibited smaller declines (7%, 0.8 kg). In Weeks 8 to 24, the athlete adhered to a moderate carbohydrate-high protein diet combined with structured resistance and field based training for both the lower and upper-body that resulted in whole-body muscle hypertrophy (varying from 0.5 to 1 kg per week). Regional hypertrophy was particularly pronounced in the trunk and nonimmobilized limb during weeks 8 to 12 (2.6 kg) and 13 to 16 (1.3 kg), respectively, whereas the previously immobilized limb exhibited slower but progressive increases in lean mass from Week 12 to 24 (1.2 kg). The athlete presented after the totality of the injured period with an improved anthropometrical and physical profile.

  17. Over-the-top ACL Reconstruction Plus Extra-articular Lateral Tenodesis With Hamstring Tendon Grafts: Prospective Evaluation With 20-Year Minimum Follow-up.

    Science.gov (United States)

    Zaffagnini, Stefano; Marcheggiani Muccioli, Giulio Maria; Grassi, Alberto; Roberti di Sarsina, Tommaso; Raggi, Federico; Signorelli, Cecilia; Urrizola, Francisco; Spinnato, Paolo; Rimondi, Eugenio; Marcacci, Maurilio

    2017-12-01

    ( P = .0003). Radiographic evaluation demonstrated significant difference of medial joint space between injured and healthy knees in patients with concomitant medial meniscectomy (n = 8, 3.2 ± 0.6 vs 5.0 ± 1.8 mm, P = .0114). No significant differences were reported regarding lateral or patellofemoral joint space. One patient (2%) experienced rerupture, with 3 of 52 (5.8%) having a contralateral ACL injury (excluded from KT-2000 and radiographic evaluations). Overall, 4 of 29 clinical failures (objective IKDC, KT-2000) and 1 rerupture among 52 patients were registered at final follow-up. Studied surgical technique demonstrated good results in laxity control at 20-year minimum follow-up. The lateral extra-articular plasty associated with ACL reconstruction did not generate lateral knee or patellofemoral osteoarthritis. The factor increasing osteoarthritis was meniscectomy.

  18. A RETROSPECTIVE ANALYSIS OF ARTHROSCOPIC ACL RECONSTRUCTION WITH HAMSTRING TENDON GRAFT

    Directory of Open Access Journals (Sweden)

    Ashish R. Agarwal

    2017-08-01

    Full Text Available BACKGROUND ACL reconstruction is one of the commonest knee surgeries done. Young adults are the commonest patients; thus, this injury has a large impact on socioeconomic status of the family. The aim of the study is to study the outcome of arthroscopic ACL reconstruction with hamstring tendon graft. MATERIALS AND METHODS 50 patients following up in the OPD who had undergone ACL reconstruction with hamstring tendon graft are evaluated. Patients who had other lesions, such meniscal injuries or collateral injuries were discarded. These patients were evaluated by using Tegner and Lysholm score of 6 months, 12 months and 24 months. Settings- It is a retrospective analysis of the data collected from the patients who were opiated at Nair Hospital. RESULTS 90% of patients in the study were males. Mean age of the study population is 30.7 years. All the patients in the study had instability as a symptom, while 80% of them also had pain. Six months after surgery, according to Tegner and Lysholm score, 52% patients had good outcome, while 48% had fair outcome. At 2 years, 98% of study population had excellent outcome. CONCLUSION Arthroscopic ACL reconstruction with hamstring graft is an effective way of treating ACL tear.

  19. Displaced Medial and Lateral Bucket Handle Meniscal Tears With Intact ACL and PCL.

    Science.gov (United States)

    Boody, Barrett S; Omar, Imran M; Hill, James A

    2015-08-01

    Bucket handle lesions are vertical longitudinal tears in the meniscus that may displace centrally into the respective medial or lateral compartment, frequently causing mechanical symptoms, including pain, perceived instability, and mechanical locking. Bucket handle meniscal tears are most commonly from a traumatic etiology and are frequently found with concomitant anterior cruciate ligament (ACL) injuries. Multiple imaging signs and associations have been described for the diagnosis of bucket handle meniscus tears, including coronal truncation, absent bow tie sign, double posterior cruciate ligament (PCL), double ACL, displacement of the bucket handle fragment, and disproportionate posterior horn signs. Among meniscal pathology encountered on magnetic resonance imaging or during arthroscopy, bucket handle meniscal tears are infrequent occurrences. Furthermore, the occurrence of displaced medial and lateral bucket handle tears found on imaging and during arthroscopy is very uncommon and is only sparsely reported in the literature. When displaced medial and lateral bucket handle meniscal segments are visualized within the intercondylar notch along with the ACL and PCL, the radiologic findings are referred to as the "quadruple cruciate" sign or the "Jack and Jill lesion." Of the few case reports described in the literature, only one noted displaced medial and lateral bucket handle meniscus tears with an intact ACL and PCL. The current case report outlines a similar rare case of the quadruple cruciate sign: displaced medial and lateral bucket handle meniscal tears located within the intercondylar notch and an intact ACL and PCL. Copyright 2015, SLACK Incorporated.

  20. Qigong in Injured Military Service Members.

    Science.gov (United States)

    Reb, Anne Marie; Saum, Nancy Seaby; Murphy, Deborah Ann; Breckenridge-Sproat, Sara Todd; Su, Xiaogang; Bormann, Jill Ellen

    2017-03-01

    Wounded, ill, and injured (WII) Military Service members experience significant stress and are at risk for developing chronic conditions including posttraumatic stress disorder and depression. Qigong, a meditative movement practice, may positively affect their ability to engage in successful rehabilitation. We assessed the feasibility of Qigong practice in WII Service members returning from combat; effects on stress, sleep, and somatic symptoms; satisfaction; and participants' experience with the practice. Single-group, pre- and posttest, mixed methods approach. Twenty-six WII were enrolled. The program was designed to include 20 classes over 10 weeks. Participants completed self-report questionnaires, practice logs, and an exit interview. Average attendance was 8.14 classes ( SD = 4.9); mean engagement was 5.7 ( SD = 3.5) weeks. Participants endorsed a high level of satisfaction with the practice. Qualitative themes included coping with stress; feeling more resilient and empowered; improvement in symptoms including sleep and physical function; and factors affecting practice. Participant-reported facilitators included accessibility and portability of the practice; barriers included scheduling conflicts and personal challenges. Participants recommended offering shorter programs with flexible scheduling options, increasing program awareness, and including significant others in future classes. Qigong was safe, portable, and easily adapted for WII Service members.

  1. Acute non-contact anterior cruciate ligament tears are associated with relatively increased vastus medialis to semimembranosus cross-sectional area ratio: a case-control retrospective MR study

    Energy Technology Data Exchange (ETDEWEB)

    Wieschhoff, Ged G.; Mandell, Jacob C.; Czuczman, Gregory J.; Nikac, Violeta; Shah, Nehal; Smith, Stacy E. [Brigham and Women' s Hospital, Harvard Medical School, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States)

    2017-11-15

    Hamstring muscle deficiency is increasingly recognized as a risk factor for anterior cruciate ligament (ACL) tears. The purpose of this study is to evaluate the vastus medialis to semimembranosus cross-sectional area (VM:SM CSA) ratio on magnetic resonance imaging (MRI) in patients with ACL tears compared to controls. One hundred knee MRIs of acute ACL tear patients and 100 age-, sex-, and side-matched controls were included. Mechanism of injury, contact versus non-contact, was determined for each ACL tear subject. The VM:SM CSA was measured on individual axial slices with a novel method using image-processing software. One reader measured all 200 knees and the second reader measured 50 knees at random to assess inter-reader variability. The intraclass correlation coefficient (ICC) was calculated to evaluate for correlation between readers. T-tests were performed to evaluate for differences in VM:SM CSA ratios between the ACL tear group and control group. The ICC for agreement between the two readers was 0.991 (95% confidence interval 0.984-0.995). Acute ACL tear patients have an increased VM:SM CSA ratio compared to controls (1.44 vs. 1.28; p = 0.005). Non-contact acute ACL tear patients have an increased VM:SM CSA ratio compared to controls (1.48 vs. 1.20; p = 0.003), whereas contact acute ACL tear patients do not (1.23 vs. 1.26; p = 0.762). Acute non-contact ACL tears are associated with increased VM:SM CSA ratios, which may imply a relative deficiency in hamstring strength. This study also demonstrates a novel method of measuring the relative CSA of muscles on MRI. (orig.)

  2. Internet-based prevention of posttraumatic stress symptoms in injured trauma patients: design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Joanne Mouthaan

    2011-11-01

    Full Text Available Background: Injured trauma victims are at risk of developing Posttraumatic Stress Disorder (PTSD and other post-trauma psychopathology. So far, interventions using cognitive behavioral techniques (CBT have proven most efficacious in treating early PTSD in highly symptomatic individuals. No early intervention for the prevention of PTSD for all victims has yet proven effective. In the acute psychosocial care for trauma victims, there is a clear need for easily applicable, accessible, cost-efficient early interventions. Objective: To describe the design of a randomized controlled trial (RCT evaluating the effectiveness of a brief Internet-based early intervention that incorporates CBT techniques with the aim of reducing acute psychological distress and preventing long-term PTSD symptoms in injured trauma victims. Method: In a two armed RCT, 300 injured trauma victims from two Level-1 trauma centers in Amsterdam, the Netherlands, will be assigned to an intervention or a control group. Inclusion criteria are: being 18 years of age or older, having experienced a traumatic event according to the diagnostic criteria of the DSM-IV and understanding the Dutch language. The intervention group will be given access to the intervention's website (www.traumatips.nl, and are specifically requested to login within the first month postinjury. The primary clinical study outcome is PTSD symptom severity. Secondary outcomes include symptoms of depression and anxiety, quality of life, and social support. In addition, a cost-effectiveness analysis of the intervention will be performed. Data are collected at one week post-injury, prior to first login (baseline, and at 1, 3, 6 and 12 months. Analyses will be on an intention-to-treat basis. Discussion: The results will provide more insight into the effects of preventive interventions in general, and Internet-based early interventions specifically, on acute stress reactions and PTSD, in an injured population, during the

  3. Fluoroscopic Analysis of Tibial Translation in Anterior Cruciate Ligament Injured Knees With and Without Bracing During Forward Lunge

    Science.gov (United States)

    Jalali, Maryam; Farahmand, Farzam; Mousavi, Seyed Mohammad Ebrahim; Golestanha, Seyed Ali; Rezaeian, Tahmineh; Shirvani Broujeni, Shahram; Rahgozar, Mehdi; Esfandiarpour, Fateme

    2015-01-01

    Background: Despite several studies with different methods, the effect of functional knee braces on knee joint kinematics is not clear. Direct visualization of joint components through medical imaging modalities may provide the clinicians with more useful information. Objectives: In this study, for the first time in the literature, video fluoroscopy was used to investigate the effect of knee bracing on the sagittal plane kinematics of anterior cruciate ligament (ACL) injured patients. Patients and Methods: For twelve male unilateral ACL deficient subjects, the anterior tibial translation was measured during lunge exercise in non-braced and braced conditions. Fluoroscopic images were acquired from the subjects using a digital fluoroscopy system with a rate of 10 fps. The image of each frame was scaled using a calibration coin and analyzed in AutoCAD environment. The angle between the two lines, tangent to the posterior cortexes of the femoral and tibial shafts was measured as the flexion angle. For the fluoroscopic images associated with 0°, 15°, 30°, 45° and 60° knee flexion angles, the relative anterior-posterior configuration of the tibiofemoral joint was assessed by measuring the position of landmarks on the tibia and femur. Results: Results indicated that the overall anterior translations of the tibia during the eccentric (down) and concentric (up) phases of lunge exercise were 10.4 ± 1.7 mm and 9.0 ± 2.2 mm for non-braced, and 10.1 ± 3.4 mm and 7.4 ± 2.5 mm, for braced conditions, respectively. The difference of the tibial anterior-posterior translation behaviors of the braced and non-braced knees was not statistically significant. Conclusion: Fluoroscopic imaging provides an effective tool to measure the dynamic behavior of the knee joint in the sagittal plane and within the limitations of this study, the pure mechanical stabilizing effect of functional knee bracing is not sufficient to control the anterior tibial translation of the ACL deficient

  4. The importance of Blumensaat's line morphology for accurate femoral ACL footprint evaluation using the quadrant method.

    Science.gov (United States)

    Yahagi, Yoshiyuki; Iriuchishima, Takanori; Horaguchi, Takashi; Suruga, Makoto; Tokuhashi, Yasuaki; Aizawa, Shin

    2018-02-01

    The purpose of this study was to evaluate the difference in the center position of the ACL footprint based on grid placement using the quadrant method according to the morphological variations of the Blumensaat's line. Fifty-nine non-paired human cadaver knees were used. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch, and the digital images were evaluated using Image J software. The femoral ACL footprint was periphery outlined and the center position was automatically measured. Following Iriuchishima's classification, the morphology of the Blumensaat's line was classified into straight, small hill, and large hill types. From the images, grid quadrants were placed as: Grid (1) without consideration of hill existence and not including the chondral lesion. Grid (2) without consideration of hill existence and including the chondral lesion. Grid (3) with consideration of hill existence and not including the chondral lesion. Grid (4) with consideration of hill existence and including the chondral lesion. The straight type consisted of 19 knees, the small hill type 13 knees, and the large hill type 27 knees. Depending on the quadrant grid placement, significant center position difference was observed both in the shallow-deep, and high-low direction. When hill existence was considered, the center position of the ACL was significantly changed to a high position. The center position of the ACL footprint exhibited significant differences according to Blumensaat's line morphology. For clinical relevance, when ACL surgery is performed in knees with small or large hill type variations, surgeons should pay close attention to femoral tunnel evaluation and placement, especially when using the quadrant method.

  5. The prevalence of drugs in injured drivers.

    Science.gov (United States)

    Drummer, Olaf H; Kourtis, Irene; Beyer, Jochen; Tayler, Penny; Boorman, Martin; Gerostamoulos, Dimitri

    2012-02-10

    In mid 2009 Victoria introduced compulsory drug testing of blood taken from all injured drivers taken to hospital. Δ(9)-Tetrahydrocannabinol (THC), methylamphetamine (MA) and 3,4-methylenedioxy-methylamphetamine (MDMA) are prohibited and if drivers are positive to any amount an automatic penalty is enforced. Laboratory screens were conducted on preserved blood using ELISA testing for cannabis metabolite and methylamphetamines and a fully validated LC-MS/MS method for 105 drugs including THC, amphetamines, opioids, benzodiazepines, antidepressants and antipsychotics and a number of other psychoactive substances using a minimum of two transitions per drug. Conventional GC-testing for ethanol was used to screen and quantify the presence of alcohol. 1714 drivers were tested and showed alcohol in 29% (≥ 0.01 g/100mL) and drugs in 35%. The positive rate for the three drugs prohibited by legislation was 12.5%. The prevalence of THC, MA and MDMA was 9.8%, 3.1%, and 0.8%, respectively. The range of THC concentrations in blood was 2-42 ng/mL (median 7) of which 70% had a concentration of 10 ng/mL or higher. The range of concentrations for MA and MDMA was 0.02-0.4 and 0.03-0.3mg/L (median for both drugs was 0.05 mg/L). Drugs of any type were detected in 35% of cases. The other drugs were largely prescribed drugs such as the antidepressants (9.3%) and benzodiazepines (8.9%). Neither 6-acetylmorphine nor cocaine (or benzoylecgonine) was detected in these cases. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  6. Trauma in children injured by physical violence

    Directory of Open Access Journals (Sweden)

    Karina S Solovyova

    2016-09-01

    Full Text Available Introduction. In recent years, legislation has changed to include the rights of children injured because of physical violence. Trauma departments of St. Petersburg outpatient clinics admit children with injuries of varying severity after physical violence. The actions of medical institutions are always aimed at protecting the child. Aims. The aim of the present study was to analyze the cases of children in connection with injuries sustained as a result of physical violence in 2014–2015, and to compare the results with those of previous studies (2007–2008. Material and methods. In 2014–2015, the trauma department of City Children's Outpatient clinic No 62 treated 268 children, who had suffered from physical violence at home, on the street, or in educational institutions, which accounted for 1.6 per 1000 children living in the district, and 1.2% of all children admitted during 2 years. Results. Compared to 2007–2008, the number of children who suffered from physical violence decreased by almost two times in 2014–2015; in addition, the severity of injuries slightly decreased but the frequency of hospital admission of victims remained high (38% in 2007–2008. With regard to the circumstances in which the injury occurred, violence from strangers was lower, but violence among peers was higher. Conclusions. Positive results have been achieved by a complex of measures, including the implementation of the Federal Law “On Basic Guarantees of the Rights of the Child” to improve the care and safety of children, and an investigation of each case of violence is conducted by local authorities for internal affairs.

  7. Functional Brace in ACL Surgery: Force Quantification in an In Vivo Study.

    Science.gov (United States)

    LaPrade, Robert F; Venderley, Melanie B; Dahl, Kimi D; Dornan, Grant J; Turnbull, Travis Lee

    2017-07-01

    A need exists for a functional anterior cruciate ligament (ACL) brace that dynamically supports the knee joint to match the angle-dependent forces of a native ACL, especially in the early postoperative period. The purpose of this study was to quantify the posteriorly directed external forces applied to the anterior proximal tibia by both a static and a dynamic force ACL brace. The proximal strap forces applied by the static force brace were hypothesized to remain relatively constant regardless of knee flexion angle compared with those of the dynamic force brace. Controlled laboratory study. Seven healthy adult males (mean age, 27.4 ± 3.4 years; mean height, 1.8 ± 0.1 m; mean body mass, 84.1 ± 11.3 kg) were fitted with both a static and a dynamic force ACL brace. Participants completed 3 functional activities: unloaded extension, sit-to-stand, and stair ascent. Kinematic data were collected using traditional motion-capture techniques while posteriorly directed forces applied to the anterior aspect of both the proximal and distal tibia were simultaneously collected using a customized pressure-mapping technique. The mean posteriorly directed forces applied to the proximal tibia at 30° of flexion by the dynamic force brace during unloaded extension (80.2 N), sit-to-stand (57.5 N), and stair ascent (56.3 N) activities were significantly larger, regardless of force setting, than those applied by the static force brace (10.1 N, 9.5 N, and 11.9 N, respectively; P force ACL brace, compared with the static force brace, applied significantly larger posteriorly directed forces to the anterior proximal tibia in extension, where the ACL is known to experience larger in vivo forces. Further studies are required to determine whether the physiological behavior of the brace will reduce anterior knee laxity and improve long-term patient outcomes. ACL braces that dynamically restrain the proximal tibia in a manner similar to physiological ACL function may improve pre- and

  8. Antagonist muscle moment is increased in ACL deficient subjects during maximal dynamic knee extension

    DEFF Research Database (Denmark)

    Alkjær, Tine; Simonsen, Erik B; Magnusson, S Peter

    2012-01-01

    -10°, angular speed: 30°/s). Hamstring antagonist EMG recorded during concentric quadriceps contraction was converted into antagonist moment based on the EMG-moment relationship observed during eccentric agonist contractions. RESULTS: The magnitude of antagonist hamstring EMG was 65.5% higher in ACL deficient...... in subjects with anterior cruciate ligament (ACL) deficiency compared to age-matched healthy controls. METHODS: Electromyography (EMG) and net knee joint moments were recorded during maximal concentric quadriceps and eccentric hamstring contractions, performed in an isokinetic dynamometer (ROM: 90...

  9. Anterior cruciate ligament- and hamstring tendon- derived cells: in vitro differential properties of cells involved in ACL reconstruction

    NARCIS (Netherlands)

    Ghebes, C.A.; Kelder, C.; Schot, T.; Renard, A.J.S.; Pakvis, D.F.M.; Fernandes, H.; Saris, Daniël B.F.

    2015-01-01

    Anterior cruciate ligament (ACL) reconstruction involves the replacement of the torn ligament with a new graft, often a hamstring tendon (HT). Described as similar, the ACL and HT have intrinsic differences related to their distinct anatomical locations. From a cellular perspective, identifying

  10. ACL graft re-rupture after double-bundle reconstruction: factors that influence the intra-articular pattern of injury

    NARCIS (Netherlands)

    van Eck, Carola F.; Kropf, Eric J.; Romanowski, James R.; Lesniak, Bryson P.; Tranovich, Michael J.; van Dijk, C. Niek; Fu, Freddie H.

    2011-01-01

    To determine the most common rupture patterns of previously reconstructed DB-ACL cases, seen at the time of revision surgery, and to determine the influence of age, gender, time between the initial ACL reconstruction and re-injury, tunnel angle and etiology of failure. Forty patients who presented

  11. Factors that influence the intra-articular rupture pattern of the ACL graft following single-bundle reconstruction

    NARCIS (Netherlands)

    van Eck, Carola F.; Kropf, Eric J.; Romanowski, James R.; Lesniak, Bryson P.; Tranovich, Michael J.; van Dijk, C. Niek; Fu, Freddie H.

    2011-01-01

    The number of revision anterior cruciate ligament (ACL) surgeries performed annually continues to rise. The purpose of this study was to determine the most common rupture pattern in ACL revision cases after previous single-bundle reconstruction. The second aim was to determine the relationship

  12. Acute respiratory distress after transfusion

    Directory of Open Access Journals (Sweden)

    Michael Jožef Gradišek

    2012-12-01

    Conclusions: Transfusion-related acute lung injury (TRALI and transfusion-associated circulatory overload (TACO are clinical syndromes with predominant pulmonary injury and respiratory distress. Anaphylactic reaction, hemolytic transfusion reaction and transfusion of contaminated blood products also impair lung function but are less frequent. Transfusion in critically ill and injured patient is an independent risk factor for acute lung injury. It remains to be determined whether transfusion is the cause of increased mortality or only an indicator of disease severity

  13. ACL footprint size is correlated with the height and area of the lateral wall of femoral intercondylar notch.

    Science.gov (United States)

    Iriuchishima, Takanori; Shirakura, Kenji; Yorifuji, Hiroshi; Aizawa, Shin; Murakami, Tohru; Fu, Freddie H

    2013-04-01

    The purpose of this study was to reveal the correlation between the size of the native anterior cruciate ligament (ACL) footprint and the size of the lateral wall of femoral intercondylar notch. Eighteen non-paired human cadaver knees were used. All soft tissues around the knee were resected except the ACL. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch. The ACL was carefully dissected, and the periphery of the ACL insertion site was outlined on both the femoral and tibial sides. An accurate lateral view of the femoral condyle and the tibial plateau was photographed with a digital camera, and the images were downloaded to a personal computer. The size of the femoral and tibial ACL footprints, length of Blumensaat's line, and the height and area of the lateral wall of femoral intercondylar notch were measured with Image J software (National Institution of Health). The sizes of the native femoral and tibial ACL footprints were 84 ± 25.3 and 144.7 ± 35.9 mm(2), respectively. The length of Blumensaat's line and the height and area of the lateral wall of femoral intercondylar notch were 29.4 ± 2.8 mm, 17.1 ± 2.7 mm, and 392.4 ± 86 mm(2), respectively. Both the height and the area of the lateral wall of femoral intercondylar notch were significantly correlated with the size of the ACL footprint on both the femoral and tibial sides. For clinical relevance, the height and area of the lateral wall of femoral intercondylar notch can be a predictor of native ACL size prior to surgery. However, the length of Blumensaat's line showed no significant correlation with native ACL size.

  14. Addressing the Needs of Children and Families of Combat Injured

    Science.gov (United States)

    2012-04-01

    08-2-0066 TITLE: Addressing the Needs of Children and Families of Combat Injured PRINCIPAL INVESTIGATOR: Dr. Stephen Cozza...Prescribed by ANSI Std. Z39.18 W81XWH-08-2-0066 Addressing the Needs of Children and Families of Combat Injured Dr. Stephen Cozza The Henry M...children under 18 years old and within 2 years of hospitalization or return from deployment), a training manual “Addressing the Needs of Children and

  15. Glucose metabolism in injured tissue: A longitudinal study

    International Nuclear Information System (INIS)

    Daley, J.M.; Shearer, J.D.; Mastrofrancesco, B.; Caldwell, M.D.

    1990-01-01

    Injured tissue is characterized by increased glucose uptake and increased lactate production as compared to normal tissue. These metabolic changes have been attributed to the presence of inflammatory cells in injured tissues. To correlate these metabolic changes with changes in the inflammatory cell population at various times after injury, we studied the lambda-carrageenan hindlimb wound model in anesthetized rats. Perfusion studies demonstrated that at 3 and 5 days after injury glucose uptake was increased in injured hindlimbs, compared with hindlimbs from pair-fed control animals. At 3, 5, and 10 days after injury, lactate production from glucose was increased in injured hindlimbs, compared with hindlimbs from pair-fed control animals. These metabolic changes were not related to differences in body weight or food intake. There was no difference in glucose oxidation or in oxygen consumption in injured hindlimbs, compared with hindlimbs from pair-fed control animals. The increased glucose uptake and increased lactate production from glucose was coincident with the presence of inflammatory cells--predominantly macrophages--at the site of injury. It is suggested that the glucose metabolism in injured tissue reflects the metabolism of the inflammatory cells at the site of injury

  16. Anterior Cruciate Ligament Reconstruction using Bone Patellar Tendon Bone autograft in ACL deficient Knee

    Directory of Open Access Journals (Sweden)

    Navin Kumar Karn

    2015-12-01

    Full Text Available Background & Objectives: Injury to Anterior Cruciate Ligament (ACL reconstruction has increased because of increased interest in sports. There are various grafts used for reconstruction of ACL, for example, Bone Patellar Tendon Bone, Hamstring etc. The study was conducted to evaluate the results of Bone Patellar Tendon Bone graft used for reconstruction of Anterior Cruciate Ligament.Materials & Methods: 40 patients with chronic ACL deficient knee presenting to Neuro Hospital from July 2011 to June 2013 were included in the study. The patients with intraarticular fracture of knee, severe OA knee, local active or suspected infection and systemic disease that might influence the study results were excluded from the study. Bone patellar tendon bone graft was harvested from ipsilateral knee in all the cases. The patient was followed till 2 year with specified programme of rehabilitation. The pain was assessed using VAS and the function of the knee was assessed using Modified WOMAC knee index.Results: The long term satisfactory results in terms of functional stability, symptom relief and return to preinjury level of activity was seen in 32 cases (80%. Two knees got infected out of which one required arthroscopic debridement. Mean visual analogue scale was 8 and modified WOMAC knee score was 3 at 2 year follow up.Conclusion: Bone patellar tendon bone graft is useful in high demand patients and cost effective option with high patient satisfaction rate for reconstruction of ACL.JCMS Nepal. 2015;11(3:12-15.

  17. Measurement of movement patterns to enhance ACL injury prevention – A dead end?

    Directory of Open Access Journals (Sweden)

    Kam-Ming Mok

    2016-07-01

    Full Text Available Vertical drop jump has been suggested to be an effective movement screening task for ACL injury risk, but recent studies have questioned the ability of such tasks to accurately identify players with increased risk of injury. In this paper, we discuss the usefulness of movement screening tests from an injury prevention perspective.

  18. Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction

    NARCIS (Netherlands)

    Hofbauer, Marcus; Muller, Bart; Murawski, Christopher D.; Baraga, Michael; van Eck, Carola Franziska; Fu, Freddie H.

    2013-01-01

    The purpose of this article was to discuss pre- and intra-operative considerations as well as surgical strategies for different femoral and tibial tunnel scenarios in revision surgery following primary double-bundle anterior cruciate ligament (ACL) reconstruction. Based on the current literature of

  19. Novel methods of instruction in ACL injury prevention programs, a systematic review.

    NARCIS (Netherlands)

    Anne Benjaminse; Bert Otten; A. Gokeler; Wouter Welling

    2014-01-01

    Anterior cruciate ligament (ACL) injury prevention programs have been successful in the short term. Motor learning strategies with an internal focus (IF) to body movements have traditionally been utilized, but may be less suitable than an external focus (EF) for the acquisition and control of

  20. Novel methods of instruction in ACL injury prevention programs, a systematic review

    NARCIS (Netherlands)

    Benjaminse, Anne; Welling, Wouter; Otten, Egbert; Gokeler, Alli

    Anterior cruciate ligament (ACL) injury prevention programs have been successful in the short term. Motor learning strategies with an internal focus (IF) to body movements have traditionally been utilized, but may be less suitable than an external focus (EF) for the acquisition and control of

  1. Quadriceps function following ACL reconstruction and rehabilitation : Implications for optimisation of current practices

    NARCIS (Netherlands)

    Anne Benjaminse; E. Otten; P. Eppinga; A. Gokeler; M. Bisschop; G.D. Myer

    2014-01-01

    Abstract PURPOSE: To determine the most effective practices for quadriceps strengthening after ACL reconstruction. METHODS: An electronic search has been performed for the literature appearing from January 1990 to January 2012. Inclusion criteria were articles written in English, German or Dutch

  2. Do ground reaction forces during unilateral and bilateral movements exhibit compensation strategies following ACL reconstruction?

    NARCIS (Netherlands)

    Baumgart, Christian; Schubert, Markus; Hoppe, Matthias W.; Gokeler, Alli; Freiwald, Juergen

    The aims of the study were (1) to evaluate the leg asymmetry assessed with ground reaction forces (GRFs) during unilateral and bilateral movements of different knee loads in anterior cruciate ligament (ACL) reconstructed patients and (2) to investigate differences in leg asymmetry depending on the

  3. Hamstrings co-activation in ACL-deficient subjects during isometric whole-leg extensions

    NARCIS (Netherlands)

    Aalbersberg, S.; Kingma, I.; van Dieen, J.H.

    2009-01-01

    It has been reported that anterior cruciate ligament (ACL)-deficient subjects increase the level of hamstrings activation and this has been interpreted as a means to cope with increased anterior tibial laxity in the knee. This study aimed to establish to what extent co-activation strategies in

  4. Long-Term Data Reveal Rate and Risk Factors for Subsequent Surgeries Following Initial ACL Reconstruction

    Science.gov (United States)

    ... Rupture of the knee’s ACL is a common sports-related injury. It is associated with other knee problems, such as meniscal tears and knee instability. ... after anterior cruciate ligament reconstruction. Am J of Sports Med. 2013; ... treatment and prevention of arthritis and musculoskeletal and skin diseases; the ...

  5. Effect of an internally versus externally focused acl injury prevention program on injury risk

    NARCIS (Netherlands)

    Dallinga, J.; Benjaminse, A.; Gokeler, A.; Otten, Egbert; Lemmink, K.

    2014-01-01

    BACKGROUND: Anterior cruciate ligament (ACL) injury prevention programs have shown mixed results, which may be in part due to suboptimal training components. OBJECTIVE: Determine effects of a prevention program with external and internal focus of attention on (potential) biomechanical risk factors

  6. Forward lunge as a functional performance test in ACL deficient subjects: test-retest reliability

    DEFF Research Database (Denmark)

    Alkjaer, Tine; Henriksen, Marius; Dyhre-Poulsen, Poul

    2009-01-01

    The forward lunge movement may be used as a functional performance test of anterior cruciate ligament (ACL) deficient and reconstructed subjects. The purposes were 1) to determine the test-retest reliability of a forward lunge in healthy subjects and 2) to determine the required numbers...

  7. Pseudocyclops: two cases of ACL graft partial tears mimicking cyclops lesions on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Simpfendorfer, Claus; Subhas, Naveen; Winalski, Carl S.; Ilaslan, Hakan [Cleveland Clinic, Department of Radiology, Cleveland, OH (United States); Miniaci, Anthony [Cleveland Clinic, Department of Orthopedics, Cleveland, OH (United States)

    2015-08-15

    Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is a common surgical procedure, particularly in young athletes. Although the procedure has excellent success rates, complications such as mechanical impingement, graft rupture, and arthrofibrosis can occur, often necessitating additional surgery. Magnetic resonance (MR) imaging has become a valuable tool in evaluating complications after ACL reconstruction. We report two cases of ACL reconstruction complicated by arthroscopically proven partial graft tears. In both cases the torn anterior graft fibers were flipped into the intercondylar notch, mimicking anterior arthrofibrosis, i.e., a ''cyclops lesion,'' on MR imaging. Careful review of the direction of graft fibers on MR imaging in the ''pseudocyclops'' lesions can help differentiate these partial tears from the fibrosis of a true cyclops. The ''pseudocyclops'' lesion is a previously undescribed MR imaging sign of partial ACL graft tear. Larger studies are required to determine the sensitivity and specificity of the sign, as well as the clinical importance of these partial graft tears. (orig.)

  8. Retention of movement technique : Implications for primary prevention of ACL injuries

    NARCIS (Netherlands)

    Welling, Wouter; Benjaminse, Anne; Gokeler, Alli; Otten, Bert

    2017-01-01

    Background: Retention of movement technique is crucial in anterior cruciate ligament (ACL) injury prevention programs. It is unknown if specific instructions or video instructions result in changes in kinematic and kinetic measures during a relatively short training session, and in a retention test

  9. Comparison between clinical grading and navigation data of knee laxity in ACL-deficient knees

    Directory of Open Access Journals (Sweden)

    Yamamoto Yuji

    2010-11-01

    Full Text Available Abstract Background The latest version of the navigation system for anterior cruciate ligament (ACL reconstruction has the supplementary ability to assess knee stability before and after ACL reconstruction. In this study, we compared navigation data between clinical grades in ACL-deficient knees and also analyzed correlation between clinical grading and navigation data. Methods 150 ACL deficient knees that received primary ACL reconstruction using an image-free navigation system were included. For clinical evaluation, the Lachman, anterior drawer, and pivot shift tests were performed under general anesthesia and were graded by an examiner. For the assessment of knee stability using the navigation system, manual tests were performed again before ACL reconstruction. Navigation data were recorded as anteroposterior (AP displacement of the tibia for the Lachman and anterior drawer tests, and both AP displacement and tibial rotation for the pivot shift test. Results Navigation data of each clinical grade were as follows; Lachman test grade 1+: 10.0 mm, grade 2+: 13.2 ± 3.1 mm, grade 3+: 14.5 ± 3.3 mm, anterior drawer test grade 1+: 6.8 ± 1.4 mm, grade 2+: 7.4 ± 1.8 mm, grade 3+: 9.1 ± 2.3 mm, pivot shift test grade 1+: 3.9 ± 1.8 mm/21.5° ± 7.8°, grade 2+: 4.8 ± 2.1 mm/21.8° ± 7.1°, and grade 3+: 6.0 ± 3.2 mm/21.1° ± 7.1°. There were positive correlations between clinical grading and AP displacement in the Lachman, and anterior drawer tests. Although positive correlations between clinical grading and AP displacement in pivot shift test were found, there were no correlations between clinical grading and tibial rotation in pivot shift test. Conclusions In response to AP force, the navigation system can provide the surgeon with correct objective data for knee laxity in ACL deficient knees. During the pivot shift test, physicians may grade according to the displacement of the tibia, rather than rotation.

  10. Stiff Landings Are Associated With Increased ACL Injury Risk in Young Female Basketball and Floorball Players.

    Science.gov (United States)

    Leppänen, Mari; Pasanen, Kati; Kujala, Urho M; Vasankari, Tommi; Kannus, Pekka; Äyrämö, Sami; Krosshaug, Tron; Bahr, Roald; Avela, Janne; Perttunen, Jarmo; Parkkari, Jari

    2017-02-01

    Few prospective studies have investigated the biomechanical risk factors of anterior cruciate ligament (ACL) injury. To investigate the relationship between biomechanical characteristics of vertical drop jump (VDJ) performance and the risk of ACL injury in young female basketball and floorball players. Cohort study; Level of evidence, 3. At baseline, a total of 171 female basketball and floorball players (age range, 12-21 years) participated in a VDJ test using 3-dimensional motion analysis. The following biomechanical variables were analyzed: (1) knee valgus angle at initial contact (IC), (2) peak knee abduction moment, (3) knee flexion angle at IC, (4) peak knee flexion angle, (5) peak vertical ground-reaction force (vGRF), and (6) medial knee displacement. All new ACL injuries, as well as match and training exposure, were then recorded for 1 to 3 years. Cox regression models were used to calculate hazard ratios (HRs) and 95% CIs. Fifteen new ACL injuries occurred during the study period (0.2 injuries/1000 player-hours). Of the 6 factors considered, lower peak knee flexion angle (HR for each 10° increase in knee flexion angle, 0.55; 95% CI, 0.34-0.88) and higher peak vGRF (HR for each 100-N increase in vGRF, 1.26; 95% CI, 1.09-1.45) were the only factors associated with increased risk of ACL injury. A receiver operating characteristic (ROC) curve analysis showed an area under the curve of 0.6 for peak knee flexion and 0.7 for vGRF, indicating a failed-to-fair combined sensitivity and specificity of the test. Stiff landings, with less knee flexion and greater vGRF, in a VDJ test were associated with increased risk of ACL injury among young female basketball and floorball players. However, although 2 factors (decreased peak knee flexion and increased vGRF) had significant associations with ACL injury risk, the ROC curve analyses revealed that these variables cannot be used for screening of athletes.

  11. A Wearable Neuromuscular Device Reduces ACL Injury Risk in Female Soccer Athletes

    Science.gov (United States)

    Decker, Michael John; Shaw, Matthew; Maddan, Casey; Campbell, Julie; Davidson, Bradley

    2016-01-01

    Objectives: Female soccer athletes have a three-fold greater risk of sustaining an ACL injury compared with their male counterparts yet only 1 in 5 teams engage in ACL risk reduction programs due to several participation barriers. The purpose of this study was to determine the effects of a wearable neuromuscular (WNM) device on postural control, performance and ACL injury risk in female soccer athletes. Methods: Seventy-nine elite youth and collegiate female soccer athletes (age range: 12-25 y) trained with a WNM device that applied bi-lateral, topical pressure to the medial quadriceps and hamstrings muscles (Topical Gear, Austin, TX). The athletes performed 7-9 weeks of pre-season training with the WNM device consisting of strength and conditioning exercises and on-field team practices (46-64 total hours of exposure). Postural control was measured in 15 athletes with and without the WNM device before and after the training program; and performance was measured in 25 athletes without the WNM device before and after the training program. Postural control was determined from a single-leg landing on a force plate from a horizontal distance normalized to leg length. The athletes were instructed to gain their balance as fast as possible upon landing and remain balanced for 5 seconds. The peak ground reaction forces (GRF) and the medial-lateral, anterior-posterior and net center of pressure (COP) velocities and displacement ranges were calculated during 2 seconds of single-leg stance. Performance measures including speed, power and endurance were measured from the 40 yard dash, vertical jump for height and the Beep test, respectively. A two-way repeated measures ANOVA and post-hoc comparisons were used to compare the postural variables; and t-tests were used to compare the performance tests (p=.05). ACL injury rates, the absolute risk reduction (ARR) and the number needed to treat (NNT) to prevent one ACL injury were calculated between the WNM intervention group and 11

  12. Hip Strength in Patients with Quadriceps Strength Deficits after ACL Reconstruction.

    Science.gov (United States)

    Bell, David R; Trigsted, Stephanie M; Post, Eric G; Walden, Courtney E

    2016-10-01

    Quadriceps strength deficits persist for years after anterior cruciate ligament (ACL) reconstruction, and patients with these deficits often shift torque demands away from the knee extensors to the hip during functional tasks. However, it is not clear how quadriceps strength deficits may affect hip strength. Therefore, the purpose of this study was to investigate differences in lower extremity strength in individuals with ACL reconstruction with differing levels of quadriceps strength asymmetry. Isometric strength was recorded bilaterally in 135 participants (73 control and 62 with unilateral ACL reconstruction, time from surgery = 30.9 ± 17.6 months) from the knee extensors and flexors, hip extensors and abductors, and hip internal and external rotator muscle groups. Symmetry indices (limb symmetry index (LSI)) were created based on quadriceps strength, and subjects with ACL reconstruction were subdivided (high quadriceps (LSI ≥ 90%), n = 37; low quadriceps (LSI limb (reconstructed/nondominant vs healthy/dominant) repeated-measures ANOVA was used to compare strength (%BW) for each of the six joint motions of interest (knee extensors/flexors, hip abductors/extensors/external, and internal rotators) while controlling for time from surgery. An interaction was observed for quadriceps strength (P limb in the low quadriceps group was weaker than all other limbs. A main effect for group was observed with the low quadriceps group having greater hip extension (P = 0.007) strength in both limbs compared with the other groups. Knee flexion strength was weaker in the reconstructed limb of the high quadriceps group (P = 0.047) compared with all other groups and limbs. Individuals with ACL reconstruction and involved limb quadriceps weakness have greater hip extension strength in both limbs compared with patients with bilateral strength symmetry and controls.

  13. Differences in ACL biomechanical risk factors between field hockey and lacrosse female athletes.

    Science.gov (United States)

    Braun, Hillary J; Shultz, Rebecca; Malone, Maria; Leatherwood, Whitney E; Silder, Amy; Dragoo, Jason L

    2015-04-01

    Previous investigations have revealed a greater incidence of anterior cruciate ligament (ACL) injuries in female lacrosse versus field hockey players. Lacrosse is played in an upright posture with overhead throwing and catching, while field hockey is almost exclusively played in a crouched, forward-flexed position. Biomechanical factors, including decreased knee, hip, and trunk flexion angles, have been identified as risk factors for ACL injury. The purpose of this study was to assess ACL biomechanical risk factors in female field hockey and lacrosse players to determine whether sport-specific posture might contribute to the increased incidence of ACL injury observed in lacrosse athletes. Thirty-one Division I NCAA females from field hockey and lacrosse completed four tasks, three times per leg: bilateral drop jump, single-leg drop jump (SDJ), single-leg jump onto a Bosu ball (SDB), and a 45° anticipated cut. Kinematic and force plate data were used to evaluate knee flexion angle, knee adduction moment, hip flexion angle, and trunk flexion and sway angles. Muscle activity of the lateral hamstrings and vastus lateralis was used to estimate peak hamstring activity and the quadriceps/hamstring ratio at the time of peak quadriceps activity (co-contraction ratio). During the SDJ and SDB, peak knee flexion angles were greater in field hockey compared with lacrosse. During cutting, field hockey players were more flexed at the trunk and had greater trunk sway, compared with the lacrosse players. No significant difference was observed for the co-contraction ratio for any of the tasks. Decreased knee flexion angle during landing, consistent with sport-specific playing postures, may contribute to the higher incidence of ACL injury in lacrosse players relative to field hockey. Sport-specific training injury prevention programmes may benefit from considering these differences between specialized athletes. II.

  14. Concurrent Meniscal and Chondral Injuries in Pediatric and Adolescent Patients Undergoing ACL Reconstruction.

    Science.gov (United States)

    Vavken, Patrick; Tepolt, Frances A; Kocher, Mininder S

    2018-02-01

    The aim of this study is to assess the prevalence of and risk factors for concurrent meniscal and articular cartilage injury in children and adolescents undergoing anterior cruciate ligament (ACL) reconstruction. Medical records of pediatric patients (below 18 y old) undergoing ACL surgery during the 2013 to 2014 academic year at a tertiary care children's hospital were reviewed for clinical or radiographic documentation of meniscal or chondral injury. Prevalence of concurrent injury was regressed on the basis of age, sex, body mass index (BMI), and time between injury and surgery. Skeletally immature patients were analyzed as a separate subgroup. Medical records of 208 patients with a mean age of 15±2 years were reviewed. Overall, 117 patients (56%) were found to have had at least 1 concurrent injury; 66 patients (32%) had a medial meniscus tear, 72 patients (35%) had a lateral meniscus tear, and 10 patients (5%) had a chondral lesion. Both BMI and time duration between injury and ACL reconstruction surgery were significant predictors for meniscal or chondral injury, with increase in injury prevalence of approximately 10% per point BMI and 6% per month delay to surgery. More than half of the children and the adolescents treated for ACL tear have concurrent meniscal or chondral injury. Risk factors for concurrent injury are BMI and time duration between injury and surgery. The prevalence of concurrent injury and associated risk factors should be considered when counseling a pediatric patient and family regarding operative versus nonoperative management in the setting of an ACL tear. Level IV-case series.

  15. "Custom-fit" versus "off-the-shelf" ACL functional braces.

    Science.gov (United States)

    Wojtys, E M; Huston, L J

    2001-01-01

    Many sports medicine practitioners believe "custom-fit" functional braces are superior in performance to "off-the-shelf" braces for anterior cruciate ligament (ACL)-deficient knees. However, this is not well substantiated. This study compares a Donjoy custom-fit ACL brace (CE 2000), Donjoy off-the-shelf brace (Goldpoint), and an athletic taping technique to determine their role in our clinical practice. Five patients (3 men and 2 women) with isolated, unilateral, chronic ACL tears with an average age of 27 years (range: 19-35 years) were used to evaluate these three restraint systems. Anterior tibial laxity, quadriceps and hamstrings strength, endurance, standing long jump, brace migration with exercise, and pattern of muscle response to forced anterior tibial displacement were studied. Each patient was tested without a brace and then in each of the three test conditions (custom brace, off-the-shelf brace, and tape), with the order of testing randomized. The Donjoy custom-fit ACL functional brace did not reduce anterior laxity or improve standing long jump, muscle strength, endurance, or muscle response times significantly more than the off-the-shelf ACL brace. Both braces improved anterior stability over knee taping when the knee muscles were contracted under the low forces used in this study. After 1 hour of exercise, brace migration was significantly greater (P=.03) for the CE-2000 custom brace (18.6 mm) than for the Goldpoint off-the-shelf brace (4.5 mm). There appears to be no advantage to the more expensive custom-fit knee brace over the off-the-shelf brace.

  16. Anterior cruciate ligament- and hamstring tendon-derived cells: in vitro differential properties of cells involved in ACL reconstruction.

    Science.gov (United States)

    Ghebes, Corina Adriana; Kelder, Cindy; Schot, Thomas; Renard, Auke J; Pakvis, Dean F M; Fernandes, Hugo; Saris, Daniel B

    2017-04-01

    Anterior cruciate ligament (ACL) reconstruction involves the replacement of the torn ligament with a new graft, often a hamstring tendon (HT). Described as similar, the ACL and HT have intrinsic differences related to their distinct anatomical locations. From a cellular perspective, identifying these differences represents a step forward in the search for new cues that enhance recovery after the reconstruction. The purpose of this study was to characterize the phenotype and multilineage potential of ACL- and HT-derived cells. ACL- and HT-derived cells were isolated from tissue harvest from patients undergoing total knee arthroplasty (TKA) or ACL reconstruction. In total, three ACL and three HT donors were investigated. Cell morphology, self-renewal potential (CFU-F), surface marker profiling, expression of tendon/ligament-related markers (PCR) and multilineage potential were analysed for both cell types; both had fibroblast-like morphology and low self-renewal potential. No differences in the expression of tendon/ligament-related genes or a selected set of surface markers were observed between the two cell types. However, differences in their multilineage potential were observed: while ACL-derived cells showed a high potential to differentiate into chondrocytes and adipocytes, but not osteoblasts, HT-derived cells showed poor potential to form adipocytes, chondrocytes and osteoblasts. Our results demonstrated that HT-derived cells have low multilineage potential compared to ACL-derived cells, further highlighting the need for extrinsic signals to fully restore the function of the ACL upon reconstruction. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  17. Acute Concomitant Anterior Cruciate Ligament and Patellar Tendon Tears in a Non-dislocated Knee

    Directory of Open Access Journals (Sweden)

    Robert D Wissman

    2012-01-01

    Full Text Available Anterior cruciate ligament (ACL tears are common and may occur in isolation or with other internal derangements of the joint. Tears of the patellar tendon (PT occur less frequently and are rarely associated with intra-articular pathology. Acute combined tears of both the ACL and PT are known complications of high-energy traumatic knee dislocations. We present a case of an acute concomitant ACL and PT tears in a low-energy non-dislocated knee. To our knowledge, this injury has only been described in a limited number of case reports in the orthopedic literature. We present the imaging findings of this combined injury and discuss the importance of magnetic resonance (MR in diagnosis.

  18. Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts.

    Science.gov (United States)

    Failla, Mathew J; Logerstedt, David S; Grindem, Hege; Axe, Michael J; Risberg, May Arna; Engebretsen, Lars; Huston, Laura J; Spindler, Kurt P; Snyder-Mackler, Lynn

    2016-10-01

    Rehabilitation before anterior cruciate ligament (ACL) reconstruction (ACLR) is effective at improving postoperative outcomes at least in the short term. Less is known about the effects of preoperative rehabilitation on functional outcomes and return-to-sport (RTS) rates 2 years after reconstruction. The purpose of this study was to compare functional outcomes 2 years after ACLR in a cohort that underwent additional preoperative rehabilitation, including progressive strengthening and neuromuscular training after impairments were resolved, compared with a nonexperimental cohort. We hypothesized that the cohort treated with extended preoperative rehabilitation would have superior functional outcomes 2 years after ACLR. Cohort study; Level of evidence, 3. This study compared outcomes after an ACL rupture in an international cohort (Delaware-Oslo ACL Cohort [DOC]) treated with extended preoperative rehabilitation, including neuromuscular training, to data from the Multicenter Orthopaedic Outcomes Network (MOON) cohort, which did not undergo extended preoperative rehabilitation. Inclusion and exclusion criteria from the DOC were applied to the MOON database to extract a homogeneous sample for comparison. Patients achieved knee impairment resolution before ACLR, and postoperative rehabilitation followed each cohort's respective criterion-based protocol. Patients completed the International Knee Documentation Committee (IKDC) subjective knee form and Knee injury and Osteoarthritis Outcome Score (KOOS) at enrollment and again 2 years after ACLR. RTS rates were calculated for each cohort at 2 years. After adjusting for baseline IKDC and KOOS scores, the DOC patients showed significant and clinically meaningful differences in IKDC and KOOS scores 2 years after ACLR. There was a significantly higher (P < .001) percentage of DOC patients returning to preinjury sports (72%) compared with those in the MOON cohort (63%). The cohort treated with additional preoperative

  19. Thrombosis and antiphospholipid antibody syndrome during acute Q fever

    Science.gov (United States)

    Million, Matthieu; Bardin, Nathalie; Bessis, Simon; Nouiakh, Nadia; Douliery, Charlaine; Edouard, Sophie; Angelakis, Emmanouil; Bosseray, Annick; Epaulard, Olivier; Branger, Stéphanie; Chaudier, Bernard; Blanc-Laserre, Karine; Ferreira-Maldent, Nicole; Demonchy, Elisa; Roblot, France; Reynes, Jacques; Djossou, Felix; Protopopescu, Camelia; Carrieri, Patrizia; Camoin-Jau, Laurence; Mege, Jean-Louis; Raoult, Didier

    2017-01-01

    Abstract Q fever is a neglected and potentially fatal disease. During acute Q fever, antiphospholipid antibodies are very prevalent and have been associated with fever, thrombocytopenia, acquired heart valve disease, and progression to chronic endocarditis. However, thrombosis, the main clinical criterion of the 2006 updated classification of the antiphospholipid syndrome, has not been assessed in this context. To test whether thrombosis is associated with antiphospholipid antibodies and whether the criteria for antiphospholipid syndrome can be met in patients with acute Q fever, we conducted a cross-sectional study at the French National Referral Center for Q fever. Patients included were diagnosed with acute Q fever in our Center between January 2007 and December 2015. Each patient's history and clinical characteristics were recorded with a standardized questionnaire. Predictive factors associated with thrombosis were assessed using a rare events logistic regression model. IgG anticardiolipin antibodies (IgG aCL) assessed by an enzyme-linked immunosorbent assay were tested on the Q fever diagnostic serum. A dose-dependent relationship between IgG aCL levels and thrombosis was tested using a receiver operating characteristic (ROC) analysis. Of the 664 patients identified for inclusion in the study, 313 (47.1%) had positive IgG aCL and 13 (1.9%) were diagnosed with thrombosis. Three patients fulfilled the antiphospholipid syndrome criteria. After multiple adjustments, only positive IgG aCL (relative risk, 14.46 [1.85–113.14], P = .011) were independently associated with thrombosis. ROC analysis identified a dose-dependent relationship between IgG aCL levels and occurrence of thrombosis (area under curve, 0.83, 95%CI [0.73–0.93], P antiphospholipid antibodies are associated with thrombosis, thrombocytopenia, and acquired valvular heart disease. Antiphospholipid antibodies should be systematically assessed in acute Q fever patients. Hydroxychloroquine

  20. Morbidity of Early Spine Surgery in the Multiply Injured Patient

    Science.gov (United States)

    2014-07-31

    chest trauma 9 30 % Exploratory laparotomy 8 27 % Lactate [ 2.5 mEq/L 6 20 % Platelet \\110,000/mm3 4 13 % 10 U PRBCs pre-spine surgery 4 13 % ISS...ORTHOPAEDIC SURGERY Morbidity of early spine surgery in the multiply injured patient J. W. Galvin • B. A. Freedman • A. J. Schoenfeld • A. P. Cap • J... surgery for multiply injured patients with operative spinal injuries remains unknown. The purported benefits of early intervention must be weighed

  1. Comparison of postural stability between injured and uninjured ballet dancers.

    Science.gov (United States)

    Lin, Cheng-Feng; Lee, I-Jung; Liao, Jung-Hsien; Wu, Hong-Wen; Su, Fong-Chin

    2011-06-01

    Ballet movements require a limited base of support; thus, ballet dancers require a high level of postural control. However, postural stability in ballet dancers is still unclear and needs to be understood. To evaluate ballet dancers' postural stability in performing single-leg standing, the en pointe task, and the first and fifth positions and to determine differences in task performance among healthy nondancers, healthy dancers, and dancers with ankle sprains. Controlled laboratory study. Injured dancers, uninjured dancers, and nondancers were recruited for this study (N = 33 age-matched participants; n= 11 per group). The tasks tested were single-leg standing with eyes open and closed, first position, fifth position, and en pointe. Center of pressure parameters were calculated from the ground-reaction force collected with 1 force plate. Analysis of variance was used to assess the differences of center of pressure parameters among 3 groups in single-leg standing; independent t test was used to examine the differences of center of pressure parameters between injured and uninjured dancers. During single-leg standing, injured dancers had significantly greater maximum displacement in the medial-lateral direction and total trajectory of center of pressure, compared with the uninjured dancers and nondancers. During the first and fifth positions, the injured dancers demonstrated significantly greater standard deviation of center of pressure position in the medial-lateral and anterior-posterior directions, compared with the uninjured dancers. During en pointe, the injured dancers had significantly greater maximum displacement in the medial-lateral direction and the anterior-posterior direction, compared with the uninjured dancers. The injured and uninjured dancers demonstrated differences in postural stability in the medial-lateral direction during single-leg standing and the ballet postures. Although the injured dancers received ballet training, their postural stability

  2. Psychoactive substances in seriously injured drivers in Denmark

    DEFF Research Database (Denmark)

    Simonsen, Kirsten Wiese; Steentoft, Anni; Bernhoft, Inger Marie

    2013-01-01

    This study assesses the presence of a number of psychoactive substances, including alcohol, based on blood samples from 840 seriously injured drivers admitted to five selected hospitals located in five different regions of Denmark. The study was a part of the EU 6th framework program DRUID (Driving...... levels above the Danish legal limit were present more than 10 times as frequently as in injured drivers, whereas ethanol was present more than 30 times as frequently than in randomly selected drivers. The results indicate that there is an increased risk in traffic when driving under the influence...

  3. An Integrated Approach to Change the Outcome Part II: Targeted Neuromuscular Training Techniques to Reduce Identified ACL Injury Risk Factors

    Science.gov (United States)

    Myer, Gregory D.; Ford, Kevin R.; Brent, Jensen L.; Hewett, Timothy E.

    2014-01-01

    Prior reports indicate that female athletes who demonstrate high knee abduction moments (KAMs) during landing are more responsive to neuromuscular training designed to reduce KAM. Identification of female athletes who demonstrate high KAM, which accurately identifies those at risk for noncontact anterior cruciate ligament (ACL) injury, may be ideal for targeted neuromuscular training. Specific neuromuscular training targeted to the underlying biomechanical components that increase KAM may provide the most efficient and effective training strategy to reduce noncontact ACL injury risk. The purpose of the current commentary is to provide an integrative approach to identify and target mechanistic underpinnings to increased ACL injury in female athletes. Specific neuromuscular training techniques will be presented that address individual algorithm components related to high knee load landing patterns. If these integrated techniques are employed on a widespread basis, prevention strategies for noncontact ACL injury among young female athletes may prove both more effective and efficient. PMID:22580980

  4. A comparison of hamstring muscle activity during different screening tests for non-contact ACL injury

    DEFF Research Database (Denmark)

    Husted, Rasmus S; Bencke, Jesper; Andersen, Lars Louis

    2016-01-01

    BACKGROUND: Reduced ability to activate the medial hamstring muscles during a sports-specific sidecutting movement has been found to be a potential risk factor for non-contact ACL injury. However, whether a reduced ability to activate the medial hamstring muscle is a general neuromuscular...... phenomenon and thereby observable independently of the type of clinical screening tests used is not known. This cross sectional study investigated the rank correlation of knee joint neuromuscular activity between three different ACL injury risk screening tests. METHODS: Sixty-two adolescent female elite...... football and handball players (16.7±1.3years) participated in the study. Using surface electromyography (EMG) assessment, the neuromuscular activity of medial hamstring muscle (semitendinosus, ST), lateral hamstring muscle (biceps femoris, BF) and quadriceps muscle (vastus lateralis, VL) were monitored...

  5. Anatomic ACL reconstruction produces greater graft length change during knee range-of-motion than transtibial technique.

    Science.gov (United States)

    Lubowitz, James H

    2014-05-01

    Because distance between the knee ACL femoral and tibial footprint centrums changes during knee range-of-motion, surgeons must understand the effect of ACL socket position on graft length, in order to avoid graft rupture which may occur when tensioning and fixation is performed at the incorrect knee flexion angle. The purpose of this study is to evaluate change in intra-articular length of a reconstructed ACL during knee range-of-motion comparing anatomic versus transtibial techniques. After power analysis, seven matched pair cadaveric knees were tested. The ACL was debrided, and femoral and tibial footprint centrums for anatomic versus transtibial techniques were identified and marked. Asuture anchor was placed at the femoral centrum and a custom, cannulated suture-centring device at the tibial centrum, and excursion of the suture, representing length change of an ACL graft during knee range-of-motion, was measured in millimeters and recorded using a digital transducer. Mean increase in length as the knee was ranged 120°–0° (full extension) was 4.5 mm (±2.0 mm) for transtibial versus 6.7 mm (±0.9 mm) for anatomic ACL technique. A significant difference in length change occurs during knee range-of-motion both within groups and between the two groups. Change in length of the ACL intra-articular distance during knee range-of-motion is greater for anatomic socket position compared to transtibial position. Surgeons performing anatomic single-bundle ACL reconstruction may tension and fix grafts with the knee in full extension to minimize risk of graft stretch or rupture or knee capture during full extension. This technique may also result in knee anterior–posterior laxity in knee flexion.

  6. ACL Injury Prevention Training Results in Modification of Hip and Knee Mechanics During a Drop-Landing Task.

    Science.gov (United States)

    Pollard, Christine D; Sigward, Susan M; Powers, Christopher M

    2017-09-01

    Injury prevention training has been shown to be effective in reducing the incidence of noncontact anterior cruciate ligament (ACL) injury; however, the underlying reason for the success of these training programs is unclear. To investigate whether an ACL injury prevention program that has been shown to reduce the incidence of ACL injury alters sagittal plane hip and knee biomechanics during a drop-landing task. Descriptive laboratory study. Thirty female club soccer players (age range, 11-17 years) with no history of knee injury participated in this study. Kinematics and ground-reaction forces were collected while each participant performed a drop-landing task prior to and immediately after participation in a 12-week ACL injury prevention training program. After ACL injury prevention training, participants demonstrated decreased knee extensor moments ( P = .03), increased energy absorption at the hip ( P = .04), decreased knee-to-hip extensor moment ratios ( P = .05), and decreased knee-to-hip energy absorption ratios ( P = .03). Participation in an ACL injury prevention training program decreased reliance on the knee extensor muscles and improved use of the hip extensor muscles, which may explain the protective effect of this type of training program on ACL injury. Based on these findings, clinicians can better understand how ACL injury prevention training, such as the Prevent Injury and Enhance Performance (PEP) Program, may change movement behavior at both the hip and knee. Furthermore, the study findings may support the implementation of the PEP Program, or a similar program, for clinicians aiming to improve use of the hip in an effort to reduce knee loading and consequent injuries.

  7. Single-leg balance and core motor control in children: when does the risk for ACL injury occurs?

    OpenAIRE

    Hutchinson, Allison B; Yao, Paul; Hutchinson, Mark R

    2016-01-01

    Introduction While numerous publications have demonstrated the correlation of poor single-leg balance and core motor control with an increased risk of anterior cruciate ligament (ACL) injuries in skeletally mature female athletes, few have analysed the preadolescent population regarding when indeed comparative deficits in balance and core control actually occur. The purpose of this study was to assess whether the neuromotor factors that place mature females at increased risk of ACL injury act...

  8. Evaluation of anterior stability of knee joint following arthroscopic ACL reconstruction with patellar ligament.

    Science.gov (United States)

    Fibiger, Wojciech; Kukiełka, Radosław T Kukiełka

    2011-01-01

    The aim of the study was to investigate and assess anterior stability of the knee joint before and during 12-month rehabilitation after arthroscopic reconstruction of the anterior cruciate ligament with the central third of the patellar ligament and stabilization with interference screws (Kenneth-Jones method) and to analyse the effectiveness of the surgery and rehabilitation by patient self-assessment of pain and crepitation in the patello-femoral joint. The study involved a group of 46 patients after arthroscopic ACL reconstruction with the patellar ligament performed in 2005 and 2006. All patients underwent examinations of anterior stability of the knee joint using a KT-1000/S arthrometer. Stability measurements were performed on both knees on the day before surgery, and at 3, 6 and 12 months after the operation. Additionally, the patients subjectively evaluated post-operative pain and crepitation in the patello-femoral joint at 3, 6 and 12 months. Knee stability after ACL reconstruction according to the Mazurkiewicz scale using a KT-1000 arthrometer was rated as good and excellent, while the patients subjectively assessed the treatment process in terms of pain and crepitation in the patello-femoral joint at 12 months after the operation as excellent (10.8%), good (74%), and satisfactory (15.2%). Arthroscopic ACL reconstruction with the central third of the patellar ligament and stabilization with interference screws fully restored the lost stability of the knee, but the possibility of pain and crepitations in the patello-femoral joint needs to be taken into account. In the course of rehabilitation, it is natural that an ACL graft may extend as a result of remodeling and the impact of rehabilitation being administered.

  9. Increase in ACL and PCL injuries after implementation of a new professional football league.

    Science.gov (United States)

    Krutsch, Werner; Zeman, Florian; Zellner, Johannes; Pfeifer, Christian; Nerlich, Michael; Angele, Peter

    2016-07-01

    In the season 2008-2009, a third professional football league was established in Germany. This study analysed the influence of increased training and playing intensity on severe knee injuries in football players. In a prospective controlled one-season trial, injury incidence and injury patterns of players of the newly established professional football league were analysed, particularly with regard to ruptures of the anterior (ACL) and posterior (PCL) cruciate ligaments. Players of the highest amateur level served as a control group. Four hundred and eight players of 24 teams were allocated to two groups. The overall training exposure was significantly (p professional league (335.3 h per player) than at the amateur level (286.6 h per player). Players at both levels showed similar overall injury rates and injury patterns. However, players in the professional league had a significantly higher (p = 0.04) incidence of ACL and PCL injuries, than players at the amateur level. More than 90 % of all ACL and PCL ruptures in both groups were sustained by players, who had played at least one level lower in the previous season. In addition, injuries of players who had sustained repeat injuries over the season were more severe. The introduction of a new professional football league increased the training and playing intensity of players as well as the number of ACL and PCL ruptures. A specific injury prevention concept, particularly for players facing rapidly increasing training and playing intensity, seems to be mandatory. Prospective controlled cohort study, Level II.

  10. Selected methods in recondition training of soccer players after plastic ACL

    OpenAIRE

    Teplan, Jaroslav

    2010-01-01

    Title: Selected methods in recondition training of soccer player after plastic surgery LCA Student: Jaroslav Teplan Supervisit: PhDr. Aleš Kaplan Ph.D. Objective: The main goal was monitoring of selected methods utilization in recondition training of soccer player after plastic surgery ACL. Another goal was level of stability and sensomotoric function evaluation. Also body composition mentoring during recondition block and the level of straining by means of mentoring hearth rate with respect ...

  11. The effect of playing surface on the incidence of ACL injuries in National Collegiate Athletic Association American Football.

    Science.gov (United States)

    Dragoo, Jason L; Braun, Hillary J; Harris, Alex H S

    2013-06-01

    Artificial playing surfaces are widely used for American football practice and competition and anterior cruciate ligament (ACL) injuries are common. This study analyzed the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) men's football ACL injury database from 2004-2005 through 2008-2009 to determine the effect of playing surface on ACL injury in NCAA football athletes. This database was reviewed from the 2004-2005 through 2008-2009 seasons using the specific injury code, "Anterior cruciate ligament (ACL) complete tear." The injury rate was computed for competition and practice exposures. Ninety-five percent confidence intervals were calculated using assumptions of a Poisson distribution. Pair-wise, two-sample tests of equality of proportions with a continuity correction were used to estimate the associations of risk factors. There was an incidence rate of 1.73 ACL injuries per 10,000 athlete-exposures (A-Es) (95% CI 1.47-2.0) on artificial playing surfaces compared with a rate of 1.24 per 10,000 A-Es (1.05-1.45, pinjuries occurred more frequently on artificial turf surfaces (44.29%) than on natural grass (36.12%). NCAA football players experience a greater number of ACL injuries when playing on artificial surfaces. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. Impact of training in Advanced Cardiac Life Support (ACLS in the professional career and work environment

    Directory of Open Access Journals (Sweden)

    Lunia Sofia Lima Azevedo

    Full Text Available Abstract We sought to evaluate the impact of Advanced Cardiac Life Support (ACLS training in the professional career and work environment of physicians who took the course in a single center certified by the American Heart Association (AHA. Of the 4631 students (since 1999 to 2009, 2776 were located, 657 letters were returned, with 388 excluded from the analysis for being returned lacking addressees. The final study population was composed of 269 participants allocated in 3 groups ( 5years. Longer training was associated with older age, male gender, having undergone residency training, private office, greater earnings and longer time since graduation and a lower chance to participate in providing care for a cardiac arrest. Regarding personal change, no modification was detected according to time since taking the course. The only change in the work environment was the purchase of an automated external defibrillator (AED by those who had taken the course more than 5 years ago. In multivariable analysis, however, the implementation of an AED was not independently associated with this group, which showed a lower chance to take a new ACLS course. ACLS courses should emphasize also how physicians could reinforce the survival chain through environmental changes.

  13. Comparison of the postural control between football players following ACL reconstruction and healthy subjects.

    Science.gov (United States)

    Pahnabi, Gholamreza; Akbari, Mohammad; Ansari, Noureddin Nakhostin; Mardani, Mahmoud; Ahmadi, Mehdi; Rostami, Mohamad

    2014-01-01

    Rupture of the Anterior Cruciate Ligment (ACL) is a common knee injury. The purpose of this study was to determine the balance control in football players with and without ACL reconstruction in posture of injury. Sway of the center of gravity of 15 patients with ACL reconstruction was compared with 15 healthy, age and sex-matched subjects as the control group. All tests were done unilaterally in the posture of injury, using a kistler force plate with the open and -closed eye conditions. The knee of the operated side of the case group showed more displacement of the center of gravity when compared to the non-operated side in the same subject for all variables of the force plate. The operated side of the case group showed more displacement of the center of gravity for all variables of the force plate in comparison with the dominant side of knees in control group. There were significant differences between the non-operated side in the case group and the dominant side of the control group. All together, postural control in the operated side of the case group was weaker than the nonoperated side of the same group and the dominant limb of the control group, which might have resulted from poor proprioception. The postural control was even weaker in the non-operated side of the case group as compared with the dominant limb of the control group, which can justify the hypo mobility of limb for several months after the surgery.

  14. Delay in ACL reconstruction is associated with more severe and painful meniscal and chondral injuries.

    Science.gov (United States)

    Fok, August W M; Yau, W P

    2013-04-01

    The goal of our study was to investigate the associations between surgical delay, pain and meniscus, and articular cartilage lesions seen at the time of ACL reconstruction. One hundred and sixty-two consecutive patients who had received ACL reconstruction were recruited. The preoperative International Knee Documentation Committee (IKDC) questionnaires, and cartilage and meniscal lesions seen at the time of surgery were analysed. Patients with surgery within 12 months were less likely to have meniscus injury (59.8/77.4 %, p = 0.032), and the meniscus injury was more likely to be salvageable. (56.3/36.0 %, p = 0.042). Patients with meniscal tear larger than 10 mm had higher pain intensity than tear lesions had longer surgical delay (mean 18.9/12.1 months, p = 0.033). The presence of meniscal tear increased the risk of cartilage lesions (p = 0.038, OR = 2.14). Patients with cartilage lesions had a greater pain frequency (mean 6.9/7.7, p = 0.048). Moderate correlation was found between the size of cartilage lesion and the frequency of pain (p = 0.013). Increased surgical delay was associated with an increased incidence of meniscus and articular cartilage injuries in patients suffering from ACL tear; also, the meniscus was less likely to be salvageable. The presence of cartilage lesions was associated with an increased frequency of pain. Size of meniscal and cartilage lesions was significantly associated with pain.

  15. Analytical performances of Hemoclot Protein C Reagent on ACL TOP analyzer.

    Science.gov (United States)

    Calmette, Leyla; Charpentier, Nicole; Tircot, Caroline; Bigot, Delphine; Dunois, Claire; Amiral, Jean; Tetegan, Marcelle; Sep Hieng, Sonnthida; Peltier, Jean-Yves

    2016-12-01

    Our study aimed to evaluate and validate according to standard NF EN ISO 15189 the original protocol ajustement of Hemoclot Protein C (PC) (Hyphen BioMed), clotting-based assay of PC on ACL TOP analyzer (Werfen/Instrumentation Laboratory). We evaluated the performance in terms of imprecision and we validate additional parameters in range B required by the SH GTA 04 (COFRAC): repeatability, reproducibility, detection and quantification limits, limits of linearity, stability, inter-samples and inter-reagents contamination, inaccuracy, evaluation of interferences (hemolysis, bilirubinemia and chyles). A comparison with Hemoclot PC on STA Compact analyzer (Stago) was performed. Coefficients of variation were lower than 5 %. Detection and quantification limits were respectively 8.3 % and 9.3 %. Superior limit of linearity was 140 %. The test didn't diplay any inter-samples and inter-reagents contamination. Reagent after reconstitution was stable 6 hours on ACL TOP. No interferences were observed for hemoglobin lower than 500 mg/dL, for bilirubin lower than and for chyles lower than 300 mg/dL. Comparison with Hemoclot PC on STA analyzer (Stago) was satisfactory. Hemoclot PC adjusted on ACL TOP analyzer showed satisfactory analytical performances with criteria chosen in our study. These data allow a better knowledge of the performances of this test and were useful to make a validation file in range B as recommended by SH GTA 04.

  16. Press-fit Femoral Fixation in ACL Reconstruction using Bone-Patellar Tendon-Bone Graft

    Directory of Open Access Journals (Sweden)

    Kaseb Mohammad Hasan

    2009-05-01

    Full Text Available Bone-patellar tendon auto graft is probably the most widely used graft for ACL reconstruction. Several methods for graft fixation have been described. To avoid intra-articular hardware we adopt biological fixation with a femoral trapezoidal press-fit fixation. A prospective study was performed on 30 consecutive active people who underwent ACL reconstruction with this technique by two surgeons between september2004 and march2007 (mean follow-up 15.2 months. Results were evaluated by an independent examiner using radiography, subjective and objective evaluation. Assessment using the IKDC knee scoring revealed 92% of the patients with a normal or nearly normal knee joint. Lysholm's score was 63.6(40- 86 preoperatively and 91.88(73-100 at the latest follow up (P < 0.005. No patient complained of instability at latest follow up. The quadriceps muscle showed mild atrophy at 3 and 6 months and at final follow-up. Five Patients complained of anterior knee pain and had a positive kneeling test. We found no graft displacement on follow up radiographs. All cases showed radiological evidence of graft osteointegration at last follow up. Our results show that press-fit fixation of trapezoidal bone graft in femoral tunnel is a simple, reliable, and cost-effective alternative for ACL recon-struction using bone-patellar tendon-bone graft.

  17. Measurement of functional recovery in individuals with acute anterior cruciate ligament rupture

    OpenAIRE

    Button, K; van Deursen, R; Price, P; Rosenbaum, D

    2005-01-01

    Objectives: To measure functional recovery following acute anterior cruciate ligament (ACL) rupture using a simple and reliable clinical movement analysis system. Clinic based methods that simultaneously quantify different aspects of movement over a range of activities and model functional recovery will help guide rehabilitation.

  18. [Hospital-based psychological first aid provided to patients injured in the Lushan earthquake].

    Science.gov (United States)

    Yin, Min; Li, Xiao-Lin; Li, Jing; Huang, Xue-Hua; Tao, Qing-Lan; Luo, Xi

    2015-04-01

    In the aftermath of the 7.0 earthquake that struck Lushan in China's Sichuan Province on April 20, 2013, a psychological crisis intervention working group was established in a hospital that was treating earthquake victims. Patients at this hospital received psychological first aid that was delivered in accordance with scientific, systematic, and standardized principles. This first aid employed a "rooting mode" methodology and was designed as a supportive psychological intervention. Mental assessment results showed that the general mental health, acute stress reactions, and anxiety and depression status of all of the 131 injured who received the psychological intervention had significantly improved (p first aid, the approach used to organize the working groups, the main contents of the intervention, specific methods used, and intervention outcomes. This information is provided as a reference for providing localized psychological assistance in the aftermath of a disaster incident.

  19. Optimization of MR imaging of the most commonly injured structures of the ankle

    International Nuclear Information System (INIS)

    Schneck, C.D.; Mesgarzadeh, M.; Bonakdarpour, A.

    1987-01-01

    MR images of the ankles of seven cadavers, nine healthy volunteers, and seven injured patients were correlated with cadaver dissections and cryosections to determine the optimum imaging plane and foot position for demonstrating each ligament's injury parameters. Axial images of the neutral-positioned foot allowed full-length visualization of the anterior and posterior talofibular ligaments, while the calcaneofibular ligament was paraxially imaged in 40 0 of plantar flexion. Coronal images allowed paraaxial visualization of major parts of the deltoid ligament: the tibionavicular ligament in 40 0 of plantar flexion and the tibospring and posterior tibiotalar ligaments in 15 0 of plantar flexion. Acute ligament rupture was well delineated on T2-weighted images by the high signal intensity of the overlying subcutaneous edema and hemorrhage and the underlying joint effusion. In chronically unstable ankles, ligament rupture, thinning, and lengthening were best demonstrated by placing that ligament in its stress position

  20. Prehospital transport of spinal cord-injured patients in Nigeria

    African Journals Online (AJOL)

    that the means of transport are generally not optimal for those with spinal cord injury. The aim of the present study was therefore to highlight the importance of prehospital transport of spinal cord-injured patients and the contribution of these injuries to mortality in Nigeria. Patients, materials and methods. The records of spinal ...

  1. RECREATION AND SOCIALIZATION FOR THE BRAIN INJURED CHILD.

    Science.gov (United States)

    GOLUB, RISA S.; GORDON, SOL

    DESIGNED FOR PARENTS AND SPECIALISTS PLANNING THERAPEUTICALLY ORIENTED RECREATIONAL AND SOCIALIZATION PROGRAMS FOR BRAIN INJURED CHILDREN, THIS DOCUMENT CONTAINS 13 CHAPTERS BY DIFFERENT AUTHORS. ACTIVITIES DISCUSSED ARE GENERALLY NONCOMPETITIVE, EMPHASIZING STRUCTURE AND LIMIT. DISCUSSED ARE (1) THE ROLE OF THE OPTOMETRIST WITH THE INADEQUATE…

  2. Prevent Tipping Furniture from Injuring or Killing Young Children

    Science.gov (United States)

    ... this! Home » Health Tips » Child Emergencies Prevent Tipping Furniture from Injuring or Killing Young Children The nation’s ... a child — killed by a piece of a furniture, appliance or a television falling on them. “It ...

  3. Replantation and revascularization vs. amputation in injured digits

    NARCIS (Netherlands)

    Mulders, Marjolein A. M.; Neuhaus, Valentin; Becker, Stéphanie J. E.; Lee, Sang-Gil; Ring, David C.

    2013-01-01

    The purpose of this study was to analyze factors associated with the decision to replant or revascularize rather than amputate an injured digit as well as factors associated with successful replantation or revascularization. We reviewed 315 complete and subtotal amputations at or proximal to the

  4. Long-term functional health status of severely injured patients

    NARCIS (Netherlands)

    Holtslag, H. R.; Post, M. W.; Lindeman, E.; Van der Werken, Chr.

    Background: Studies of the consequences of major trauma have traditionally focused on mortality rates. The aims of this study were, firstly, to investigate the long-term functional health status in a large, unselected group of severely injured patients and to compare this with normative data, and

  5. Effect of sildenafil on erectile dysfunction in spinal Cord injured ...

    African Journals Online (AJOL)

    Effect of sildenafil on erectile dysfunction in spinal Cord injured patients. ... Trauma was the etiology in 87.5% of the cases (44% were road accidents). 12/16 patients were paraplegics (10 above ... in SCI patients. This approach is compatible with the efforts to improve the quality of life and rehabilitation of these patients.

  6. Repair and Enumeration of Injured Coliforms by a Plating Procedure

    Science.gov (United States)

    Speck, M. L.; Ray, B.; Read, R. B.

    1975-01-01

    Surface plating of coliforms on Trypticase soy agar, followed by 1 to 2 h of incubation at 25 C and subsequent overlay with violet red bile agar, was found to be a useful method for the repair and enumeration of coliforms injured by freezing. PMID:1092266

  7. Cognitive Rehabilitation and the Head-Injured Child.

    Science.gov (United States)

    Henry, Kevin

    1983-01-01

    Discusses development of cognitive rehabilitation therapy (which attempts to address intervention needs of traumatically brain-injured child), particular concerns at various stages of patients' recovery, some fundamental principles of treatment, and framework for viewing cognition functionally. Considers questions clinicians ask and strategies for…

  8. MANAGING THE INJURED CHILD: MORE THAN JUST TREATING ...

    African Journals Online (AJOL)

    Enrique

    There are issues of particular importance to injured children and situations where ... friendly language, and the caregiver should be allowed to stay with the child as long as possible. Equipment. Appropriately sized equipment similar to that needed for the management of ..... Child abuse and neglect occur in boys and girls of ...

  9. Recovery of an injured fornix in a stroke patient.

    Science.gov (United States)

    Yeo, Sang Seok; Jang, Sung Ho

    2013-11-01

    Knowledge about recovery of an injured fornix following brain injury is limited. We describe here a patient who showed recovery of an injured fornix following stroke. A 57-year-old female patient underwent coiling for a ruptured anterior communicating cerebral artery aneurysm, and conservative management for subarachnoid and intraventricular haemorrhage. The patient showed severe cognitive impairment 6 weeks after onset. However, her cognition showed continuous improvement with time; based on the Mini-Mental State Examination and the Memory Assessment Scale, her cognition was within the normal range 7 months after onset. Findings from diffusion tensor tractography at 6 weeks and 7 months showed discontinuations in both columns of the fornix. The proximal portion of both crus also showed discontinuation on diffusion tensor tractography at 6 weeks and 7 months; however, on 7-month diffusion tensor tractography, the end of the fornical body was shown to be connected to the splenium of the corpus callosum and then branched to the right medial temporal lobe and right thalamus. The unusual neural connection between the injured fornix and the thalamus appears to be a recovery phenomenon, which allows the injured fornix and the medial temporal lobe to obtain cholinergic innervation from cholinergic nuclei in the brainstem rather than from cholinergic nuclei in the basal forebrain.

  10. Midodrine improves ejaculation in spinal cord injured men.

    Science.gov (United States)

    Soler, J M; Previnaire, J G; Plante, P; Denys, P; Chartier-Kastler, E

    2007-11-01

    We evaluated the effect of the alpha1-adrenergic agonist midodrine given orally for anejaculation in spinal cord injured men. A total of 185 spinal cord injured patients who reported absent ejaculation during sexual intercourse and who failed to respond to penile vibratory stimulation were treated with midodrine 30 to 120 minutes before a new stimulation. The procedure was repeated weekly, increasing doses by 7.5 mg to a maximum of 30 mg. Cardiovascular effects were monitored throughout the procedure. Antegrade or retrograde ejaculation was achieved in 102 spinal cord injured men (64.6%). A positive response was more frequent in patients with complete lesions (American Spinal Injury Association A) and upper motor neuron lesions above T10. Midodrine induced a significant but moderate increase (maximum 10 mm Hg) in mean arterial pressure in all patients. The highest systolic blood pressure (more than 200 mm Hg) was seen in patients with quadriplegia. No other significant side effect was recorded. The average dose of midodrine required for ejaculation was 18.7 mg. Midodrine is a safe and efficient adjunct to penile vibratory stimulation for anejaculation in spinal cord injured patients.

  11. Anatomic Double Bundle single tunnel Foreign Material Free ACL-Reconstruction - a technical note.

    Science.gov (United States)

    Felmet, Gernot

    2011-10-01

    The anterior cruciate ligament (ACL) consists of two bundles, the anteromedial (AM) and posterolateral bundle (PM). Double bundle reconstructions appear to give better rotational stability. The usual technique is to make two tunnels in the femur and two in the tibia. This is difficult and in small knees may not even be possible. We have developed a foreign material free press fit fixation for double bundle ACL reconstruction using a single femoral tunnel ((R)). This is based on the ALL PRESS FIT ACL reconstruction. It is suitable for the most common medium and, otherwise difficult, small sizes of knees. Using diamond edged wet grinding hollow reamers, bone cylinders in different diameters are harvested from the implantation tunnels of the tibia and femur and used for the press fit fixation. Using the press fit technique the graft is first fixed in tibia. It is then similarly fixed under tension in the femoral side with the knee in 120 degree flexion. This is called Bottom To Top Fixation (BTT). On extending the knee the graft tension is self adapting. Depending on the size of the individual knee, the diameter of the femoral bone plug is varied from 8 to 13 mm to achieve an anatomic spread with a double bundle-like insertion. The tibia tunnel can be applied with two 7 or 8 mm diameter tunnels overlapping to a semi oval tunnel between 10 to 13 mm. Since May 2003 we have carried out ACL-reconstructions with Hamstring grafts without foreign material using the ALL PRESS FIT technique. Initially, an 8 mm press fit fixation was used proximally with good results. Since April 2008, the range of diameters was increased up to 13 mm. The results of the Lachman tests have been good to excellent. Results of the Pivot shift test suggested more stability with femoral broader diameters of 9,5 to 13 mm. The foreign material free fixation of ham-string in the ALL PRESS FIT Bottom To Top Fixation is a successful method for ACL Reconstruction. The Diamond Instruments and tubed guiding

  12. Role of biomechanics in the understanding of normal, injured, and healing ligaments and tendons

    Directory of Open Access Journals (Sweden)

    Jung Ho-Joong

    2009-05-01

    Full Text Available Abstract Ligaments and tendons are soft connective tissues which serve essential roles for biomechanical function of the musculoskeletal system by stabilizing and guiding the motion of diarthrodial joints. Nevertheless, these tissues are frequently injured due to repetition and overuse as well as quick cutting motions that involve acceleration and deceleration. These injuries often upset this balance between mobility and stability of the joint which causes damage to other soft tissues manifested as pain and other morbidity, such as osteoarthritis. The healing of ligament and tendon injuries varies from tissue to tissue. Tendinopathies are ubiquitous and can take up to 12 months for the pain to subside before one could return to normal activity. A ruptured medial collateral ligament (MCL can generally heal spontaneously; however, its remodeling process takes years and its biomechanical properties remain inferior when compared to the normal MCL. It is also known that a midsubstance anterior cruciate ligament (ACL tear has limited healing capability, and reconstruction by soft tissue grafts has been regularly performed to regain knee function. However, long term follow-up studies have revealed that 20–25% of patients experience unsatisfactory results. Thus, a better understanding of the function of ligaments and tendons, together with knowledge on their healing potential, may help investigators to develop novel strategies to accelerate and improve the healing process of ligaments and tendons. With thousands of new papers published in the last ten years that involve biomechanics of ligaments and tendons, there is an increasing appreciation of this subject area. Such attention has positively impacted clinical practice. On the other hand, biomechanical data are complex in nature, and there is a danger of misinterpreting them. Thus, in these review, we will provide the readers with a brief overview of ligaments and tendons and refer them to

  13. Critical components of neuromuscular training to reduce ACL injury risk in female athletes: meta-regression analysis.

    Science.gov (United States)

    Sugimoto, Dai; Myer, Gregory D; Barber Foss, Kim D; Pepin, Michael J; Micheli, Lyle J; Hewett, Timothy E

    2016-10-01

    The aim of this study was to determine key components in neuromuscular training that optimise ACL injury reduction in female athletes using meta-regression analyses. Systematic review and meta-regression. The literature search was performed in PubMed and EBSCO. Inclusion criteria for the current analysis were: (1) documented the number of ACL injuries, (2) employed a neuromuscular training intervention that aimed to reduce ACL injuries, (3) had a comparison group, (4) used a prospective control study design and (5) recruited female athletes as participants. Two independent reviewers extracted studies which met the inclusion criteria. Methodological quality of included study and strength of recommendation were evaluated. Number of ACL injuries and participants in control and intervention groups, age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and status of verbal feedback were extracted. The meta-regression analyses identified age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback as significant predictors of ACL injury reduction (p=0.01 in fixed-effects model, p=0.03 in random-effects model). Inclusion of 1 of the 4 components in neuromuscular training could reduce ACL injury risk by 17.2-17.7% in female athletes. No significant heterogeneity and publication bias effects were detected. Strength of recommendation was rated as A (recommendation based on consistent and good-quality patient-oriented study evidence). Age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback are predictors that influence the optimisation of prophylactic effects of neuromuscular training and the resultant ACL injury reduction in female athletes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  14. Critical components of neuromuscular training to reduce ACL injury risk in female athletes: meta-regression analysis

    Science.gov (United States)

    Sugimoto, Dai; Myer, Gregory D; Barber Foss, Kim D; Pepin, Michael J; Micheli, Lyle J; Hewett, Timothy E

    2017-01-01

    Objective The aim of this study was to determine key components in neuromuscular training that optimise ACL injury reduction in female athletes using meta-regression analyses. Design Systematic review and meta-regression. Data sources The literature search was performed in PubMed and EBSCO. Eligibility criteria Inclusion criteria for the current analysis were: (1) documented the number of ACL injuries, (2) employed a neuromuscular training intervention that aimed to reduce ACL injuries, (3) had a comparison group, (4) used a prospective control study design and (5) recruited female athletes as participants. Two independent reviewers extracted studies which met the inclusion criteria. Methodological quality of included study and strength of recommendation were evaluated. Number of ACL injuries and participants in control and intervention groups, age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and status of verbal feedback were extracted. Results The meta-regression analyses identified age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback as significant predictors of ACL injury reduction (p=0.01 in fixed-effects model, p=0.03 in random-effects model). Inclusion of 1 of the 4 components in neuromuscular training could reduce ACL injury risk by 17.2–17.7% in female athletes. No significant heterogeneity and publication bias effects were detected. Strength of recommendation was rated as A (recommendation based on consistent and good-quality patient-oriented study evidence). Conclusions Age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback are predictors that influence the optimisation of prophylactic effects of neuromuscular training and the resultant ACL injury reduction in female athletes. PMID:27251898

  15. Transportal femoral drilling creates more horizontal ACL graft orientation compared to transtibial drilling: A 3D CT imaging study.

    Science.gov (United States)

    Clockaerts, S; Van Haver, A; Verhaegen, J; Vuylsteke, K; Leenders, T; Lagae, K C; Verdonk, P

    2016-06-01

    The principle of anatomic anterior cruciate ligament (ACL) reconstruction is to create a femoral and tibial tunnel that resembles the insertion of the native ACL. Anatomic reconstruction leads to a more horizontal graft orientation that provides more rotational stability. The aim of this study is to investigate the best method to achieve anatomical reconstruction of femoral insertion of the ACL and thus, a more horizontal orientation of the ACL. We compared tunnel position and orientation between transportal femoral drilling technique and transtibial technique. Thirty-two patients were included. Post-operative CT scans were obtained and femur, tibia and ACL tunnels were reconstructed. The position and orientation of tibial and femoral tunnels were quantified using the quadrant method, and femoral tunnel length, ellipticity and posterior wall breakage were assessed. We also investigated clinical outcome. Analyses show that transportal drilled femoral tunnels were situated significantly lower than transtibial drilled tunnels (p<0.0001), resulting in a significantly more horizontal oriented ACL in the transportal group in coronal (p<0.0001) and sagittal plane (p=0.01). No differences were observed in depth of femoral tunnel position (p=0.44). Femoral tunnel length was shorter in the transportal group (p=0.01) with a more ellipsoidal femoral aperture (p=0.01). There were no differences between both groups in tibial position. There were no differences in clinical outcome measure between the transportal and transtibial groups. This study indicates that transportal drilling of the femoral tunnel leads to a more horizontal graft orientation of the ACL, without differences in clinical outcome. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Painful knee joint after ACL reconstruction using biodegradable interference screws- SPECT/CT a valuable diagnostic tool? A case report

    Directory of Open Access Journals (Sweden)

    Hirschmann Michael T

    2010-09-01

    Full Text Available Abstract With the presented case we strive to introduce combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT as new diagnostic imaging modality and illustrate the possible clinical value in patients after ACL reconstruction. We report the case of a painful knee due to a foreign body reaction and delayed degradation of the biodegradable interference screws after ACL reconstruction. The MRI showed an intact ACL graft, a possible tibial cyclops lesion and a patella infera. There was no increased fluid collection within the bone tunnels. The 99mTc-HDP-SPECT/CT clearly identified a highly increased tracer uptake around and within the tibial and femoral tunnels and the patellofemoral joint. On 3D-CT out of the SPECT/CT data the femoral graft attachment was shallow (50% along the Blumensaat's line and high in the notch. At revision arthroscopy a diffuse hypertrophy of the synovium, scarring of the Hoffa fat pad and a cyclops lesion of the former ACL graft was found. The interference screws were partially degraded and under palpation and pressure a grey fluid-like substance drained into the joint. The interference screws and the ACL graft were removed and an arthrolysis performed. In the case presented it was most likely a combination of improper graft placement, delayed degradation of the interference screws and unknown biological factors. The too shallow and high ACL graft placement might have led to roof impingement, chronic intraarticular inflammation and hence the delayed degradation of the screws. SPECT/CT has facilitated the establishment of diagnosis, process of decision making and further treatment in patients with knee pain after ACL reconstruction. From the combination of structural (tunnel position in 3D-CT and metabolic information (tracer uptake in SPECT/CT the patient's cause of the pain was established.

  17. The ACL GTA, an advanced turbo alternator for marine application; L'ACL GTA, un turboalternateur de conception avancee pour applications navales

    Energy Technology Data Exchange (ETDEWEB)

    Poumarede, V. [Turbomeca, Groupe Safran, 64 - Bordes (France)

    2006-04-15

    In December 2000, the British Ministry of Defence and french DGA awarded Turbomeca the development contract of a new turbogenerator rated at 1,8 MW, designed for auxiliary power generation on board of the latest 'All Electric' warships generation. The prime mover of this generator set is an industrial gas turbine using a recuperated cycle whose heat recuperator significantly increases the engine efficiency, further improved at part load thanks to a variable speed control. The voltage supplied by the permanent magnets alternator, directly driven by the gas turbine at a speed of 22 500 rpm, is rectified by a power electronics cabinet and supplies the ship's grid with 800 V DC voltage. Particularly lightweight and compact, the ACL GTA has a reduced specific fuel consumption of around 225 g/kWhe at nominal load, while also offering high performances in terms of vibration levels, reliability, maintenance requirements, transient stability and exhaust emissions. (author)

  18. Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? A prospective observational study

    DEFF Research Database (Denmark)

    Johansson, Per Ingemar; Sorensen, Anne Marie; Perner, Anders

    2011-01-01

    ABSTRACT: INTRODUCTION: It is debated whether the early trauma induced coagulopathy (TIC) in severely injured patients reflects disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype, acute coagulopathy of trauma shock (ACoTS) or yet other entities. This study investigated...

  19. Characteristics of injured children attending the emergency department : patients potentially in need of rehabilitation

    NARCIS (Netherlands)

    Sturms, L.M.; van der Sluis, C.K.; Groothoff, J.W.; Ten Duis, H.J.; Eisma, W.H.

    Objective: To provide an epidemiological overview of the characteristics of injured children and to compare hospitalized and nonhospitalized injured children to identify predictors of hospitalization and, with that, possible predictors of disablement. Design: Retrospective analysis of data obtained

  20. Effect of ski boot rear stiffness (SBRS) on maximal ACL force during injury prone landing movements in alpine ski racing: A study with a musculoskeletal simulation model.

    Science.gov (United States)

    Eberle, Robert; Heinrich, Dieter; Kaps, Peter; Oberguggenberger, Michael; Nachbauer, Werner

    2017-06-01

    A common anterior cruciate ligament (ACL) injury situation in alpine ski racing is landing back-weighted after a jump. Simulated back-weighted landing situations showed higher ACL-injury risk for increasing ski boot rear stiffness (SBRS) without considering muscles. It is well known that muscle forces affect ACL tensile forces during landing. The purpose of this study is to investigate the effect of different SBRS on the maximal ACL tensile forces during injury prone landings considering muscle forces by a two-dimensional musculoskeletal simulation model. Injury prone situations for ACL-injuries were generated by the musculoskeletal simulation model using measured kinematics of a non-injury situation and the method of Monte Carlo simulation. Subsequently, the SBRS was varied for injury prone landings. The maximal ACL tensile forces and contributing factors to the ACL forces were compared for the different SBRS. In the injury prone landings the maximal ACL tensile forces increased with increasing SBRS. It was found that the higher maximal ACL force was caused by higher forces acting on the tibia by the boot and by higher quadriceps muscle forces both due to the higher SBRS. Practical experience suggested that the reduction of SBRS is not accepted by ski racers due to performance reasons. Thus, preventive measures may concentrate on the reduction of the quadriceps muscle force during impact.

  1. Corticotherapy for traumatic brain-injured Patients - The Corti-TC trial: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Asehnoune Karim

    2011-10-01

    Full Text Available Abstract Background Traumatic brain injury (TBI is a main cause of severe prolonged disability of young patients. Hospital acquired pneumonia (HAP add to the morbidity and mortality of traumatic brain-injured patients. In one study, hydrocortisone for treatment of traumatic-induced corticosteroid insufficiency (CI in multiple injured patients has prevented HAP, particularly in the sub-group of patients with severe TBI. Fludrocortisone is recommended in severe brain-injured patients suffering from acute subarachnoid hemorrhage. Whether an association of hydrocortisone with fludrocortisone protects from HAP and improves neurological recovery is uncertain. The aim of the current study is to compare corticotherapy to placebo for TBI patients with CI. Methods The CORTI-TC (Corticotherapy in traumatic brain-injured patients trial is a multicenter, randomized, placebo controlled, double-blind, two-arms study. Three hundred and seventy six patients hospitalized in Intensive Care Unit with a severe traumatic brain injury (Glasgow Coma Scale ≤ 8 are randomized in the first 24 hours following trauma to hydrocortisone (200 mg.day-1 for 7 days, 100 mg on days 8-9 and 50 mg on day-10 with fludrocortisone (50 μg for 10 days or double placebo. The treatment is stopped if patients have an appropriate adrenal response. The primary endpoint is HAP on day-28. The endpoint of the ancillary study is the neurological status on 6 and 12 months. Discussion The CORTI-TC trial is the first randomized controlled trial powered to investigate whether hydrocortisone with fludrocortisone in TBI patients with CI prevent HAP and improve long term recovery. Trial registration NCT01093261

  2. Caring for the injured child in settings of limited resource.

    Science.gov (United States)

    Stephenson, Jacob

    2016-02-01

    Children represent the most vulnerable members of our global society, a truth that is magnified when they are physically wounded. In much of the developed world, society has responded by offering protection in the form of law, injury prevention guidelines, and effective trauma systems to provide care for the injured child. Much of our world, though, remains afflicted by poverty and a lack of protective measures. As the globe becomes smaller by way of ease of travel and technology, surgeons are increasingly able to meet these children where they live and in doing so offer their hands and voices to care and protect these young ones. This article is intended as an overview of current issues in pediatric trauma care in the developing world as well as to offer some tips for the volunteer surgeon who may be involved in the care of the injured child in a setting of limited resource availability. Published by Elsevier Inc.

  3. Characterization of high hydrostatic pressure-injured Bacillus subtilis cells.

    Science.gov (United States)

    Inaoka, Takashi; Kimura, Keitarou; Morimatsu, Kazuya; Yamamoto, Kazutaka

    2017-06-01

    High hydrostatic pressure (HHP) affects various cellular processes. Using a sporulation-deficient Bacillus subtilis strain, we characterized the properties of vegetative cells subjected to HHP. When stationary-phase cells were exposed to 250 MPa of HHP for 10 min at 25 °C, approximately 50% of cells were viable, although they exhibited a prolonged growth lag. The HHP-injured cells autolyzed in the presence of NaCl or KCl (at concentrations ≥100 mM). Superoxide dismutase slightly protected the viability of HHP-treated cells, whereas vegetative catalases had no effect. Thus, unlike HHP-injured Escherichia coli, oxidative stress only slightly affected vegetative B. subtilis subjected to HHP.

  4. Enhanced susceptibility to urinary tract infection in the spinal cord-injured host with neurogenic bladder.

    Science.gov (United States)

    Balsara, Zarine R; Ross, Sherry S; Dolber, Paul C; Wiener, John S; Tang, Yuping; Seed, Patrick C

    2013-08-01

    Neurogenic bladder predisposes to recurrent urinary tract infections (UTI) and renal failure, and susceptibility is commonly ascribed to urinary stasis from elevated residual urine volumes. Escherichia coli UTI was modeled in the spinal cord-injured (SCI) rat with the hypothesis that SCI animals would require fewer bacteria to establish infection, have an exaggerated inflammatory response, and have delayed clearance of infection compared to normal-voiding controls. T10 SCI rats and controls had median infectious doses (ID50) of 10(2) and 10(5) CFU, respectively. Mean residual volumes in the SCI animals did not correlate with susceptibility to initiation of UTI or outcome. In the acute infection, control and SCI rats developed acute cystitis and pyelitis without acute differences in histopathological scores of inflammation. However, in vivo imaging of infected animals revealed persistently higher levels of bacteria in the SCI urine and bladders than were seen for controls over 2 weeks. Likewise, at 2 weeks, acute and chronic inflammatory infiltrates persisted in the bladders and kidneys of SCI rats, whereas inflammation largely resolved within the controls. Together these data demonstrate that SCI rats exhibit delayed clearance of infection and exaggerated inflammatory responses in bladders and kidneys; however, the severity of residual volumes does not predict increased susceptibility to UTI. These studies suggest that host-dependent mechanisms that are discrete from alterations in bladder physiology influence UTI susceptibility with the SCI-neurogenic bladder. This model will allow elucidation of SCI-neurogenic bladder-mediated changes in host response that yield UTI susceptibility and may lead to new preventative and therapeutic options.

  5. Psychiatric morbidity among physically injured Syrian refugees in Turkey.

    Science.gov (United States)

    Al-Nuaimi, Saleem; Aldandashi, Samer; Easa, Abdul Kadir Saed; Saqqur, Maher

    2018-01-01

    To the best of our knowledge, the mental health status of physically injured Syrian refugees has not yet been investigated. The aim of this study was to examine the prevalence of psychiatric morbidity among physically injured Syrian refugees in Turkey receiving treatment at the main rehabilitation centre near the Syrian border. This is a cross sectional study. Information was collected from consenting injured Syrian refugees at Dar-el-Shefa'a Hospital in Reyhanlı (Turkey) during a one week period in December 2012 and another one week period in August 2013. A clinical psychiatric interview was conducted to determine a diagnosis according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV-TR. A total of 40 refugees consented and completed a clinical psychiatric interview. All refugees in this study did not have a significant past psychiatric history. The most prevalent current diagnosis was major depressive disorder (22.5%), adjustment disorder (20%), and post-traumatic stress disorder (15%). Five (12.5%) patients had no evidence of a psychiatric disorder. The prevalence of psychiatric morbidity among injured Syrian refugees in our study was extremely high. This may help guide the treatment and management of this select population. This study had a low number of participants. The method of assessment was not standardized with a validated tool. This study may help guide the treatment and management of this select population, both in neighbouring countries and as resettled refugees in Western host countries. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Employment Effects of educational measures for work-injured people

    DEFF Research Database (Denmark)

    Bach, Henning Bjerregaard; Datta Gupta, Nabanita; Høgelund, Jan

    employers a partial wage subsidy for disabled workers’ wages, by distinguishing between education effects of a return to wage-subsidized work versus a return to ordinary work. Unlike previous studies, we find a positive impact of educational measures on the probability of returning to work for the work...... injured and a stronger effect for a return to wage-subsidized employment compared to a return to ordinary employment....

  7. Use of Knee Extension Device During Rehabilitation of a Patient with Type 3 Arthrofibrosis after ACL Reconstruction.

    Science.gov (United States)

    Biggs, Angie; Shelbourne, K Donald

    2006-08-01

    Arthrofibrosis is a frequent complication following rehabilitation of a patient with anterior cruciate ligament (ACL) reconstruction. Although prevention is the best treatment, little information exists within the literature regarding the management and rehabilitation intervention for arthrofibrosis. In this case report a rehabilitation program in the treatment of a patient with arthrofibrosis is described. To identify the importance of discrete measures of knee range of motion in the knee of a patient following ACL reconstruction in order to help prevent postoperative complications. The patient was an 18-year-old female who sustained an ACL and medial collateral ligament (MCL) injury in a basketball game and underwent an ACL reconstruction with an ipsilateral patellar tendon graft. The patient developed arthrofibrosis and, despite traditional physical therapy of therapeutic exercise and manual therapy, the patient continued to complain of pain, stiffness, limited activities of daily living, and the inability to participate in competitive sports. This patient used a knee extension device as part of her rehabilitation program. The patient was able to obtain knee extension and flexion equal to her opposite normal knee. Upon completion of the rehabilitation program, the patient returned to full activities of daily living and competitive sports. Increasing and maintaining knee extension that is equal to the opposite normal knee is an important component in the successful outcome for the patient after ACL reconstruction. The use of a knee extension device may provide an effective rehabilitation intervention in the treatment of arthrofibrosis.

  8. Mitochondria Localize to Injured Axons to Support Regeneration.

    Science.gov (United States)

    Han, Sung Min; Baig, Huma S; Hammarlund, Marc

    2016-12-21

    Axon regeneration is essential to restore the nervous system after axon injury. However, the neuronal cell biology that underlies axon regeneration is incompletely understood. Here we use in vivo, single-neuron analysis to investigate the relationship between nerve injury, mitochondrial localization, and axon regeneration. Mitochondria translocate into injured axons so that average mitochondria density increases after injury. Moreover, single-neuron analysis reveals that axons that fail to increase mitochondria have poor regeneration. Experimental alterations to axonal mitochondrial distribution or mitochondrial respiratory chain function result in corresponding changes to regeneration outcomes. Axonal mitochondria are specifically required for growth-cone migration, identifying a key energy challenge for injured neurons. Finally, mitochondrial localization to the axon after injury is regulated in part by dual-leucine zipper kinase 1 (DLK-1), a conserved regulator of axon regeneration. These data identify regulation of axonal mitochondria as a new cell-biological mechanism that helps determine the regenerative response of injured neurons. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Decreased mortality after prehospital interventions in severely injured trauma patients.

    Science.gov (United States)

    Meizoso, Jonathan P; Valle, Evan J; Allen, Casey J; Ray, Juliet J; Jouria, Jassin M; Teisch, Laura F; Shatz, David V; Namias, Nicholas; Schulman, Carl I; Proctor, Kenneth G

    2015-08-01

    We test the hypothesis that prehospital interventions (PHIs) performed by skilled emergency medical service providers during ground or air transport adversely affect outcome in severely injured trauma patients. Consecutive trauma activations (March 2012 to June 2013) transported from the scene by air or ground emergency medical service providers were reviewed. PHI was defined as intubation, needle decompression, tourniquet, cricothyroidotomy, or advanced cardiac life support. In 3,733 consecutive trauma activations (71% blunt, 25% penetrating, 4% burns), age was 39 years, 74% were male, Injury Severity Score (ISS) was 5, and Glasgow Coma Score (GCS) was 15, with 32% traumatic brain injury (TBI) and 7% overall mortality. Those who received PHI (n = 130, 3.5% of the trauma activations) were more severely injured: ISS (26 vs. 5), GCS (3 vs. 15), TBI (57% vs. 31%), Revised Trauma Score (RTS, 5.45 vs. 7.84), Trauma and Injury Severity Score (TRISS, 1.32 vs. 4.89), and mortality (56% vs. 5%) were different (all p blunt injury, high ISS, and long prehospital times (all p blunt trauma, and air transport were similar, but mortality was significantly lower (43% vs. 23%, p= 0.021). In our urban trauma system, PHIs are associated with a lower incidence of mortality in severely injured trauma patients and do not delay transport to definitive care. Prognostic/epidemiologic study, level III; therapeutic study, level IV.

  10. Inefficacy of Kinesio-Taping(®) on early postoperative pain after ACL reconstruction: Prospective comparative study.

    Science.gov (United States)

    Laborie, M; Klouche, S; Herman, S; Gerometta, A; Lefevre, N; Bohu, Y

    2015-12-01

    Kinesio-Taping(®) (K-Tape) is used in sports traumatology with the aim of reducing pain and improving blood and lymph circulation. The main objective of the present study was to assess the efficacy of K-Tape on early postoperative pain after anterior cruciate ligament (ACL) reconstruction. The study hypothesis was that K-Tape significantly decreases pain. A prospective non-randomized comparative study was conducted in 2013-2014 and included all patients who underwent primary ACL reconstruction by hamstring graft. Analgesia was standardized. Two groups, "K-Tape" and "controls", were formed according to the days on which the study physiotherapist was present. The K-Tape compression/decompression assembly was applied immediately postoperatively and maintained for 3days. Patients filled out online questionnaires. The main assessment criterion was mean postoperative pain (D0-D3) on a 0-to-10 scale. Secondary criteria were analgesia intake on the three WHO levels, awakening during the night of D0 due to pain, signs of postoperative discomfort, and patient satisfaction. Sixty patients (30 per group) were included, 57 of whom could be assessed: 28 K-Tape, 29 controls; 44 male, 13 female; mean age, 30.9±8.9 years. At inclusion, the two groups were comparable. There was no significant difference in mean (D0-D3) knee pain intensity: 3.8±2.2 for K-Tape, and 3.9±2 for controls (P=0.93). Analysis of variance (ANOVA) found no significant intergroup difference in evolution of pain (P=0.34). There were no other significant differences on the other assessment criteria. K-Tape showed no efficacy on early postoperative pain following ACL reconstruction. III; prospective non-randomized comparative study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  11. Genome-wide association screens for Achilles tendon and ACL tears and tendinopathy.

    Directory of Open Access Journals (Sweden)

    Stuart K Kim

    Full Text Available Achilles tendinopathy or rupture and anterior cruciate ligament (ACL rupture are substantial injuries affecting athletes, associated with delayed recovery or inability to return to competition. To identify genetic markers that might be used to predict risk for these injuries, we performed genome-wide association screens for these injuries using data from the Genetic Epidemiology Research on Adult Health and Aging (GERA cohort consisting of 102,979 individuals. We did not find any single nucleotide polymorphisms (SNPs associated with either of these injuries with a p-value that was genome-wide significant (p<5x10-8. We found, however, four and three polymorphisms with p-values that were borderline significant (p<10-6 for Achilles tendon injury and ACL rupture, respectively. We then tested SNPs previously reported to be associated with either Achilles tendon injury or ACL rupture. None showed an association in our cohort with a false discovery rate of less than 5%. We obtained, however, moderate to weak evidence for replication in one case; specifically, rs4919510 in MIR608 had a p-value of 5.1x10-3 for association with Achilles tendon injury, corresponding to a 7% chance of false replication. Finally, we tested 2855 SNPs in 90 candidate genes for musculoskeletal injury, but did not find any that showed a significant association below a false discovery rate of 5%. We provide data containing summary statistics for the entire genome, which will be useful for future genetic studies on these injuries.

  12. CORE STABILIZATION EXERCISES AFTER ACL RECONSTRUCTION SURGERY PROVIDES BETTER OUTCOMES: A RANDOMIZED CONTROLLED TRIAL

    Directory of Open Access Journals (Sweden)

    Dilpreet Kaur

    2015-12-01

    Full Text Available Background: Decreased core stability displaces center of gravity away from base of support reducing activity participation of athlete. Present study was conducted to study the effect of core stabilization exercises after reconstruction surgery of ACL on functional outcomes. Methods: 30 subjects following 5 months of ACL reconstruction were randomly assigned to either group that performed (study group or did not performed (control group additional core stabilization exercises in conjugation with standard rehabilitation protocol. Outcome measures were: activity level using Tegnar activity level scale and functional performance using triple hop test. Outcome measures were compared at day 1 and day 42 of the treatment. Result: Significant improvement was seen in the study group for Tegnar score with mean difference changing from 4.5 to 1.5 from day 1 to day 42 of treatment (p=0.039 while the control group showed improvement in mean difference changing from 3.8 to 1.4 (p=.045 from day 1 to day 42 of treatment. Highly significant improvement was seen in the study group for triple hop test with mean difference changing from 25 to 6.7 (p<.001 compared to the control group with mean difference changing from 15.2 to 9.7(p=.005 from day 1 to day 42 of treatment. Conclusions: Both the groups showed improvement for activity level and functional performance but highly significant improvement was seen in the study group for functional performance. Core stabilization exercises in conjugation with the standard ACL rehabilitation protocol results better improvement in the triple hop test.

  13. Genome-wide association screens for Achilles tendon and ACL tears and tendinopathy

    Science.gov (United States)

    Roos, Thomas R.; Roos, Andrew K.; Kleimeyer, John P.; Ahmed, Marwa A.; Goodlin, Gabrielle T.; Fredericson, Michael; Ioannidis, John P. A.; Avins, Andrew L.; Dragoo, Jason L.

    2017-01-01

    Achilles tendinopathy or rupture and anterior cruciate ligament (ACL) rupture are substantial injuries affecting athletes, associated with delayed recovery or inability to return to competition. To identify genetic markers that might be used to predict risk for these injuries, we performed genome-wide association screens for these injuries using data from the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort consisting of 102,979 individuals. We did not find any single nucleotide polymorphisms (SNPs) associated with either of these injuries with a p-value that was genome-wide significant (p<5x10-8). We found, however, four and three polymorphisms with p-values that were borderline significant (p<10−6) for Achilles tendon injury and ACL rupture, respectively. We then tested SNPs previously reported to be associated with either Achilles tendon injury or ACL rupture. None showed an association in our cohort with a false discovery rate of less than 5%. We obtained, however, moderate to weak evidence for replication in one case; specifically, rs4919510 in MIR608 had a p-value of 5.1x10-3 for association with Achilles tendon injury, corresponding to a 7% chance of false replication. Finally, we tested 2855 SNPs in 90 candidate genes for musculoskeletal injury, but did not find any that showed a significant association below a false discovery rate of 5%. We provide data containing summary statistics for the entire genome, which will be useful for future genetic studies on these injuries. PMID:28358823

  14. A comparison of hamstring muscle activity during different screening tests for non-contact ACL injury.

    Science.gov (United States)

    Husted, Rasmus S; Bencke, Jesper; Andersen, Lars L; Myklebust, Grethe; Kallemose, Thomas; Lauridsen, Hanne B; Hölmich, Per; Aagaard, Per; Zebis, Mette K

    2016-06-01

    Reduced ability to activate the medial hamstring muscles during a sports-specific sidecutting movement has been found to be a potential risk factor for non-contact ACL injury. However, whether a reduced ability to activate the medial hamstring muscle is a general neuromuscular phenomenon and thereby observable independently of the type of clinical screening tests used is not known. This cross sectional study investigated the rank correlation of knee joint neuromuscular activity between three different ACL injury risk screening tests. Sixty-two adolescent female elite football and handball players (16.7±1.3years) participated in the study. Using surface electromyography (EMG) assessment, the neuromuscular activity of medial hamstring muscle (semitendinosus, ST), lateral hamstring muscle (biceps femoris, BF) and quadriceps muscle (vastus lateralis, VL) were monitored during three standardized screening tests - i.e. one-legged horizontal hop (OLH), drop vertical jump (DJ) and sidecutting (SC). Neuromuscular pre-activity was measured in the time interval 10ms prior to initial contact on a force plate. For neuromuscular hamstring muscle pre-activity, correlation analysis (Spearman correlation coefficient) showed low-to-moderate correlations between SC and 1) DJ (rs=0.34-0.36, Phamstring pre-activity share some common variance during the examined tests. However, a lack of strong correlation suggests that we cannot generalize one risk factor during one test to another test. The present data demonstrate that one-legged horizontal hop and drop vertical jump testing that are commonly used in the clinical setting does not resemble the specific neuromuscular activity patterns known to exist during sidecutting, a well known high risk movement for non-contact ACL injury. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Iliotibial band autograft versus bone-patella-tendon-bone autograft, a possible alternative for ACL reconstruction

    DEFF Research Database (Denmark)

    Stensbirk, Frederik; Thorborg, Kristian; Konradsen, Lars

    2014-01-01

    reconstruction. Forty-nine participated at follow-up in 2010 (82%). Primary outcome was the failure rate after ACL reconstruction. Secondary outcomes were knee injury osteoarthritis outcome score (KOOS) [pain, symptoms, Sport/Rec, quality of life (QOL), daily living function], Tegner activity scale, anterior...... knee pain-score, Lysholm score, Rolimeter laxity, extension deficit, single hop and crossover hop for distance. RESULTS: At 15-year follow-up, no significant difference existed between the groups. Graft failure occurred in 4 ITB subjects (16%) and 3 BPTB subjects (13%). KOOS (Sport/Rec) for the ITB...

  16. Differences in muscle strength after ACL reconstruction do not influence cardiorespiratory responses to isometabolic exercise

    Directory of Open Access Journals (Sweden)

    Marília S. Andrade

    2014-05-01

    Full Text Available Objectives: To investigate whether the muscle strength decrease that follows anterior cruciate ligament (ACL reconstruction would lead to different cardiorespiratory adjustments during dynamic exercise. Method: Eighteen active male subjects were submitted to isokinetic evaluation of knee flexor and extensor muscles four months after ACL surgery. Thigh circumference was also measured and an incremental unilateral cardiopulmonary exercise test was performed separately for both involved and uninvolved lower limbs in order to compare heart rate, oxygen consumption, minute ventilation, and ventilatory pattern (breath rate, tidal volume, inspiratory time, expiratory time, tidal volume/inspiratory time at three different workloads (moderate, anaerobic threshold, and maximal. Results: There was a significant difference between isokinetic extensor peak torque measured in the involved (116.5±29.1 Nm and uninvolved (220.8±40.4 Nm limbs, p=0.000. Isokinetic flexor peak torque was also lower in the involved limb than in the uninvolved limb (107.8±15.4 and 132.5±26.3 Nm, p=0.004, respectively. Lower values were also found in involved thigh circumference as compared with uninvolved limb (46.9±4.3 and 48.5±3.9 cm, p=0.005, respectively. No differences were found between the lower limbs in any of the variables of the incremental cardiopulmonary tests at all exercise intensities. Conclusions: Our findings indicate that, four months after ACL surgery, there is a significant deficit in isokinetic strength in the involved limb, but these differences in muscle strength requirement do not produce differences in the cardiorespiratory adjustments to exercise. Based on the hypotheses from the literature which explain the differences in the physiological responses to exercise for different muscle masses, we can deduce that, after 4 months of a rehabilitation program after an ACL reconstruction, individuals probably do not present differences in muscle oxidative and

  17. Development of the Knee Numeric-Entity Evaluation Score (KNEES – ACL)

    DEFF Research Database (Denmark)

    Comins, J D; Krogsgaard, M R; Brodersen, J

    2013-01-01

    patients, item relevance and comprehensiveness can only be confirmed by the patient (content validity). Focus group and single interviews were conducted with patients' pre- and post-ACL reconstruction in order to construct a condition-specific PROM for the target patients. One hundred fifty-seven items...... from a previously conducted literature search were used as a basis for content genesis. Content saturation was achieved after three focus groups and seven single interviews. Thirty-eight items from the literature search were directly endorsed, and five modified items were endorsed. Twelve new item...... survey to assess the psychometric properties will be performed using Rasch measurement theory....

  18. Antiphospholipid Antibody Syndrome With Valvular Vegetations in Acute Q Fever.

    Science.gov (United States)

    Million, Matthieu; Thuny, Franck; Bardin, Nathalie; Angelakis, Emmanouil; Edouard, Sophie; Bessis, Simon; Guimard, Thomas; Weitten, Thierry; Martin-Barbaz, François; Texereau, Michèle; Ayouz, Khelifa; Protopopescu, Camelia; Carrieri, Patrizia; Habib, Gilbert; Raoult, Didier

    2016-03-01

    Coxiella burnetii endocarditis is considered to be a late complication of Q fever in patients with preexisting valvular heart disease (VHD). We observed a large transient aortic vegetation in a patient with acute Q fever and high levels of IgG anticardiolipin antibodies (IgG aCL). Therefore, we sought to determine how commonly acute Q fever could cause valvular vegetations associated with antiphospholipid antibody syndrome, which would be a new clinical entity. We performed a consecutive case series between January 2007 and April 2014 at the French National Referral Center for Q fever. Age, sex, history of VHD, immunosuppression, and IgG aCL assessed by enzyme-linked immunosorbent assay were tested as potential predictors. Of the 759 patients with acute Q fever and available echocardiographic results, 9 (1.2%) were considered to have acute Q fever endocarditis, none of whom had a previously known VHD. After multiple adjustment, very high IgG aCL levels (>100 immunoglobulin G-type phospholipid units; relative risk [RR], 24.9 [95% confidence interval {CI}, 4.5-140.2]; P = .002) and immunosuppression (RR, 10.1 [95% CI, 3.0-32.4]; P = .002) were independently associated with acute Q fever endocarditis. Antiphospholipid antibody syndrome with valvular vegetations in acute Q fever is a new clinical entity. This would suggest the value of systematically testing for C. burnetii in antiphospholipid-associated cardiac valve disease, and performing early echocardiography and antiphospholipid dosages in patients with acute Q fever. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  19. Falling up the stairs: the equivalent of 'bashing it with a bible' for an ACL ganglion cyst of the knee.

    Science.gov (United States)

    Dacombe, Peter Jonathan; Robinson, James

    2012-03-27

    Intra-articular anterior cruciate ligament (ACL) cysts are rare, the pathogenesis remains unknown, with trauma often implicated. Often asymptomatic, incidental MRI findings, 11% produce symptoms such as pain, locking or instability. Treatment of intra-articular ganglia differs from the traditional 'bash it with a bible' mantra for ganglia elsewhere with surgical debridement generally indicated for symptomatic cases. This case report describes a 43-year-old male car mechanic who presented with a symptomatic ACL cyst diagnosed on MRI. While waiting for surgery the patient fell up his stairs at home, causing forced hyperflexion of his knee. After an initial sharp pain, within 24 h the patient experienced complete resolution of symptoms. Postfall MRI showed no evidence of the initial lesion, leading to our conclusion that for this patient, a fall up the stairs was the equivalent of 'bashing it with a bible' for an ACL ganglion cyst of the knee.

  20. ACL reconstruction

    Science.gov (United States)

    ... and insert other medical instruments. Your surgeon will fix any other damage found, and then will replace ... your surgeon will close your cuts with sutures (stitches) and cover the area with a dressing. You ...

  1. High non-anatomic tunnel position rates in ACL reconstruction failure using both transtibial and anteromedial tunnel drilling techniques.

    Science.gov (United States)

    Jaecker, Vera; Zapf, Tabea; Naendrup, Jan-Hendrik; Pfeiffer, Thomas; Kanakamedala, Ajay C; Wafaisade, Arasch; Shafizadeh, Sven

    2017-09-01

    Although it is well known from cadaveric and biomechanical studies that transtibial femoral tunnel (TT) positioning techniques are associated with non-anatomic tunnel positions, controversial data exist as so far no clinical differences could have been found, comparing transtibial with anteromedial techniques (AM). The purpose of the study was to analyze if graft failure following TT ACL reconstruction was more commonly associated with non-anatomic tunnel position in comparison with the AM technique. We hypothesized that, compared to AM techniques, non-anatomic tunnel positions correlate with TT tunnel positioning techniques. A total of 147 cases of ACL revision surgery were analyzed retrospectively. Primary ACL reconstructions were analyzed regarding the femoral tunnel drilling technique. Femoral and tibial tunnel positions were determined on CT scans using validated radiographic measurement methods. Correlation analysis was performed to determine differences between TT and AM techniques. A total of 101 cases were included, of whom 64 (63.4%) underwent the TT technique and 37 (36.6%) the AM technique for primary ACL reconstruction. Non-anatomic femoral tunnel positions were found in 77.2% and non-anatomical tibial tunnel positions in 40.1%. No correlations were found comparing tunnel positions in TT and AM techniques, revealing non-anatomic femoral tunnel positions in 79.7 and 73% and non-anatomic tibial tunnel positions in 43.7 and 35.1%, respectively (p > 0.05). Considerable rates of non-anatomic femoral and tibial tunnel positions were found in ACL revisions with both transtibial and anteromedial femoral drilling techniques. Despite the potential of placing tunnels more anatomically using an additional AM portal, this technique does not ensure anatomic tunnel positioning. Consequently, the data highlight the importance of anatomic tunnel positioning in primary ACL reconstruction, regardless of the applied drilling technique.

  2. Copy number variation in CEP57L1 predisposes to congenital absence of bilateral ACL and PCL ligaments.

    Science.gov (United States)

    Liu, Yichuan; Li, Yun; March, Michael E; Nguyen, Kenny; Kenny, Nguyen; Xu, Kexiang; Wang, Fengxiang; Guo, Yiran; Keating, Brendan; Glessner, Joseph; Li, Jiankang; Ganley, Theodore J; Zhang, Jianguo; Deardorff, Matthew A; Xu, Xun; Hakonarson, Hakon

    2015-11-11

    Absence of the anterior (ACL) or posterior cruciate ligament (PCL) are rare congenital malformations that result in knee joint instability, with a prevalence of 1.7 per 100,000 live births and can be associated with other lower-limb abnormalities such as ACL agnesia and absence of the menisci of the knee. While a few cases of absence of ACL/PCL are reported in the literature, a number of large familial case series of related conditions such as ACL agnesia suggest a potential underlying monogenic etiology. We performed whole exome sequencing of a family with two individuals affected by ACL/PCL. We identified copy number variation (CNV) deletion impacting the exon sequences of CEP57L1, present in the affected mother and her affected daughter based on the exome sequencing data. The deletion was validated using quantitative PCR (qPCR), and the gene was confirmed to be expressed in ACL ligament tissue. Interestingly, we detected reduced expression of CEP57L1 in Epstein-Barr virus (EBV) cells from the two patients in comparison with healthy controls. Evaluation of 3D protein structure showed that the helix-binding sites of the protein remain intact with the deletion, but other functional binding sites related to microtubule attachment are missing. The specificity of the CNV deletion was confirmed by showing that it was absent in ~700 exome sequencing samples as well as in the database of genomic variations (DGV), a database containing large numbers of annotated CNVs from previous scientific reports. We identified a novel CNV deletion that was inherited through an autosomal dominant transmission from an affected mother to her affected daughter, both of whom suffered from the absence of the anterior and posterior cruciate ligaments of the knees.

  3. Use of transtibial aimer via the accessory anteromedial portal to identify the center of the ACL footprint.

    Science.gov (United States)

    Celentano, Umberto; Cardoso, Marcos P A; Martins, Cesar A Q; Ramirez, Claudia P; van Eck, Carola F; Smolinski, Patrick; Fu, Freddie H

    2012-01-01

    To assess the ability of a transtibial aimer with a 7-mm off-set in a standardized position to reach the center of the ACL footprint on the femur through the AM portal. Nineteen cadaveric knees were dissected, and the perimeter of the femoral ACL footprint was marked. The aimer was placed just superior to the medial joint line close to the medial condyle through the AM portal. The guide was rested upon the posterior cortex and placed in three different positions: (A) at zero degrees in frontal plane and 60° in axial plane, (B) at 45° in frontal and 45° in axial, and (C) at the center of the ACL insertion site under direct visualization. A digital camera was used to take pictures on the axial plane, and Image J software was used for angle measurement. Aluminum beads were used to mark the three positions indicated by the aimer, and CT scans were performed. The distances from the true center of the ACL to each point were determined. Position A resulted in femoral tunnel placement furthest from the center of the ACL footprint (8.6 mm). Position B was at a distance of 3.2 mm, and position C was the most accurate, with an average distance of 2.0 mm. The angles required by Position C varied with an average of 54° ± 11° in the frontal plane and an average of 44° ± 6° in the axial plane. The 7-mm transtibial aimer was unable to reach the center of ACL footprint at a fixed orientation.

  4. Sagittal Plane Knee Biomechanics and Vertical Ground Reaction Forces Are Modified Following ACL Injury Prevention Programs: A Systematic Review.

    Science.gov (United States)

    Padua, Darin A; Distefano, Lindsay J

    2009-03-01

    Injuries to the anterior cruciate ligament (ACL) occur because of excessive loading on the knee. ACL injury prevention programs can influence sagittal plane ACL loading factors and vertical ground reaction force (VGRF). To determine the influence of ACL injury prevention programs on sagittal plane knee biomechanics (anterior tibial shear force, knee flexion angle/moments) and VGRF. The PubMed database was searched for studies published between January 1988 and June 2008. Reference lists of selected articles were also reviewed. Studies were included that evaluated healthy participants for knee flexion angle, sagittal plane knee kinetics, or VGRF after performing a multisession training program. Two individuals reviewed all articles and determined which articles met the selection criteria. Approximately 4% of the articles fulfilled the selection criteria. Data were extracted regarding each program's duration, frequency, exercise type, population, supervision, and testing procedures. Means and variability measures were recorded to calculate effect sizes. One reviewer extracted all data and assessed study quality using PEDro (Physiotherapy Evidence Database). A second reviewer (blinded) verified all information. There is moderate evidence to indicate that knee flexion angle, external knee flexion moment, and VGRF can be successfully modified by an ACL injury prevention program. Programs utilizing multiple exercises (ie, integrated training) appear to produce the most improvement, in comparison to that of single-exercise programs. Knee flexion angle was improved following integrated training (combined balance and strength exercises or combined plyometric and strength exercises). Similarly, external knee flexion moment was improved following integrated training consisting of balance, plyometric, and strength exercises. VGRF was improved when incorporating supervision with instruction and feedback on proper technique. ACL injury prevention programs that are aimed at

  5. Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Park, Lawrence S.; Jacobson, Jon A.; Jamadar, David A.; Caoili, Elaine; Kalume-Brigido, Monica [University of Michigan, Department of Radiology, Ann Arbor, MI (United States); Wojtys, Edward [University of Michigan, Department of Orthopaedic Surgery, 24 Frank Lloyd Wright Drive, Box 391, Ann Arbor, MI (United States); University of Michigan Sports Medicine Program, Department of MedSport, 24 Frank Lloyd Wright Drive, Box 391, Ann Arbor, MI (United States)

    2007-05-15

    We have noted apparent far lateral meniscal attachment of the meniscofemoral ligament (MFL) with an anterior cruciate ligament (ACL) tear. This study evaluates MFL attachment and association with posterior horn lateral meniscus (PHLM) tear. Nine months of knee arthroscopy reports were reviewed to classify the PHLM and ACL as torn or normal. After excluding those with prior knee surgery, MR images were reviewed by two radiologists to determine the number of images lateral to PCL, which showed the ligaments of Humphrey and Wrisberg visible as structures separate from the PHLM. Any patient with abnormal PHLM surface signal not continuous with the MFL was excluded. MRI findings were compared with arthroscopy using Student's t test and Fisher's exact test. Of the 54 participants, 5 had PHLM tears and 49 were normal. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. The ligament of Humphrey inserted on average 0.9 consecutive images lateral to the PCL without an PHLM tear and 4.7 with an PHLM tear; the ligament of Wrisberg inserted on average 3.0 consecutive images without an PHLM tear and 4.5 with an PHLM tear (slice thickness/gap = 3 mm/0.5 mm). There was a significant association between PHLM tear and number of images (p = 0.0028), and between ACL tear and this type of PHLM tear (p = 0.0064). Apparent far lateral meniscal extension of a meniscofemoral ligament (greater than or equal to four images lateral to the PCL) should be considered as a possible PHLM tear, especially in the setting of an ACL tear. (orig.)

  6. MRI of double-bundle ACL reconstruction: evaluation of graft findings

    Energy Technology Data Exchange (ETDEWEB)

    Kiekara, Tommi; Paakkala, Antti [Tampere University Hospital, Medical Imaging Centre, Tampere (Finland); Jaervelae, Timo [Sports Clinic and Hospital Mehilaeinen, Tampere (Finland); Huhtala, Heini [University of Tampere, School of Health Sciences, Tampere (Finland)

    2012-07-15

    To demonstrate the magnetic resonance imaging (MRI) findings of double-bundle (DB) anterior cruciate ligament (ACL) reconstruction grafts. Sixty-six patients with DB ACL reconstruction were evaluated with MRI 2 years postoperatively. Graft thickness was measured separately by two musculoskeletal radiologists. The MRI findings of graft disruption, signal intensity (SI) changes, cystic degeneration, arthrofibrosis, and impingement were analyzed. The statistical significance of the association between MRI findings was calculated. The mean anteromedial (AM) graft thickness was reduced 9% and the mean posterolateral (PL) graft thickness was reduced 18% from the original graft thickness. Disruption was seen in 3% of AM grafts and 6% of PL grafts and a partial tear in 8 and 23%, respectively. Both grafts were disrupted in 3% of patients. Increased SI was seen in 14% of intact AM grafts and in 60% of partially torn AM grafts (p = 0.032). In PL grafts the increased SI was seen in 51% of the intact grafts and in 93% of the partially torn grafts (p = 0.005). Cystic degeneration was seen in 8% of AM grafts and in 5% of PL grafts. Diffuse arthrofibrosis was seen in 5% of patients and a localized cyclops lesion in 3% of patients. Impingement of the AM graft was seen in 8% of patients. Both grafts were disrupted in 3% of patients. Also, the frequencies of other complications were low. The use of orthogonal sequences in the evaluation of the PL graft SI seems to cause volume-averaging artefacts. (orig.)

  7. Identification of types of landings after blocking in volleyball associated with risk of ACL injury.

    Science.gov (United States)

    Zahradnik, David; Jandacka, Daniel; Farana, Roman; Uchytil, Jaroslav; Hamill, Joseph

    2017-03-01

    Landing with a low knee flexion angle after volleyball block jumps may be associated with an increased risk of anterior cruciate ligament (ACL) injury. The aim of the present study was to identify the types of volleyball landings after blocks where the knee flexion angle is found to be under a critical knee flexion angle value of 30° at the instant of the first peak of the ground reaction force (GRF). Synchronized kinematic and kinetic data were collected for each trial. T-tests were used to determine if each knee flexion angle at the instant of the peak GRF was significantly different from the critical value of 30°. A repeated measures ANOVA was used to compare knee flexion angle, time to first peak and the magnitude of the first peak of the resultant GRF and knee stiffness. Significantly lower knee flexion angles were found in the "go" landing (p = .01, ES = 0.6) and the "reverse" landing (p = .02, ES = 0.6) only. The results for knee flexion angle and GRF parameters indicated a significant difference between a "reverse" and "go" and other types of landings, except the "side stick" landing for GRF. The "reverse" and "go" landings may present a risk for ACL injury due to the single-leg landing of these activities that have an associated mediolateral movement.

  8. ACL Injury Risk Factors Decrease & Jumping Performance Improvement in Female Basketball Players: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Benoit Pairot de Fontenay

    2013-07-01

    Full Text Available The aim of this explorative study was to determine the most effective physical training program to reduce neuromuscular risk factors of Anterior Cruciate Ligament (ACL tear and to improve jumping performance. Twenty-four female basketball players were divided into three groups: Specific Physical Training Group (SPTG, combined specific Physical and Mental Training Group (PMTG and Control Group (CG. The training program was conducted over a period of eight weeks including two sessions per week during basketball practice. Dynamic valgus, Peak Vertical Impact Force (PVIF, Rate of Force Development (RFD, and jumping performance were measured at pre- and post-tests. When all the participants were pooled, statistics showed a decrease (-36% in dynamic valgus. No significant results were observed for PVIF and RFD. Jumping performance improved by 12% in SPTG and remained constant in PMTG and CG. Adding specific physical training to basketball practice should be the most effective program to prevent ACL tear while improving jumping performance in young female basketball players.

  9. Effect of Plyometric Training on Prevention of ACL Injuries in Females Volleyball Players

    Science.gov (United States)

    Enginsu, Müjdat; Lokmaoğlu, Recep; Korkmaz, Erol; Arıbaş, İlker; Selimoğlu, Şafak

    2014-01-01

    Objectives: To verify the effects of plyometric training on prevention of ACL injuries with lower limp kinematics,eccentric hip and knee torques,and functional performance. Methods: 36 females volleyball players were divided into a training group (TG no:18) that carried out the plyometric training for 12 weeks,and a control group (CG no:18)that carried out no physical training.24 plyometric trainin sessions during approximately 12 weeks with 3 sessions ,30 minutes per week on alternate days. Lower limb kinematics (maximum excursion of hip adduction,hip medial rotation,and knee abduction during the single leg squat),eccentric hip (abductor,adductor,medial and lateral rotator) isokinetic peak torques and knee (flexor and extansor) isokinetic peak torques,and fuctional performance(trşpl hpo test and the 6-m timed hop test). Results: After 12 weeks, only the TG significantly reduced the values for the maximum excursion of knee abduction (P=0.01) and hip adduction (P 0.001).Similarly ,only the TG significantly increased the eccentic hip abductor (P 0.001) and adductor (P=0.01) torques.Finally,only the TG significantly increased the values in the tripl hop test (P 0.001) and significantly decreased the values in the 6-m timed hop test (P 0.001) after intervention. Conclusion: Plyometric training alters lower limb kinematics and increases eccentric hip torque and functional performance, suggesting the incorporation of these exercises in preventive programs for ACL injuries.

  10. Sidestep cutting technique and knee abduction loading: implications for ACL prevention exercises.

    Science.gov (United States)

    Kristianslund, Eirik; Faul, Oliver; Bahr, Roald; Myklebust, Grethe; Krosshaug, Tron

    2014-05-01

    Sidestep cutting technique is essential in programmes to prevent anterior cruciate ligament (ACL) injury. A better understanding of how technique affects potentially harmful joint loading may improve prevention programmes. The purpose of this study was to investigate the effect of sidestep cutting technique on maximum knee abduction moments. Cross-sectional study. Whole-body kinematics and knee joint kinetics were calculated in 123 female handball players (mean±SD, 22.5±7.0 years, 171±7 cm, 67±7 kg) performing sidestep cutting. Three cuts from each side were analysed. Linear regression was applied between selected technique factors and maximum knee abduction moment during the first 100 ms of the contact phase. Furthermore, we investigated to what degree the abduction moment originated from the magnitude of the ground reaction force (GRF) or the knee abduction moment arm of the GRF. Technique factors explained 62% of the variance in knee abduction moments. Cut width, knee valgus, toe landing, approach speed and cutting angle were the most significant predictors. An increase in one of these factors of 1 SD increased the knee abduction moment from 12% to 19%. The effect of the moment arm of the GRF was more important than the force magnitude for maximum knee abduction moments. Lower knee abduction loads during sidestep cutting may be achieved if cuts are performed as narrow cuts with low knee valgus and toe landings. These factors may be targeted in ACL injury prevention programmes.

  11. The Utility of a High-intensity Exercise Protocol to Prospectively Assess ACL Injury Risk.

    Science.gov (United States)

    Bossuyt, F M; García-Pinillos, F; Raja Azidin, R M F; Vanrenterghem, J; Robinson, M A

    2016-02-01

    This study investigated the utility of a 5-min high-intensity exercise protocol (SAFT(5)) to include in prospective cohort studies investigating ACL injury risk. 15 active females were tested on 2 occasions during which their non-dominant leg was analysed before SAFT(5) (PRE), immediately after (POST0), 15 min after (POST15), and 30 min after (POST30). On the first occasion, testing included 5 maximum isokinetic contractions for eccentric and concentric hamstring and concentric quadriceps and on the second occasion, 3 trials of 2 landing tasks (i. e., single-leg hop and drop vertical jump) were conducted. Results showed a reduced eccentric hamstring peak torque at POST0, POST15 and POST30 (pACL injury risk and similar to observations from match simulations. Our findings therefore support the utility of a high-intensity exercise protocol such as SAFT(5) to strengthen injury screening tests and to include in prospective cohort studies where time constraints apply. © Georg Thieme Verlag KG Stuttgart · New York.

  12. SYNOVIAL CYST IN THE PROJECTION OF TIBIAL TUNNEL AFTER ACL RECONSTRUCTION (CASE REPORT

    Directory of Open Access Journals (Sweden)

    V. B. Bogatov

    2017-01-01

    Full Text Available ACL  tears  are the  most  widespread  lesions  among  isolated  trauma  of knee  ligaments  that  require  early  surgical treatment especially in young active patients. There  are various ACL reconstruction techniques where femur and tibia tunnels are formed and graft is fixed by cannulated interference screws. One of the possible complications is the formation of a postoperative soft tissue cyst in the projection of tibial tunnel.  The nature  as well as mechanism of cyst formation  is still unclear.A relevant  clinical case of cyst formation  in a patient five years after ACL grating  is described  in this publication. MRI findings demonstrated that  the origin of the cyst was hole of the tibial interference screw.Conclusion. The authors  observed that  synovial cyst was formed due to use of cannulated interference screws where synovial  fluid was leaking  from joint  cavity  through screw holes. Cystectomy and  autografting of tibial  bone tunnel allowed to reduce such complication.

  13. Combined intra- and extra-articular grafting for revision ACL reconstruction: A multicentre study by the French Arthroscopy Society (SFA).

    Science.gov (United States)

    Louis, M-L; D'ingrado, P; Ehkirch, F P; Bertiaux, S; Colombet, P; Sonnery-Cottet, B; Schlatterer, B; Pailhé, R; Panisset, J C; Steltzlen, C; Lustig, S; Lutz, C; Dalmay, F; Imbert, P; Saragaglia, D

    2017-12-01

    A careful analysis of the reasons for ACL reconstruction failure is essential to selection of the optimal surgical revision technique designed to ensure good rotational stability and to minimise the risk of re-rupture. To evaluate anterolateral ligament (ALL) stabilisation during revision ACL reconstruction. ALL stabilisation during revision ACL reconstruction provides good rotational stability without increasing the risk of complications. This multicentre study included 349 patients, 151 retrospectively and 198 prospectively. There were 283 males and 66 females. Inclusion criteria were an indication for revision ACL reconstruction surgery with combined intra-articular reconstruction and ALL stabilisation after failed autograft ACL reconstruction, and intact PCL. Exclusion criteria were primary ACL reconstruction and concomitant peripheral medial and/or lateral lesions. Each patient underwent a clinical and radiographic evaluation before and after revision surgery. Before revision surgery, the mean IKDC score was 56.5±15.5 and 96% of patients were IKDC C or D. Rates were 5.0% for early and 10.5% for late postoperative complications. Lachmann's test had a hard stop at last follow-up in 97% of patients. The pivot-shift test was positive in 1% of patients. The mean subjective IKDC score was 84.5±13.0 and 86.5% of patients were IKDC A or B. The proportions of patients with radiographic knee osteoarthritis at last follow-up was unchanged for the lateral tibio-femoral and patello-femoral compartments but increased by 9.7% to 21.2% for the medial tibio-femoral compartment. The re-rupture rate was 1.2% and the further surgical revision rate was 5.4%. Anterior laxity at last follow-up was consistent with previous studies of revision ACL reconstruction. However, rotational stability and the re-rupture risk were improved. ALL stabilisation is among the techniques that deserve consideration as part of the therapeutic options for revision ACL reconstruction. IV, retrospective

  14. Altered lower extremity joint mechanics occur during the star excursion balance test and single leg hop after ACL-reconstruction in a collegiate athlete.

    Science.gov (United States)

    Samaan, Michael A; Ringleb, Stacie I; Bawab, Sebastian Y; Greska, Eric K; Weinhandl, Joshua T

    2018-03-15

    The effects of ACL-reconstruction on lower extremity joint mechanics during performance of the Star Excursion Balance Test (SEBT) and Single Leg Hop (SLH) are limited. The purpose of this study was to determine if altered lower extremity mechanics occur during the SEBT and SLH after ACL-reconstruction. One female Division I collegiate athlete performed the SEBT and SLH tasks, bilaterally, both before ACL injury and 27 months after ACL-reconstruction. Maximal reach, hop distances, lower extremity joint kinematics and moments were compared between both time points. Musculoskeletal simulations were used to assess muscle force production during the SEBT and SLH at both time points. Compared to the pre-injury time point, SEBT reach distances were similar in both limbs after ACL-reconstruction except for the max anterior reach distance in the ipsilateral limb. The athlete demonstrated similar hop distances, bilaterally, after ACL-reconstruction compared to the pre-injury time point. Despite normal functional performance during the SEBT and SLH, the athlete exhibited altered lower extremity joint mechanics during both of these tasks. These results suggest that measuring the maximal reach and hop distances for these tasks, in combination with an analysis of the lower extremity joint mechanics that occur after ACL-reconstruction, may help clinicians and researchers to better understand the effects of ACL-reconstruction on the neuromuscular system during the SEBT and SLH.

  15. The Effects of High-Intensity versus Low-Intensity Resistance Training on Leg Extensor Power and Recovery of Knee Function after ACL-Reconstruction

    DEFF Research Database (Denmark)

    Bieler, Theresa; Sobol, Nanna Aue; Andersen, Lars L

    2014-01-01

    OBJECTIVE: Persistent weakness is a common problem after anterior cruciate ligament- (ACL-) reconstruction. This study investigated the effects of high-intensity (HRT) versus low-intensity (LRT) resistance training on leg extensor power and recovery of knee function after ACL-reconstruction. METH...

  16. Concurrent assessments of lower limb loading patterns, mechanical muscle strength and functional performance in ACL-patients - A cross-sectional study

    DEFF Research Database (Denmark)

    Holsgaard-Larsen, Anders; Jensen, C; Mortensen, N H M

    2014-01-01

    Full recovery in muscle strength and functional performance may not be achieved after ACL-injury. Aim: The aim of this study is to investigate loading patterns during jumping, muscle function and functional performance in ACL-reconstructed patients and to investigate the origin of between-limb...

  17. Muscle timing in injured and non-injured leg of athletes with chronic ankle instability in response to a visual stimulus during forward jumping.

    Science.gov (United States)

    Fereydounnia, Sara; Shadmehr, Azadeh; Talebian Moghadam, Saeed; Olyaei, Gholamreza; Jalaie, Shohreh; Tahmasebi, Ali

    2016-01-01

    The aim of this study was to investigate premotor time, motor time and reaction time of the injured and non-injured leg muscles of athletes with chronic ankle instability in response to a visual stimulus during forward jumping. Surface electromyography was performed on injured and non-injured leg of eight athletes with chronic ankle instability during forward jumping. Results showed that premotor time of the peroneus longus was significantly longer in non-injured leg compared with injured leg (489.37 ± 220.22 ms vs. 306.46 ± 142.92 ms, P = 0.031); on the contrary, motor time of the peroneus longus was significantly shorter in non-injured leg compared with injured leg (569.04 ± 318.62 ms vs. 715.12 ± 328.72 ms, P = 0.022). No significant difference was noted in the timing of other calf muscles (P > 0.05). According to the results of this study, rehabilitation protocols, regarding ankle instability, need to put greater emphasis on tasks that require proper timing of muscles and muscle re-education so that protocols could reduce residual symptoms after sprain and prevent recurrent sprains. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. In-hospital mortality pattern of severely injured children

    DEFF Research Database (Denmark)

    Do, Hien Quoc; Steinmetz, Jacob; Rasmussen, Lars S

    2012-01-01

    BACKGROUND: Although trauma remains a major cause of morbidity and mortality in children, less attention has been directed to this group of patients. Whilst there is considerable literature on trauma in adults, only few studies describe paediatric trauma. The aim of this study was to describe...... the mortality pattern of severely injured children admitted to a Danish level I trauma centre. METHODS: We included trauma patients aged 15 years or less, who subsequent a trauma team activation were admitted during the 9-year period 1999-2007. Data were collected prospectively for subjects who had a length...

  19. Sialic acid accelerates the electrophoretic velocity of injured dorsal root ganglion neurons

    Directory of Open Access Journals (Sweden)

    Chen-xu Li

    2015-01-01

    Full Text Available Peripheral nerve injury has been shown to result in ectopic spontaneous discharges on soma and injured sites of sensory neurons, thereby inducing neuropathic pain. With the increase of membrane proteins on soma and injured site neurons, the negatively charged sialic acids bind to the external domains of membrane proteins, resulting in an increase of this charge. We therefore speculate that the electrophoretic velocity of injured neurons may be faster than non-injured neurons. The present study established rat models of neuropathic pain via chronic constriction injury. Results of the cell electrophoresis test revealed that the electrophoretic velocity of injured neuronal cells was faster than that of non-injured (control cells. We then treated cells with divalent cations of Ca 2+ and organic compounds with positive charges, polylysine to counteract the negatively charged sialic acids, or neuraminidase to specifically remove sialic acids from the membrane surface of injured neurons. All three treatments significantly reduced the electrophoretic velocity of injured neuronal cells. These findings suggest that enhanced sialic acids on injured neurons may accelerate the electrophoretic velocity of injured neurons.

  20. Report of the Clinical and Functional Primary Outcomes in Men of the ACL-SPORTS Trial: Similar Outcomes in Men Receiving Secondary Prevention With and Without Perturbation Training 1 and 2 Years After ACL Reconstruction.

    Science.gov (United States)

    Arundale, Amelia J H; Cummer, Kathleen; Capin, Jacob J; Zarzycki, Ryan; Snyder-Mackler, Lynn

    2017-10-01

    Athletes often are cleared to return to activities 6 months after anterior cruciate ligament (ACL) reconstruction; however, knee function measures continue to improve up to 2 years after surgery. Interventions beyond standard care may facilitate successful return to preinjury activities and improve functional outcomes. Perturbation training has been used in nonoperative ACL injury and preoperative ACL reconstruction rehabilitation, but has not been examined in postoperative ACL reconstruction rehabilitation, specifically return to sport rehabilitation. The purpose of this study was to determine whether there were differences at 1 and 2 years after ACL reconstruction between the male SAP (strengthening, agility, and secondary prevention) and SAP+PERT (SAP protocol with the addition of perturbation training) groups with respect to (1) quadriceps strength and single-legged hop limb symmetry; (2) patient-reported knee outcome scores; (3) the proportion who achieve self-reported normal knee function; and (4) the time from surgery to passing return to sport criteria. Forty men who had completed ACL reconstruction rehabilitation and met enrollment criteria (3-9 months after ACL reconstruction, > 80% quadriceps strength limb symmetry, no pain, full ROM, minimal effusion) were randomized into the SAP or SAP+PERT groups of the Anterior Cruciate Ligament-Specialised Post-Operative Return to Sports trial (ACL-SPORTS), a single-blind randomized clinical study of secondary prevention and return to sport. Quadriceps strength, single-legged hopping, the International Knee Documentation Committee (IKDC) 2000 subjective knee form, Knee Injury and Osteoarthritis Outcome Score (KOOS)-sports and recreation, and KOOS-quality-of-life subscales were collected 1 and 2 years after surgery by investigators blind to group. Athletes were categorized as having normal or abnormal knee function at each time point based on IKDC score, and the time until athletes passed strict return

  1. Injured Athletes' Attitudes and Judgments Toward Rehabilitation Adherence

    Science.gov (United States)

    Fisher, A. Craig; Hoisington, Linda L.

    1993-01-01

    In a follow-up study to certified athletic trainers' (ATCs') attitudes and judgments toward injury rehabilitation adherence, previously injured and rehabilitated athletes (n=36) were administered the Athletic Injury Rehabilitation Adherence Questionnaire. The purpose of the study was to compare the results collected from athletes with those collected previously from ATCs. The questionnaire consisted of 60 statements, categorized into seven scales: athletic trainers' influence, environmental influences, athlete's personality, pain tolerance, self-motivation, goals and incentives, and significant others. Four additional open-ended questions dealing with successful and unsuccessful rehabilitation strategies also were completed. Athletes' responses were generally similar to those of ATCs. Factors deemed significant to rehabilitation adherence were: (a) good rapport and communication between athletic trainers and injured athletes, (b) support from athletic trainers and coaches, (c) self-motivation on the part of athletes, and (d) convenience, accessibility, and flexibility of the rehabilitation facility and staff. The greatest deviations between athletes' and ATCs' responses were in the areas of self-motivation, pain tolerance, education about injury and rehabilitation exercises, and degree of realistic feedback. Analyses of open-ended question responses reinforced the aforementioned results. The strongest findings derived from these questions were the importance of rapport, communication, and support to rehabilitation adherence. Also, athletes' distastes for threats and scare tactics were quite evident. ImagesINGING PMID:16558204

  2. Thrombosis and antiphospholipid antibody syndrome during acute Q fever: A cross-sectional study.

    Science.gov (United States)

    Million, Matthieu; Bardin, Nathalie; Bessis, Simon; Nouiakh, Nadia; Douliery, Charlaine; Edouard, Sophie; Angelakis, Emmanouil; Bosseray, Annick; Epaulard, Olivier; Branger, Stéphanie; Chaudier, Bernard; Blanc-Laserre, Karine; Ferreira-Maldent, Nicole; Demonchy, Elisa; Roblot, France; Reynes, Jacques; Djossou, Felix; Protopopescu, Camelia; Carrieri, Patrizia; Camoin-Jau, Laurence; Mege, Jean-Louis; Raoult, Didier

    2017-07-01

    Q fever is a neglected and potentially fatal disease. During acute Q fever, antiphospholipid antibodies are very prevalent and have been associated with fever, thrombocytopenia, acquired heart valve disease, and progression to chronic endocarditis. However, thrombosis, the main clinical criterion of the 2006 updated classification of the antiphospholipid syndrome, has not been assessed in this context. To test whether thrombosis is associated with antiphospholipid antibodies and whether the criteria for antiphospholipid syndrome can be met in patients with acute Q fever, we conducted a cross-sectional study at the French National Referral Center for Q fever.Patients included were diagnosed with acute Q fever in our Center between January 2007 and December 2015. Each patient's history and clinical characteristics were recorded with a standardized questionnaire. Predictive factors associated with thrombosis were assessed using a rare events logistic regression model. IgG anticardiolipin antibodies (IgG aCL) assessed by an enzyme-linked immunosorbent assay were tested on the Q fever diagnostic serum. A dose-dependent relationship between IgG aCL levels and thrombosis was tested using a receiver operating characteristic (ROC) analysis.Of the 664 patients identified for inclusion in the study, 313 (47.1%) had positive IgG aCL and 13 (1.9%) were diagnosed with thrombosis. Three patients fulfilled the antiphospholipid syndrome criteria. After multiple adjustments, only positive IgG aCL (relative risk, 14.46 [1.85-113.14], P = .011) were independently associated with thrombosis. ROC analysis identified a dose-dependent relationship between IgG aCL levels and occurrence of thrombosis (area under curve, 0.83, 95%CI [0.73-0.93], P antiphospholipid antibodies are associated with thrombosis, thrombocytopenia, and acquired valvular heart disease. Antiphospholipid antibodies should be systematically assessed in acute Q fever patients. Hydroxychloroquine, which has been

  3. A Life of Learning: Nancy Siraisi. Charles Homer Haskins Prize Lecture for 2010. ACLS Occasional Paper, No. 67

    Science.gov (United States)

    American Council of Learned Societies, 2010

    2010-01-01

    Nancy Siraisi has been a prolific and leading scholar in the history of medicine and science of the Middle Ages and the Renaissance. This lecture of hers is the twenty-eighth of series of lectures named for Charles Homer Haskins, first chairman of the American Council of Learned Societies (ACLS) and himself a famed medievalist who brought…

  4. An integrated approach to change the outcome part I: neuromuscular screening methods to identify high ACL injury risk athletes.

    Science.gov (United States)

    Myer, Gregory D; Ford, Kevin R; Brent, Jensen L; Hewett, Timothy E

    2012-08-01

    An important step for treatment of a particular injury etiology is the appropriate application of a treatment targeted to the population at risk. An anterior cruciate ligament (ACL) injury risk algorithm has been defined that employs field-based techniques in lieu of laboratory-based motion analysis systems to identify athletes with high ACL injury risk landing strategies. The resultant field-based assessment techniques, in combination with the developed prediction algorithm, allow for low-cost identification of athletes who may be at increased risk of sustaining ACL injury. The combined simplicity and accuracy of the field-based tool facilitate its use to identify specific factors that may increase risk of injury in female athletes. The purpose of this report is to demonstrate novel algorithmic techniques to accurately capture and analyze measures of knee valgus motion, knee flexion range of motion, body mass, tibia length and quadriceps to hamstrings ratio with video analysis software typically used by coaches, strength and conditioning specialists, and athletic trainers. The field-based measurements and software analyses were used in a prediction algorithm to identify those at potential risk of noncontact ACL injury that may directly benefit from neuromuscular training.

  5. The effects of attentional focus on jump performance and knee joint kinematics in patients after ACL reconstruction

    NARCIS (Netherlands)

    Gokeler, Alli; Benjaminse, Anne; Welling, Wouter; Alferink, Malou; Eppinga, Peter; Otten, Bert

    Objectives: The purpose of this study was to determine the effect of an internal and external attentional focus on single leg hop jump distance and knee kinematics in patients after ACL reconstruction (ACLR). Design: Experimental. Setting: Outpatient physical therapy facility. Participants: Sixteen

  6. Lower limb asymmetry in mechanical muscle function: A comparison between ski racers with and without ACL reconstruction.

    Science.gov (United States)

    Jordan, M J; Aagaard, P; Herzog, W

    2015-06-01

    Due to a high incidence of anterior cruciate ligament (ACL) re-injury in alpine ski racers, this study aims to assess functional asymmetry in the countermovement jump (CMJ), squat jump (SJ), and leg muscle mass in elite ski racers with and without anterior cruciate ligament reconstruction (ACL-R). Elite alpine skiers with ACL-R (n = 9; 26.2 ± 11.8 months post-op) and uninjured skiers (n = 9) participated in neuromuscular screening. Vertical ground reaction force during the CMJ and SJ was assessed using dual force plate methodology to obtain phase-specific bilateral asymmetry indices (AIs) for kinetic impulse (CMJ and SJ phase-specific kinetic impulse AI). Dual x-ray absorptiometry scanning was used to assess asymmetry in lower body muscle mass. Compared with controls, ACL-R skiers had increased AI in muscle mass (P ski racers. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Knee complaints and prognosis of osteoarthritis at 10 years : impact of ACL ruptures, meniscal tears, genetic predisposition and surgery

    NARCIS (Netherlands)

    Huetink, Kasper

    2015-01-01

    In this thesis we demonstrated that several known risk factors for knee OA development i.e. ACL ruptures, meniscal tears, the presence of hand OA and increased BMI, are already associated with knee OA development as demonstrated on radiographs and MR images early in life. Identifying these factors

  8. Radiographic positions of femoral ACL, AM and PL centres : accuracy of guidelines based on the lateral quadrant method

    NARCIS (Netherlands)

    Luites, Joan W.H.; Verdonschot, Nico

    2017-01-01

    Purpose: Femoral tunnel positioning is an important factor in anatomical ACL reconstructions. To improve accuracy, lateral radiographic support can be used to determine the correct tunnel location, applying the quadrant method. Piefer et al. (Arthroscopy 28:872–881, 2012) combined various outcomes

  9. Motor learning strategies in basketball players and its implications for ACL injury prevention : a randomized controlled trial

    NARCIS (Netherlands)

    Benjaminse, Anne; Otten, Bert; Gokeler, Alli; Diercks, Ron L.; Lemmink, Koen A. P. M.

    Adding external focus of attention (EF, focus on the movement effect) may optimize current anterior cruciate ligament (ACL) injury prevention programmes. The purpose of the current study was to investigate the effects of an EF, by a visual stimulus and an internal focus, by a verbal stimulus during

  10. MRI evaluation of the knee post double bundle ACL reconstruction: Association of graft findings and comparison with arthroscopy

    Directory of Open Access Journals (Sweden)

    Mohammed Farghally Amin

    2016-06-01

    Conclusion: Increased signal intensity within the anteromedial or posterolateral bundles of a double bundle ACL reconstruction is frequently associated with a partial tear. Impingement of the anteromedial graft is frequently associated with partial tear and increased signal intensity which is proved by arthroscopy/surgery. A low incidence of other complications is seen.

  11. Feasibility of establishing an Australian ACL registry: a pilot study by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR).

    Science.gov (United States)

    Lekkas, Christina; Clarnette, Richard; Graves, Stephen E; Rainbird, Sophia; Parker, David; Lorimer, Michelle; Paterson, Roger; Roe, Justin; Morris, Hayden; Feller, Julian A; Annear, Peter; Forster, Ben; Hayes, David

    2017-05-01

    Rupture of the anterior cruciate ligament (ACL) is a common and debilitating injury that impacts significantly on knee function and risks the development of degenerative arthritis. The outcome of ACL surgery is not monitored in Australia. The optimal treatment is unknown. Consequently, the identification of best practice in treating ACL is crucial to the development of improved outcomes. The Australian Knee Society (AKS) asked the Australian Orthopaedic Association (AOA) to consider establishing a national ACL registry. As a first step, a pilot study was undertaken by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to test the hypothesis that collecting the required information in the Australian setting was possible. Surgeons completed an operative form which provided comprehensive information on the surgery undertaken. Patients provided pre- and post-operative questionnaires including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Marx Activity Scale (MA Scale). The number of ACL procedures undertaken at each hospital during the recruitment period was compared against State Government Health Department separation data. A total of 802 patients were recruited from October 2011 to January 2013. The overall capture rate for surgeon-derived data was 99%, and the capture rate for the pre-operative patient questionnaire was 97.9%. At 6 months, patient-reported outcomes were obtained from 55% of patients, and 58.5% of patients at 12 months. When checked against State Government Health Department separation data, 31.3% of procedures undertaken at each study hospital were captured in the study. It is possible to collect surgeon-derived and pre-operative patient-reported data, following ACL reconstruction in Australia. The need to gain patient consent was a limiting factor to participation. When patients did consent to participate in the study, we were able to capture nearly 100% of surgical procedures. Patient consent

  12. MODERN TRENDS IN SURGICAL TREATMENT OF PATIENTS WITH ACL RUPTURES (LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    O. V. Rikun

    2017-01-01

    Full Text Available The authors conducted an analysis of national and foreign scientific publications dedicated to the problems in treatment of patients with ruptures of the anterior cruciate ligament of the knee joint. The results of the analysis demonstrated that such lesions still remain the key knee pathology resulting from sports injuries that significantly affect knee function and require timely reconstructive surgical correction. Based on the study the key areas of improvement in treatment for mentioned category of patients have been identified. This is the biomechanically justified single bundle anatomical ACL reconstruction which is currently widely applied in the clinical practice by using of an isometrically located autograft. Such technique represents a radically new stage in the development of treatment methods for young and middle-aged patients with high functional demands.

  13. Increased bone tracer uptake in symptomatic patients with ACL graft insufficiency: a correlation of MRI and SPECT/CT findings.

    Science.gov (United States)

    Mathis, Dominic T; Hirschmann, Anna; Falkowski, Anna L; Kiekara, Tommi; Amsler, Felix; Rasch, Helmut; Hirschmann, Michael T

    2018-02-01

    Magnetic resonance imaging (MRI) and single-photon emission computerised tomography/computerised tomography (SPECT/CT) are used as diagnostic tools in symptomatic patients after reconstruction of the anterior cruciate ligament (ACL). The benefit of SPECT/CT in comparison with MRI is under debate. The purpose of this study was to investigate whether and how bone tracer uptake (BTU) intensity and distribution in SPECT/CT correlate with MRI findings in symptomatic patients after ACL reconstruction. Twenty-nine patients (male:female = 22:7, mean age ± SD 26 ± 10 years) with symptoms of pain and instability after ACL reconstruction were retrospectively investigated using prospectively acquired SPECT/CT and MRI. On MRI graft tear, graft signal intensity, bone marrow oedema, tunnel cyst formation, roof impingement, roof osteophytes, local arthrofibrosis, joint effusion and synovial thickness were analysed by two readers blinded to the BTU results. BTU was anatomically localised and volumetrically quantified. Spearman's rho test was used for correlation of BTU in SPECT/CT and MRI findings (p tracer uptake in SPECT/CT and defined MRI findings in symptomatic patients after ACL reconstruction were correlated. Both imaging modalities have a definite role in post-operative diagnostic and have established their value in those patients. This study provides a better understanding of the clinical value of SPECT/CT versus MRI in the clinical decision-making process. SPECT/CT provides a window into the in vivo loading of the joint as well as bone remodelling and graft incorporation process. In addition, ACL graft insufficiency can be detected by increased BTU. Retrospective cohort study, Level III.

  14. Anatomic single-bundle ACL surgery: consequences of tibial tunnel diameter and drill-guide angle on tibial footprint coverage.

    Science.gov (United States)

    Van der Bracht, H; Verhelst, L; Stuyts, B; Page, B; Bellemans, J; Verdonk, P

    2014-05-01

    To investigate the consequences of differences in drill-guide angle and tibial tunnel diameter on the amount of tibial anatomical anterior cruciate ligament (ACL) footprint coverage and the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint. Twenty fresh-frozen adult human knee specimens with a median age of 46 years were used for this study. Digital templates mimicking the ellipsoid aperture of tibial tunnels with a different drill-guide angle and a different diameter were designed. The centres of these templates were positioned over the geometric centre of the tibial ACL footprint. The amount of tibial ACL footprint coverage and overhang was calculated. Risk factors for overhang were determined. Footprint coverage and the risk of overhang were also compared between a lateral tibial tunnel and a classic antero-medial tibial tunnel. A larger tibial tunnel diameter and a smaller drill-guide angle both will create significant more footprint coverage and overhang. In 45% of the knees, an overhang was created with a 10-mm diameter tibial tunnel with drill-guide angle 45°. Furthermore, a lateral tibial tunnel was found not to be at increased risk of overhang. A larger tibial tunnel diameter and a smaller drill-guide angle both will increase the amount of footprint coverage. Inversely, larger tibial tunnel diameters and smaller drill-guide angles will increase the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint. A lateral tibial tunnel does not increase the risk of overhang.

  15. Functional capability is enhanced with semitendinosus than patellar tendon ACL repair.

    Science.gov (United States)

    Rudroff, Thorsten

    2003-09-01

    The patellar and semitendinosus tendon autograft are the two most common techniques that orthopedic surgeons use to reconstruct the anterior cruciate ligament (ACL). It has not been established, however, whether either of these techniques provides a greater functional advantage to the patient. To identify patients' functional capabilities after reconstruction of the ACL with a patellar or semitendinosus tendon autograft. Forty male soccer players volunteered for the study and were assigned to three homogeneous groups: individuals who had patellar tendon reconstruction (N = 15), individuals who had semitendinosus tendon reconstruction (N = 15), and a control group (N = 10). All patients had undergone surgery 2 yr before this study and received the same rehabilitation training. The testing procedures included measurement of thigh circumference, maximal isometric strength of quadriceps and hamstrings, two- and one-legged jump, squat and gait analysis. Kinetic, kinematic, and electromyographic data were collected. The patellar tendon group exhibited lower (P < 0.05) coactivation of the agonist and antagonist muscles around the knee joint during the squat movement and lower stabilization- and landing degrees during the jumps. Furthermore, the patellar tendon group had a shorter stance phase and reached the first vertical maximum later with the impaired leg while walking (720.2 +/- 15.6 ms vs 740.3 +/- 14.3 ms, and 24.3 +/- 0.64% vs 22.9 +/- 0.74% of stance phase), which was not observed in the semitendinosus tendon and control groups. Functional performance is compromised in patients who undergo a patellar tendon graft compared with a semitendinosus graft, possibly due to an altered activation of the quadriceps and hamstring muscles.

  16. Sex-specific gait adaptations prior to and up to six months after ACL reconstruction

    Science.gov (United States)

    Stasi, Stephanie L. Di; Hartigan, Erin H.; Snyder-Mackler, Lynn

    2015-01-01

    STUDY DESIGN Controlled longitudinal laboratory study. OBJECTIVES Compare sagittal plane gait mechanics of men and women before and up to 6 months after anterior cruciate ligament reconstruction (ACLR). BACKGROUND Aberrant gait patterns are ubiquitous after anterior cruciate ligament (ACL) rupture and persist after ACLR despite skilled physical therapy. Sex influences post-operative function and second ACL injury risk, but its influence on gait adaptations after injury have not been investigated. METHODS Sagittal plane knee and hip joint excursions during midstance and internal knee and hip extension moments at peak knee flexion were collected on 12 women and 27 men using 3-dimensional gait analysis before (Screen) and after pre-operative physical therapy (Pre-sx), and 6 months after ACLR (6mo). Repeated measures analysis of variance models were used to determine whether limb asymmetries changed differently over time in men and women. RESULTS Significant time x limb x sex interactions were identified for hip and knee excursions and internal knee extension moments (P≤.007). Both sexes demonstrated smaller knee excursions on the involved compared to the uninvolved knee at each time point (P≤.007), but only women demonstrated a decrease in the involved knee excursion from pre-sx to 6mo (P=.03). Women also demonstrated smaller hip excursions (P<.001) and internal knee extension moments (P=.005) on the involved limb compared to the uninvolved limb at 6mo. Men demonstrated smaller hip excursions and knee moments on the involved limb compared to the uninvolved limb (main effects, P<.001). CONCLUSION The persistence of limb asymmetries in men and women 6 months after ACLR indicates that current rehabilitation efforts are inadequate for some individuals following ACLR. PMID:25627155

  17. [Application of statistical models for prognostication of outcomes in injured persons with severe trauma].

    Science.gov (United States)

    Boĭko, V V; Zamiatin, P N; Dubrovina, N A; Zamiatin, D P

    2014-02-01

    Basing on data, concerning the injured persons state, the investigations results for elaboration and application of statistic models, prognosticating the trauma outcome, were analyzed. Selected information about 373 injured persons, who were treated in Traumatic Shock Department, is presented. There was established, that the statistical models elaborated is expedient to use together with other qualitative and quantitative methods of prognostic determination of outcome in severely injured persons.

  18. Time from ACL injury to reconstruction and the prevalence of additional intra-articular pathology: is patient age an important factor?

    Science.gov (United States)

    Magnussen, Robert A; Pedroza, Angela D; Donaldson, Christopher T; Flanigan, David C; Kaeding, Christopher C

    2013-09-01

    Meniscus and cartilage lesions have been reported to be prevalent during delayed reconstruction of anterior cruciate ligament (ACL) injuries. Relatively, little work has been done exploring the influence of patient age on this relationship. The purpose of this study is to determine whether the effect of time from ACL injury to reconstruction on the prevalence of associated meniscal and chondral injury is influenced by patient age. It was hypothesized that patients in whom the time from ACL injury to reconstruction exceeds 12 weeks will exhibit an increased prevalence of medial compartment pathology relative to those reconstructed within 12 weeks of injury in patients of all ages. Data detailing time from ACL injury to reconstruction and the prevalence of intra-articular findings were obtained in 311 of 489 consecutive patients undergoing primary isolated ACL reconstruction. Patients were divided into two groups based on whether the time from ACL injury to reconstruction was time from ACL injury to reconstruction exceeded 12 weeks. The prevalence of lateral meniscal injury did not increase with increasing time ACL injury to surgery. Among patients aged 22 years and under, there was no increase in the prevalence of intra-articular pathology in any compartment in the late reconstruction group. In contrast, among patients over the age of 22, there was a significant increase in the prevalence of medial chondral injury (p = 0.042) in the late reconstruction group. The prevalence of injuries to the meniscus and articular cartilage in the medial compartment of the knee is increased with increasing time from ACL injury to reconstruction. This relationship may vary depending on patient age. Patients over the age of 22 exhibit a higher prevalence of intra-articular injury with delayed reconstruction, while no such differences are noted among younger patients. Retrospective comparative study, level III.

  19. Correlation of sequential MR imaging of the injured spinal cord with prognosis

    International Nuclear Information System (INIS)

    Takahashi, Mutsumasa; Izunaga, Hiroshi; Sato, Ryuichiro; Shinzato, Jintetsu; Korogi, Yukunori; Yamashita, Yasuyuki; Sakae, Terumi

    1993-01-01

    Forty-nine patients with acute spinal cord injuries were studied sequentially with MR imaging by using 0.5 Tesla superconductive units, and sequential MR changes were correlated with the prognosis of the patients. MR images were obtained within one week of the injury and then every two to six months when possible. The Frankel classification of neurologic function was correlated with MR findings. The most frequently observed types of signal intensity patterns on MR imaging were type 0 (isointensity on both T 1 - and T 2 -weighted images) and type I (isointensity on T 1 - and hyperintensity on T 2 -weighted images). In subsequent subacute and chronic stages, type II (hypointensity on T 1 and hyperintensity on T 2 ) was most frequently observed. The evolution of type 0 was to types I and II, whereas type I usually turned into type II or remained as type I. Type III (hyperintensity on T 1 and hyper-, iso- or hypointensity on T 2 images) patients were few in number. There was a good correlation between MR imaging patterns and neurologic recovery for initial and subsequent MR patterns, in that type 0 showed good recovery, whereas types I and II revealed good improvement or no recovery. In addition, the extent of the high signal intensity area on initial as well as on subsequent T 2 -weighted images was proportionally correlated to neurologic recovery. The degree of cord compression was also important for predicting recovery of neurologic function. Findings of MR imaging of acutely injured spinal cord suggested the prognosis of spinal cord injury, especially when sequential studies were obtained. (author)

  20. Can injured adult CNS axons regenerate by recapitulating development?

    Science.gov (United States)

    Hilton, Brett J; Bradke, Frank

    2017-10-01

    In the adult mammalian central nervous system (CNS), neurons typically fail to regenerate their axons after injury. During development, by contrast, neurons extend axons effectively. A variety of intracellular mechanisms mediate this difference, including changes in gene expression, the ability to form a growth cone, differences in mitochondrial function/axonal transport and the efficacy of synaptic transmission. In turn, these intracellular processes are linked to extracellular differences between the developing and adult CNS. During development, the extracellular environment directs axon growth and circuit formation. In adulthood, by contrast, extracellular factors, such as myelin and the extracellular matrix, restrict axon growth. Here, we discuss whether the reactivation of developmental processes can elicit axon regeneration in the injured CNS. © 2017. Published by The Company of Biologists Ltd.

  1. Mammillary bodies and fornix fibers are injured in heart failure

    Science.gov (United States)

    Kumar, Rajesh; Woo, Mary A.; Birrer, Bramley V.X.; Macey, Paul M.; Fonarow, Gregg C.; Hamilton, Michele A.; Harper, Ronald M.

    2009-01-01

    Cognitive abnormalities, including memory deficits, are common in heart failure (HF). Brain structures, including the hippocampus, fornix, and thalamus participate in memory processing, and most show structural injury and functional deficits in HF. The mammillary bodies and fornix play essential roles in spatial and working memory processing, interact with other structures, and may also be injured in HF. We assessed mammillary body volumes and cross-sectional fornix areas in 17 HF and 50 control subjects using high-resolution T1-weighted magnetic resonance images. Mammillary body volumes and fornix cross-sectional areas were significantly reduced bilaterally in HF, and these differences remained after controlling age, gender, and intracranial volume. Mammillary body and fornix injury may contribute to the compromised spatial and working memory deficits in HF. Pathological processes eliciting the damage may include injury accompanying hypoxic/ischemic processes in pathologic HF perfusion and breathing, and thiamine deficiency accompanying diuretic use and nutritional malabsorption in the condition. PMID:19022386

  2. Acute pancreatitis

    Science.gov (United States)

    ... its blood vessels. This problem is called acute pancreatitis. Acute pancreatitis affects men more often than women. Certain ... well it can be treated. Complications of acute pancreatitis may include: Acute kidney failure Long-term lung damage (ARDS) Buildup ...

  3. Gene expression changes in the injured spinal cord following transplantation of mesenchymal stem cells or olfactory ensheathing cells.

    Directory of Open Access Journals (Sweden)

    Abel Torres-Espín

    Full Text Available Transplantation of bone marrow derived mesenchymal stromal cells (MSC or olfactory ensheathing cells (OEC have demonstrated beneficial effects after spinal cord injury (SCI, providing tissue protection and improving the functional recovery. However, the changes induced by these cells after their transplantation into the injured spinal cord remain largely unknown. We analyzed the changes in the spinal cord transcriptome after a contusion injury and MSC or OEC transplantation. The cells were injected immediately or 7 days after the injury. The mRNA of the spinal cord injured segment was extracted and analyzed by microarray at 2 and 7 days after cell grafting. The gene profiles were analyzed by clustering and functional enrichment analysis based on the Gene Ontology database. We found that both MSC and OEC transplanted acutely after injury induce an early up-regulation of genes related to tissue protection and regeneration. In contrast, cells transplanted at 7 days after injury down-regulate genes related to tissue regeneration. The most important change after MSC or OEC transplant was a marked increase in expression of genes associated with foreign body response and adaptive immune response. These data suggest a regulatory effect of MSC and OEC transplantation after SCI regarding tissue repair processes, but a fast rejection response to the grafted cells. Our results provide an initial step to determine the mechanisms of action and to optimize cell therapy for SCI.

  4. Differential Expression of Sox11 and Bdnf mRNA Isoforms in the Injured and Regenerating Nervous Systems

    Directory of Open Access Journals (Sweden)

    Felix L. Struebing

    2017-11-01

    Full Text Available In both the central nervous system (CNS and the peripheral nervous system (PNS, axonal injury induces changes in neuronal gene expression. In the PNS, a relatively well-characterized alteration in transcriptional activation is known to promote axonal regeneration. This transcriptional cascade includes the neurotrophin Bdnf and the transcription factor Sox11. Although both molecules act to facilitate successful axon regeneration in the PNS, this process does not occur in the CNS. The present study examines the differential expression of Sox11 and Bdnf mRNA isoforms in the PNS and CNS using three experimental paradigms at different time points: (i the acutely injured CNS (retina after optic nerve crush and PNS (dorsal root ganglion after sciatic nerve crush, (ii a CNS regeneration model (retina after optic nerve crush and induced regeneration; and (iii the retina during a chronic form of central neurodegeneration (the DBA/2J glaucoma model. We find an initial increase of Sox11 in both PNS and CNS after injury; however, the expression of Bdnf isoforms is higher in the PNS relative to the CNS. Sustained upregulation of Sox11 is seen in the injured retina following regeneration treatment, while the expression of two Bdnf mRNA isoforms is suppressed. Furthermore, two isoforms of Sox11 with different 3′UTR lengths are present in the retina, and the long isoform is specifically upregulated in later stages of glaucoma. These results provide insight into the molecular cascades active during axonal injury and regeneration in mammalian neurons.

  5. Electrophysiological assessment of sexual dysfunction in spinal cord injured patients.

    Science.gov (United States)

    Tas, I; Yagiz On, A; Altay, B; Ozdedeli, K

    2007-04-01

    Survey. To determine associations between sexual dysfunctions and electrophysiological examinations of the genital system in spinal cord injured patients. Ege University Hospital, Izmir, Turkey. In total, 25 patients (17 men, eight women) who were out of the spinal shock period were examined. Neurological levels were determined according to the American Spinal Injury Association (ASIA) impairment scale. Data about erection, ejaculation and vaginal lubrication were obtained via inquiry forms. Bulbocavernosus reflex (BCR), pudendal somatosensorial evoked potentials (pSEP) and perineal sympathetic skin responses (pSSR) were recorded by an electromyographer unaware of the sexual state or neurological level of the patient. BCRs could be obtained from all patients with lesion levels above the sacral centre. A significant association was found between reflex erection and BCR positivity, while psychogenic erection was shown to have a significant association with the preservation of pSSR in men. Despite the lack of statistical significance due to the small sample size of the women examined, a similar association with lubrication was observed. Ejaculation and orgasm were not shown to be significantly associated with any electrophysiological examination. However, ejaculation was preserved in all men with a lesion level below T12 and with positive pSSR. There was no significant relationship between pSEP and sexual functions. The relationship between the existence of sacral sensation and pSEP positivity was statistically significant. This study has proved that BCR and pSSR have an important role in the estimation of the remaining sexual function in spinal cord injured patients. STATEMENT ON ETHICS: We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

  6. Endovascular transplantation of stem cells to the injured rat CNS

    International Nuclear Information System (INIS)

    Lundberg, Johan; Soederman, Mikael; Andersson, Tommy; Holmin, Staffan; Le Blanc, Katarina

    2009-01-01

    Transplantation procedures using intraparenchymal injection of stem cells result in tissue injury in addition to associated surgical risks. Intravenous injection of mesenchymal stem cells gives engraftment to lesions, but the method has low efficiency and specificity. In traumatic brain injuries (TBI), there is a transient breakdown of the blood-brain barrier and an inflammatory response, which increase migration of cells from blood to parenchyma. The aim of this investigation was to analyze the effect of intra-arterial administration on cellular engraftment. Experimental TBI was produced in a rat model. Endovascular technique was used to administer human mesenchymal stem cells in the ipsilateral internal carotid artery. Evaluation of engraftment and side effects were performed by immunohistochemical analysis of the brain and several other organs. The results were compared to intravenous administration of stem cells. Intra-arterial transplantion of mesenchymal stem cells resulted in central nervous system (CNS) engraftment without thromboembolic ischemia. We observed a significantly higher number of transplanted cells in the injured hemisphere after intra-arterial compared to intravenous administration both 1 day (p<0.01) and 5 days (p<0.05) after the transplantation. Some cells were also detected in the spleen but not in the other organs analyzed. Selective intra-arterial administration of mesenchymal stem cells to the injured CNS is a minimally invasive method for transplantation. The method is significantly more efficient than the intravenous route and causes no side effects in the current model. The technique can potentially be used for repeated transplantation to the CNS after TBI and in other diseases. (orig.)

  7. Evaluating Age in the Field Triage of Injured Persons

    Science.gov (United States)

    Nakamura, Yoko; Daya, Mohamud; Bulger, Eileen M.; Schreiber, Martin; Mackersie, Robert; Hsia, Renee Y.; Mann, N. Clay; Holmes, James F.; Staudenmayer, Kristan; Sturges, Zachary; Liao, Michael; Haukoos, Jason; Kuppermann, Nathan; Barton, Erik D.; Newgard, Craig D.

    2012-01-01

    Study Objective In this study, we evaluated (1) trauma under-triage by age group; (2) the association between age and serious injury after accounting for other field triage criteria and confounders; and (3) the potential impact of a mandatory age triage criterion for field triage. Methods This was a retrospective cohort study of injured children and adults transported by 48 EMS agencies to 105 hospitals in 6 regions of the Western U.S. from 2006 through 2008. We used probabilistic linkage to match EMS records to hospital records, including: trauma registries, state discharge databases and emergency department databases. The primary outcome measure was serious injury, as measured by an Injury Severity Score (ISS) ≥ 16. We assessed under-triage (ISS ≥ 16 and triage-negative or transport to a non-trauma center) by age decile and used multivariable logistic regression models to estimate the association (linear and non-linear) between age and ISS ≥ 16, adjusted for important confounders. We also evaluated the potential impact of age on triage efficiency and trauma center volume. Results 260,027 injured patients were evaluated and transported by EMS over the 3-year study period. Under-triage increased for patients over 60 years of age, reaching approximately 60% for those older than 90 years. There was a strong non-linear association between age and ISS ≥ 16. For patients not meeting other triage criteria, the probability of serious injury was most notable after 60 years. A mandatory age triage criterion would have decreased under-triage at the expense of over-triage, with one ISS ≥ 16 patient identified for every 60–65 additional patients transported to major trauma centers. Conclusion Trauma under-triage increases in patients older than 60 years. While the probability of serious injury increases among triage-negative patients with increasing age, the use of a mandatory age triage criterion appears inefficient for improving field triage. PMID:22633339

  8. Acute Lung Injury: Making the Injured Lung Perform Better and Rebuilding Healthy Lungs

    Science.gov (United States)

    2014-04-01

    Hence, those398 Cell Stem Cell 10, 398–411, April 6, 2012 ª2012 Elsevier Inc.interested in purifying thyroid, lung, liver, or pancreatic stem or... pancreatic lineage (Micallef et al., 2005), no tools have been engineered that can allow the isolation of the most primor- dial murine lung and thyroid...timed pregnancy , identification of the vaginal plug was considered as embryonic day (E) 0.5. To activate CreERT2, 1 mg tamoxifen (TAM) (5 mg/ml, Sigma

  9. Acute Resuscitation and Transfer Management of Burned and Electrically Injured Patients,

    Science.gov (United States)

    1994-01-01

    resuscitation, significant de- tion of xanthine oxidase , complement creases in intravascular oncotic pres- byproduct activation and oxygen radi- sure...myoglobin and to the terminal cyto- have evidence of smoke inhalation chrome oxidase , further impairing tis- (b) Patients with steam burns of the sue...voltage electric in- to fruit juices, milk , or other electrolyte- jury, burns >20% TBSA, suspected containing fluids should be provided. If smoke

  10. Acute Lung Injury: Making Injured Lungs Perform Better and Rebuilding Healthy Lungs

    Science.gov (United States)

    2010-07-01

    Increased Intracranial pressure 3. Pregnancy (urine pregnancy test for all women of child-bearing age) 4. Planned transport out of ICU during planned...pseudoaneurysm (0.09%), sepsis (0.13%), local infection (0.72%), hematoma (14%), temporary arterial occlusion (19%) (Scheer et al Critical Care 2002, 6:198- 204...Potential subjects will be excluded from the study if: • There is a “Do not resuscitate” order. • There is suspicion of increased intracranial pressure

  11. Association between maximal hamstring strength and hamstring muscle pre-activity during a movement associated with non-contact ACL injury

    DEFF Research Database (Denmark)

    Skov Husted, Rasmus; Bencke, Jesper; Thorborg, Kristian

    2014-01-01

    Introduction Reduced hamstring pre-activity during side-cutting may predispose for non-contact ACL injury. During the last decade resistance training of the lower limb muscles has become an integral part of ACL injury prevention in e.g. soccer and handball. However, it is not known whether a strong...... translate into high levels of muscle pre-activity during movements like the sidecutting maneuver. Thus, other exercise modalities (i.e. neuromuscular training) are needed to optimize hamstring muscle pre-activity during movements associated with non-contact ACL injury....

  12. Describing and comparing the characteristics of injured bicyclists and other injured road users: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Bamini Gopinath

    2016-04-01

    Full Text Available Abstract Background We aimed to establish the frequency and characteristics (e.g. socioeconomic, pre-injury, and crash-related parameters of injured bicyclists and other injured road users. Methods 748 participants aged ≥17 years who had sustained a minor or non-catastrophic injury in a land-transport crash, were interviewed after presenting to a metro hospital emergency department in New South Wales, Australia. A telephone-administered questionnaire obtained information on socio-economic, pre-injury health, and crash-related characteristics. These factors were then compared between injured bicyclists and other road users (car driver/passengers, motorcyclists/pillion and pedestrians/skateboarders. Cycling injury severity was characterized by three metrics (sustaining multiple injuries; hospital admission for ≥12 h; and sustaining a head/neck and/or facial injury. Results In this cohort of people with injuries, 238 (32 % were bicyclists. Frequency of cycling injuries were significantly different between age-groups among men (p = 0.0002, and were more common in men aged 45–59. Bicyclists were more likely to be aged 45–59, married, have university/tertiary qualifications and have a professional occupation compared to other road users (all p <0.0001. Bicyclists compared to participants involved in other types of land transport crashes were more likely to self-report excellent general health (p = 0.01, and were less likely to report a great/overwhelming perceived danger of death or 15.0 % versus 23–41 %; p <0.0001. Frequency of upper extremity and lower extremity injuries in bicyclists were 81.9 % and 60.5 %, respectively. Explanatory variables significantly associated with injury severity metrics were age, education level, paid work status and perceived danger of death/disability in the crash. Conclusions Minor cycling injuries were a relatively common cause of mild-moderate injury presentations to metro emergency

  13. Differentiation of different mixed Listeria strains and also acid-injured, heat-injured, and repaired cells of Listeria monocytogenes using fourier transform infrared spectroscopy.

    Science.gov (United States)

    Nyarko, Esmond; Donnelly, Catherine

    2015-03-01

    Fourier transform infrared (FT-IR) spectroscopy was used to differentiate mixed strains of Listeria monocytogenes and mixed strains of L. monocytogenes and Listeria innocua. FT-IR spectroscopy was also applied to investigate the hypothesis that heat-injured and acid-injured cells would return to their original physiological integrity following repair. Thin smears of cells on infrared slides were prepared from cultures for mixed strains of L. monocytogenes, mixed strains of L. monocytogenes and L. innocua, and each individual strain. Heat-injured and acid-injured cells were prepared by exposing harvested cells of L. monocytogenes strain R2-764 to a temperature of 56 ± 0.2°C for 10 min or lactic acid at pH 3 for 60 min, respectively. Cellular repair involved incubating aliquots of acid-injured and heat-injured cells separately in Trypticase soy broth supplemented with 0.6% yeast extract for 22 to 24 h; bacterial thin smears on infrared slides were prepared for each treatment. Spectral collection was done using 250 scans at a resolution of 4 cm(-1) in the mid-infrared wavelength region. Application of multivariate discriminant analysis to the wavelength region from 1,800 to 900 cm(-1) separated the individual L. monocytogenes strains. Mixed strains of L. monocytogenes and L. monocytogenes cocultured with L. innocua were successfully differentiated from the individual strains when the discriminant analysis was applied. Different mixed strains of L. monocytogenes were also successfully separated when the discriminant analysis was applied. A data set for injury and repair analysis resulted in the separation of acid-injured, heat-injured, and intact cells; repaired cells clustered closer to intact cells when the discriminant analysis (1,800 to 600 cm(-1)) was applied. FT-IR spectroscopy can be used for the rapid source tracking of L. monocytogenes strains because it can differentiate between different mixed strains and individual strains of the pathogen.

  14. Incidence and MRI characterization of the spectrum of posterolateral corner injuries occurring in association with ACL rupture

    Energy Technology Data Exchange (ETDEWEB)

    Frois Temponi, Eduardo [Hospital Madre Teresa, Belo Horizonte, Minas Gerais (Brazil); Honorio de Carvalho, Lucio Jr. [Hospital Madre Teresa, Belo Horizonte, Minas Gerais (Brazil); Universidade Federal de Minas Gerais, Departamento do Aparelho Locomotor, Faculdade de Medicina, Belo Horizonte, Minas Gerais (Brazil); Saithna, Adnan [Southport and Ormskirk Hospitals, Southport (United Kingdom); University of Liverpool, Department of Clinical Engineering, Liverpool (United Kingdom); Thaunat, Mathieu; Sonnery-Cottet, Bertrand [Centre Orthopedic Santy, FIFA Medical Center of Excellence, Ramsay-Generale de Sante, Hopital Prive Jean Mermoz, Lyon (France)

    2017-08-15

    To determine the incidence and MRI characteristics of the spectrum of posterolateral corner (PLC) injuries occurring in association with anterior cruciate ligament (ACL) rupture. We carried out a level IV, retrospective case series study. All patients clinically diagnosed with an ACL rupture between July 2015 and June 2016 who underwent MRI of the knee were included in the study. In addition to standard MRI knee reporting, emphasis was placed on identifying injury to the PLC and a description of involvement of these structures by two musculoskeletal radiologists. Association with PLC involvement was sought with concomitant injuries using correlation analysis and logistic regression. One hundred sixty-two patients with MRI following ACL rupture were evaluated. Thirty-two patients (19.7%) had an injury to at least one structure of the PLC, including the inferior popliteomeniscal fascicle (n = 28), arcuate ligament (n = 20), popliteus tendon (n = 20), superior popliteomeniscal fascicle (n = 18), lateral collateral ligament (n = 8), popliteofibular ligament (n = 7), biceps tendon (n = 4), iliotibial band (n = 3), and fabellofibular ligament (n = 1). Seventy-five percent of all patients with combined ACL and PLC injuries had bone contusions involving the lateral compartment of the knee. The presence of these contusions strongly correlated with superior popliteomeniscal fascicle lesions (p < 0.05). There was no correlation between injuries to other structures of the PLC and other intra-articular lesions. Missed injuries of the PLC lead to considerable morbidity. The relevance of this study is to highlight that these injuries occur more frequently than previously described and that an appropriate index of suspicion, clinical examination, and MRI are all required to reduce the risk of missed diagnoses. The results of this study support previous suggestions that the rate of concomitant PLC injury in the ACL-deficient knee is under-reported. The rate of combined injuries in

  15. Change in Size of Hamstring Grafts During Preparation for ACL Reconstruction: Effect of Tension and Circumferential Compression on Graft Diameter.

    Science.gov (United States)

    Cruz, Aristides I; Fabricant, Peter D; Seeley, Mark A; Ganley, Theodore J; Lawrence, J Todd R

    2016-03-16

    There is good consensus that anterior cruciate ligament (ACL) grafts should be pretensioned to remove creep prior to implantation, but the literature contains little information on the influence of graft preparation or circumferential compression on graft size. The purpose of this study was to investigate how the size of hamstring allografts changes as they are prepared for ACL reconstruction. We hypothesized that grafts decrease in diameter as they are prepared with both tension and circumferential compression. We also investigated the interrater reliability of graft diameter measurements during each step of graft preparation. Twenty pairs of fresh-frozen human hamstring tendons obtained from an allograft supplier were prepared in a standardized fashion for ACL reconstruction (suturing followed by longitudinal tensioning followed by circumferential compression followed by relaxation). Four blinded raters measured each graft in a sequential manner after each graft preparation step. Interrater reliability was assessed using the intraclass correlation coefficient ICC(2,1). The mean allograft diameter at each time point was calculated and compared across all time points using repeated-measures analysis of variance (ANOVA). Subjecting the grafts to both tension and circumferential compression significantly decreased their mean diameter (to 7.38 mm compared with 8.28 mm at baseline; p = 0.044). Interrater reliability revealed almost perfect agreement at each measurement interval, with the ICC ranging from 0.933 to 0.961. The average diameter of hamstring ACL grafts decreases by almost 1 mm after they are subjected to both tension and circumferential compression within a standard cylindrical sizing block. Because ACL bone tunnels are drilled in 0.5-mm increments, preparing soft-tissue grafts with circumferential compression in addition to tension may allow creation of tunnels that are one to two incremental sizes smaller. This could permit less bone removal, which may be

  16. Gait Patterns Differ Between ACL-Reconstructed Athletes Who Pass Return-to-Sport Criteria and Those Who Fail

    Science.gov (United States)

    Di Stasi, Stephanie L.; Logerstedt, David; Gardinier, Emily S.; Snyder-Mackler, Lynn

    2013-01-01

    Background The current standard of practice for an athlete to return to sport after anterior cruciate ligament (ACL) reconstruction is varied. Attempt to return to activity is typically advised 6 months after surgery, but functional performance deficits and gait abnormalities are often still evident and may have important implications on future function. Hypothesis When comparing the involved and uninvolved limbs, patients who failed return-to-sport (RTS) criteria would demonstrate (1) smaller peak knee angles, extensor moments, and peak power absorption at the knee of the involved limb and (2) larger peak hip angles, extensor moments, and peak power generation of the involved limb. Study Design Controlled laboratory study. Methods A total of 42 patients completed functional and biomechanical gait assessment 6 months after ACL reconstruction. Functional testing involved an isometric quadriceps strength test, 4 single-legged hop tests, and 2 self-report questionnaires. Three-dimensional motion analysis was used to measure sagittal plane kinematics and kinetics of the hip and knee. A mixed-model analysis of variance and post hoc t tests were used to compare the limb symmetry of those who passed and those who did not pass RTS criteria. Minimal clinically important differences were calculated from healthy gait data and used to further define meaningful limb asymmetries. Results Twenty of the 42 (48%) patients passed RTS criteria 6 months after ACL reconstruction. Patients who did not pass the criteria demonstrated statistically significant differences between limbs on all kinematic and kinetic variables at the knee (P ≤ .027). Clinically meaningful asymmetries at the hip were also identified in this group. Only kinetic asymmetries at the knee were identified in the patients who passed RTS criteria. Conclusion Athletes who demonstrate superior functional performance 6 months after ACL reconstruction may have fewer abnormal and asymmetrical gait behaviors than their

  17. Report of the Primary Outcomes for Gait Mechanics in Men of the ACL-SPORTS Trial: Secondary Prevention With and Without Perturbation Training Does Not Restore Gait Symmetry in Men 1 or 2 Years After ACL Reconstruction.

    Science.gov (United States)

    Capin, Jacob John; Zarzycki, Ryan; Arundale, Amelia; Cummer, Kathleen; Snyder-Mackler, Lynn

    2017-10-01

    Movement asymmetries during walking are common after anterior cruciate ligament (ACL) injury and reconstruction and may influence the early development of posttraumatic osteoarthritis. Preoperative neuromuscular training (like perturbation training, which is neuromuscular training requiring selective muscle activation in response to surface perturbations) improves gait asymmetries and functional outcomes among people who are ACL-deficient, but the effect of postoperative perturbation training on gait mechanics after ACL reconstruction is unknown. Among men undergoing ACL reconstruction, we sought to compare strength, agility, and secondary prevention (SAP) treatment with SAP plus perturbation training (SAP+PERT) with respect to (1) gait mechanics; and (2) elimination of gait asymmetries 1 and 2 years after ACL reconstruction. Forty men were randomized into a SAP group or a SAP+PERT group after ACL reconstruction and before returning to preinjury activities. Participants were required to achieve ≥ 80% quadriceps muscle strength symmetry, minimal knee effusion, full ROM, no reports of pain, and completion of a running progression (all between 3 and 9 months postoperatively) before enrollment. Of 94 potentially eligible athletic male patients evaluated knee angles and moments at peak knee flexion angle; (2) sagittal plane hip and knee angles and moments at peak knee extension angle; (3) sagittal plane hip and knee excursion during weight acceptance; and (4) sagittal plane hip and knee excursion during midstance. We also calculated the proportion of athletes in each group who walked with clinically meaningful interlimb asymmetry in sagittal plane hip and knee variables and compared these proportions using odds ratios. There was no differential loss to followup between groups. There were no differences between the SAP or SAP+PERT groups for the biomechanical gait variables. The involved limb's knee excursion during midstance for the SAP (mean ± SD: 1 year: 15° ± 5

  18. Differences in kinetic asymmetry between injured and noninjured novice runners : A prospective cohort study

    NARCIS (Netherlands)

    Bredeweg, S. W.; Buist, I.; Kluitenberg, B.

    Purpose: The purpose of this prospective study was to describe natural levels of asymmetry in running, compare levels of asymmetry between injured and noninjured novice runners and compare kinetic variables between the injured and noninjured lower limb within the novice runners with an injury.

  19. Quantitative Study of Vibrational Symmetry of Injured Vocal Folds via Digital Kymography in Excised Canine Larynges

    Science.gov (United States)

    Krausert, Christopher R.; Ying, Di; Zhang, Yu; Jiang, Jack J.

    2011-01-01

    Purpose: Digital kymography and vocal fold curve fitting are blended with detailed symmetry analysis of kymograms to provide a comprehensive characterization of the vibratory properties of injured vocal folds. Method: Vocal fold vibration of 12 excised canine larynges was recorded under uninjured, unilaterally injured, and bilaterally injured…

  20. Prevalence of alcohol and other psychoactive substances in injured drivers : comparison between Belgium and The Netherlands.

    NARCIS (Netherlands)

    Legrand, S.-A. Houwing, S. Hagenzieker, M. & Verstraete, A.G.

    2013-01-01

    The study objective was to compare the prevalence of alcohol and (il)licit drugs in seriously injured drivers in Belgium (BE) and the Netherlands (NL). Injured car and van drivers admitted to the emergency departments of five hospitals in Belgium and three in the Netherlands from January 2008 to May

  1. Employment among Spinal Cord Injured Patients Living in Turkey: A Cross-Sectional Study

    Science.gov (United States)

    Gunduz, Berrin; Erhan, Belgin; Bardak, Ayse Nur

    2010-01-01

    The aim of this study was to determine the rate of employment and to establish the factors affecting vocational status in spinal cord injured patients living in Turkey. One hundred and fifty-two traumatic spinal cord injured patients older than 18 years with injury duration of at least 1 year and living in the community were included in the study;…

  2. Big Five Personality Characteristics and Adherence to Clinic-Based Rehabilitation Activities after ACL Surgery: A Prospective Analysis.

    Science.gov (United States)

    Hilliard, Robert C; Brewer, Britton W; Cornelius, Allen E; Van Raalte, Judy L

    2014-05-30

    A prospective, longitudinal study was conducted to examine Big Five personality characteristics as predictors of adherence to clinic-based rehabilitation activities following anterior cruciate ligament (ACL) reconstruction surgery. Participants (72 men, 36 women) completed a questionnaire assessing Big Five personality dimensions prior to surgery. For the first 7 weeks after surgery, participants' rehabilitation session attendance was recorded and rehabilitation professionals rated participants' adherence during rehabilitation sessions.. Results of multiple regression analyses indicated that the 5 personality factors explained 11 percent of the variance in attendance and 17 percent of the variance in adherence ratings, that agreeableness was a significant positive predictor of attendance, and that conscientiousness and openness to experience were significant positive predictors of adherence ratings. As a potential contributor to adherence, personality warrants consideration when implementing rehabilitation programs after ACL surgery.

  3. Relationship between knee kinetic outcome measures in vertical counter movement jumps and self-reported function in ACL reconstructed subjects

    DEFF Research Database (Denmark)

    Brekke, Anders Falk

    2014-01-01

    ±7 months post-surgery. Bilateral and unilateral counter movement jumps (CMJ) was measured by a 6 camera Vicon-MX03 system and two AMTI OR6-7 force-plates. Three kinetic outcomes related to the medial aspect of the knee were calculated: Peak knee adduction moment (P-KAM), KAM impulse (I-KAM) and the Total......Relationship between knee kinetic outcome measures in counter movement jumps and self-reported function in ACL reconstructed subjects Brekke AF1,2, Nielsen DB2, Holsgaard-Larsen A2 1School of physiotherapy, University College Zealand, Denmark 2Orthopaedic Research Unit, Department of Orthopaedics...... with early-onset OA with associated pain, functional limitations, and decreased quality of life. However, specific knee loading pattern of the medial aspect has not been investigated during different jump-tasks in ACL-reconstructed patients. The purpose was to investigate potential kinetic differences...

  4. Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes

    DEFF Research Database (Denmark)

    Zebis, Mette K.; Andersen, Lars L.; Brandt, Mikkel

    2016-01-01

    risk factors for non-contact ACL injury. METHODS: 40 adolescent female football and handball players (15-16 years) were randomly allocated to a control group (CON, n=20) or neuromuscular training group (NMT, n=20). The NMT group performed an injury prevention programme as a warm-up before their usual......BACKGROUND: Adolescent female football and handball players are among the athletes with the highest risk of sustaining anterior cruciate ligament (ACL) injuries. AIM: This study evaluated the effects of evidence-based lower extremity injury prevention training on neuromuscular and biomechanical...... training 3 times weekly for 12 weeks. The CON group completed their regular warm-up exercise programme before training. Players were tested while performing a side cutting movement at baseline and 12-week follow-up, using surface electromyography (EMG) and three-dimensional movement analysis. We calculated...

  5. Broken Bioabsorbable Tibial Interference Screw after Anterior Cruciate Ligament (ACL Reconstruction using a Semitendinosus-gracilis Graft: A Case Report

    Directory of Open Access Journals (Sweden)

    Huang ME Deborah

    2012-07-01

    Full Text Available When a patient presents with knee pain and locking after an anterior cruciate ligament (ACL reconstruction, a new meniscal injury or an osteochondral loose body are usually considered for differential diagnosis. We present the case of a 22-year-old female with just these complaints 6 months after ACL reconstruction surgery. Magnetic resonance imaging (MRI of the knee showed a broken screw tip which was later arthroscopically removed. At arthroscopy, an 11mm long broken bioabsorbable interference screw tip was found lying in the intercondylar notch; this resulted in a 0.5cm Outerbridge grade II chondral ulcer located at mid- patella. Both menisci and cruciate ligaments were intact and no other loose bodies were found in the knee joint.

  6. POTENTIAL FOR NON-CONTACT ACL INJURY BETWEEN STEP-CLOSE-JUMP AND HOP-JUMP TASKS

    Directory of Open Access Journals (Sweden)

    Li-I Wang

    2010-03-01

    Full Text Available This study aimed to compare the kinematics and kinetics during the landing of hop-jump and step-close-jump movements in order to provide further inferring that the potential risk of ACL injuries. Eleven elite male volleyball players were recruited to perform hop-jump and step-close-jump tasks. Lower extremity kinematics and ground reaction forces during landing in stop-jump tasks were recorded. Lower extremity kinetics was calculated by using an inverse dynamic process. Step-close-jump tasks demonstrated smaller peak proximal tibia anterior shear forces during the landing phase. In step-close-jump tasks, increasing hip joint angular velocity during initial foot-ground contact decreased peak posterior ground reaction force during the landing phase, which theoretically could reduce the risk of ACL injury

  7. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture.

    Science.gov (United States)

    Kyritsis, Polyvios; Bahr, Roald; Landreau, Philippe; Miladi, Riadh; Witvrouw, Erik

    2016-08-01

    The decision as to whether or not an athlete is ready to return to sport (RTS) after ACL reconstruction is difficult as the commonly used RTS criteria have not been validated. To evaluate whether a set of objective discharge criteria, including muscle strength and functional tests, are associated with risk of ACL graft rupture after RTS. 158 male professional athletes who underwent an ACL reconstruction and returned to their previous professional level of sport were included. Before players returned to sport they underwent a battery of discharge tests (isokinetic strength testing at 60°, 180° and 300°/s, a running t test, single hop, triple hop and triple crossover hop tests). Athletes were monitored for ACL re-ruptures once they returned to sport (median follow-up 646 days, range 1-2060). Of the 158 athletes, 26 (16.5%) sustained an ACL graft rupture an average of 105 days after RTS. Two factors were associated with increased risk of ACL graft rupture: (1) not meeting all six of the discharge criteria before returning to team training (HR 4.1, 95% CI 1.9 to 9.2, p≤0.001); and (2) decreased hamstring to quadriceps ratio of the involved leg at 60°/s (HR 10.6 per 10% difference, 95% CI 10.2 to 11, p=0.005). Athletes who did not meet the discharge criteria before returning to professional sport had a four times greater risk of sustaining an ACL graft rupture compared with those who met all six RTS criteria. In addition, hamstring to quadriceps strength ratio deficits were associated with an increased risk of an ACL graft rupture. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  8. Indian and United States paramedic students: comparison of examination performance for the American Heart Association Advanced Cardiovascular Life Support (ACLS) training.

    Science.gov (United States)

    Goodwin, Tress; Delasobera, B Elizabeth; Strehlow, Matthew; Camacho, Jolyn; Koskovich, Mary; D'Souza, Peter; Gilbert, Gregory; Mahadevan, S V

    2012-08-01

    The American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) course is taught worldwide. The ACLS course is designed for consistency, regardless of location; to our knowledge, no previous study has compared the cognitive performance of international ACLS students to those in the United States (US). As international health educational initiatives continue to expand, an assessment of their efficacy is essential. This study assesses the AHA ACLS curriculum in an international setting by comparing performance of a cohort of US and Indian paramedic students. First-year paramedic students at the Emergency Management and Research Institute, Hyderabad, India, and a cohort of first-year paramedic students from the United States comprised the study population. All study participants had successfully completed the standard 2-day ACLS course, taught in English. Each student was given a 40-question standardized AHA multiple-choice examination. Examination performance was calculated and compared for statistical significance. There were 117 Indian paramedic students and 43 US paramedic students enrolled in the study. The average score was 86% (± 11%) for the Indian students and 87% (± 6%) for the US students. The difference between the average examination scores was not statistically significant in an independent means t-test (p=0.508) and a Wilcoxon test (p=0.242). Indian paramedic students demonstrated excellent ACLS cognitive comprehension and performed at a level equivalent to their US counterparts on an AHA ACLS written examination. Based on the study results, the AHA ACLS course proved effective in an international setting despite being taught in a non-native language. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Clinical and Arthroscopic Findings of Acute Anterior Cruciate Ligament Tears of the Knee

    Directory of Open Access Journals (Sweden)

    Kenji Shirakura

    1995-01-01

    Full Text Available Clinical, arthrographic, and arthroscopic findings in 53 patients with acutely torn anterior cruciate ligaments (ACLs were documented. Arthroscopy and instability tests under anesthesia were performed on all patients within 2 weeks after the initial injury. Twenty-three patients complained of extension blocks, and localized tenderness on the medial side was revealed in 26 patients at the initial examination. Aspiration from joints exhibited hemarthrosis in 52 patients. Arthroscopy revealed ACL ruptures in all patients. Four Segond's fractures, 26 meniscus tears (8 medial and 18 lateral, 1 osteochondral fracture, and 19 medial collateral ligament ruptures were revealed. Arthroscopy detected only 1 of the 5 ruptures of the posteromedial corner of the medial meniscus, which were noted on arthrography. Three ACL stumps were protruding among the femorotibial joint, which seemed to be restricting full extension. Statistical analysis showed that tenderness on the medial side was not revealed more frequently in knees with medial collateral ligament injuries than in the others. The volume of aspirated fluids in knees with no leakage in arthrography significantly increased over those with leakages (p < 0.05. Diagnosis of ACL injuries should be completed by clinical, arthrographic, and arthroscopic examinations.

  10. The effect of targeted exercise on knee-muscle function in patients with persistent hamstring deficiency following ACL reconstruction

    DEFF Research Database (Denmark)

    Bregenhof, Bo; Jørgensen, Uffe; Aagaard, Per

    2018-01-01

    at 12-24 months' post surgery, will be recruited through outpatient clinics and advertisements. Patients will be randomized to a 12-week progressive, strength and neuromuscular exercise group (SNG) with supervised training twice weekly or a control intervention (CON) consisting of a home-based, low...... treatment strategies in ACL-reconstructed patients. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02939677 (recruiting). Registered on 20 October 2016....

  11. The effect of intraoperative fluoroscopy on the accuracy of femoral tunnel placement in single-bundle anatomic ACL reconstruction.

    Science.gov (United States)

    Inderhaug, Eivind; Larsen, Allan; Waaler, Per Arne; Strand, Torbjørn; Harlem, Thomas; Solheim, Eirik

    2017-04-01

    The purpose of the current study was to investigate the potential effect of intraoperative fluoroscopy on the accuracy of femoral tunnel placement in anatomic ACL reconstruction, using an ideal anatomic point as reference and evaluating postoperative tunnel placement based on 3D CT. An experienced ACL surgeon, using the anatomic approach for femoral tunnel placement, relying on intraarticular landmarks and remnants of the torn ACL-and novel to the fluoroscopic assist-was introduced to its use. A prospective series of patients was included where group 1 (without fluoroscopy) and group 2 (with fluoroscopy) both had postoperative CT scans so that femoral tunnel position could be evaluated and compared to an ideal tunnel centre based on anatomic studies by using the Bernard and Hertel grid. Group 2, where fluoroscopy was used, had a mean femoral tunnel that was closer to the ideal anatomic centre than group 1. In the Bernard and Hertel grid, the distance in the high-low axis (y-axis) was found significantly closer (P = 0.001), whilst the deep-shallow axis (x-axis) and a total absolute distance were not significantly closer to the ideal described anatomic centre. Intraoperative fluoroscopy was found effective as an aid for placing the femoral tunnel in a more accurate position, as compared to a desired anatomic centre. Although the concept of the "one-size-fits-all" approach for tunnel placement is debatable, the avoidance of grossly misplaced tunnels is the benefit of using fluoroscopy during ACL reconstruction. The authors hold that fluoroscopy is readily available, safe and easy to use and therefore a good aid in the anatomic approach for graft tunnel placement, for example, in a learning situation, in revision cases and when performing low volumes of such surgery. III.

  12. Magnetic resonance imaging in evaluation of tunnel diameters prior to revision ACL reconstruction: a comparison to computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Drews, Bjoern Holger; Gulkin, Daniel; Guelke, Joachim; Gebhard, Florian [University of Ulm, Center of Surgery, Department for Orthopedic Trauma, Hand and Reconstructive Surgery, Ulm (Germany); Merz, Cornelia; Huth, Jochen; Mauch, Frieder [Sportklinik Stuttgart GmbH, Stuttgart (Germany)

    2017-10-15

    Revision ACL reconstruction is becoming more frequent because of a 10% rate of re-ruptures and insufficiencies. Currently, computed tomography (CT) represents the gold standard in detecting and measuring the tunnels of the initial ACL reconstruction. The purpose of this study was to compare measurement results of CT and thin-sliced MRI sequences, which were modified to a high soft tissue-bone contrast. Prior to an ACL revision surgery, 16 consecutive patients had an MRI in addition to the standard CT scan. A dedicated 0.25-T Esaote G-Scan (Esaote Biomedica, Cologne, Germany) with a Turbo 3D T1 sequence was used for MRI. Tunnel diameters were measured at 11 defined points of interest. For the statistical evaluation, the Mann-Whitney U test for connected samples was used. Inter- and intraobserver reliability was additionally calculated. All measured diameters showed significant to highly significant correlations between both diagnostic tools (r = 0.7-0.98). In addition, there was no significant difference (p > 0.5) between the two techniques. Almost all diameters showed nearly perfect intraobserver reliability (ICC 0.8-0.97). Interobserver reliability showed an ICC of 0.91/0.92 for only one diameter in MRI and CT. Prior to ACL revision surgery, bone tunnel measurements can be done using a 3D T1-MRI sequence in low-field MRI. MRI measurements show the same accuracy as CT scans. Preoperative radiation exposure in mainly young patients could be reduced. Also the costs of an additional CT scan could be saved. (orig.)

  13. Single Wake Meandering, Advection and Expansion - An analysis using an adapted Pulsed Lidar and CFD LES-ACL simulations

    DEFF Research Database (Denmark)

    Machefaux, Ewan; Larsen, Gunner Chr.; Troldborg, Niels

    2013-01-01

    In this paper, single wake characteristics have been studied both experimentally and numerically. Firstly, the wake is studied experimentally using full-scale measurements from an adapted focused pulsed lidar system, which potentially gives more insight into the wake dynamics as compared to class...... using the EllipSys3D flow solver using Large Eddy Simulation (LES) and Actuator Line Technique (ACL) to model the rotor. Discrepancies due to the uncertainties on the wake advection velocity are observed and discussed....

  14. Single Wake Meandering, Advection and Expansion - An analysis using an adapted Pulsed Lidar and CFD LES-ACL simulations

    DEFF Research Database (Denmark)

    In this paper, single wake characteristics have been studied both experimentally and numerically. Firstly, the wake is studied experimentally using full-scale measurements from an adapted focused pulsed lidar system, which potentially gives more insight into the wake dynamics as compared to class...... using the EllipSys3D flow solver using Large Eddy Simulation (LES) and Actuator Line Technique (ACL) to model the rotor. Discrepancies due to the uncertainties on the wake advection velocity are observed and discussed....

  15. Neuromuscular Coordination Deficit Persists 12 Months after ACL Reconstruction But Can Be Modulated by 6 Weeks of Kettlebell Training: A Case Study in Women's Elite Soccer

    Science.gov (United States)

    Andersen, Christoffer H.; Bencke, Jesper; Ørntoft, Christina; Linnebjerg, Connie; Hölmich, Per

    2017-01-01

    The aim of the present single-case study was to investigate the effect of 6 weeks' kettlebell training on the neuromuscular risk profile for ACL injury in a high-risk athlete returning to sport after ACL reconstruction. A female elite soccer player (age 21 years) with no previous history of ACL injury went through neuromuscular screening as measured by EMG preactivity of vastus lateralis and semitendinosus during a standardized sidecutting maneuver. Subsequently, the player experienced a noncontact ACL injury. The player was screened again following postreconstruction rehabilitation, then underwent 6-week kettlebell training, and was subsequently screened again at 6-week follow-up. Prior to and after postreconstruction rehabilitation the player demonstrated a neuromuscular profile during sidecutting known to increase the risk for noncontact ACL injury, that is, reduced EMG preactivity for semitendinosus and elevated EMG preactivity for vastus lateralis. Subsequently, the 6-week kettlebell training increased semitendinosus muscle preactivity during sidecutting by 38 percentage points to a level equivalent to a neuromuscular low-risk profile. An ACL rehabilitated female athlete with a high-risk neuromuscular profile changed to low-risk in response to 6 weeks of kettlebell training. Thus, short-term kettlebell exercise with documented high levels of medial hamstring activation was found to transfer into high medial hamstring preactivation during a sidecutting maneuver. PMID:28197354

  16. Neuromuscular Coordination Deficit Persists 12 Months after ACL Reconstruction But Can Be Modulated by 6 Weeks of Kettlebell Training: A Case Study in Women’s Elite Soccer

    Directory of Open Access Journals (Sweden)

    Mette K. Zebis

    2017-01-01

    Full Text Available The aim of the present single-case study was to investigate the effect of 6 weeks’ kettlebell training on the neuromuscular risk profile for ACL injury in a high-risk athlete returning to sport after ACL reconstruction. A female elite soccer player (age 21 years with no previous history of ACL injury went through neuromuscular screening as measured by EMG preactivity of vastus lateralis and semitendinosus during a standardized sidecutting maneuver. Subsequently, the player experienced a noncontact ACL injury. The player was screened again following postreconstruction rehabilitation, then underwent 6-week kettlebell training, and was subsequently screened again at 6-week follow-up. Prior to and after postreconstruction rehabilitation the player demonstrated a neuromuscular profile during sidecutting known to increase the risk for noncontact ACL injury, that is, reduced EMG preactivity for semitendinosus and elevated EMG preactivity for vastus lateralis. Subsequently, the 6-week kettlebell training increased semitendinosus muscle preactivity during sidecutting by 38 percentage points to a level equivalent to a neuromuscular low-risk profile. An ACL rehabilitated female athlete with a high-risk neuromuscular profile changed to low-risk in response to 6 weeks of kettlebell training. Thus, short-term kettlebell exercise with documented high levels of medial hamstring activation was found to transfer into high medial hamstring preactivation during a sidecutting maneuver.

  17. Neuromuscular Coordination Deficit Persists 12 Months after ACL Reconstruction But Can Be Modulated by 6 Weeks of Kettlebell Training: A Case Study in Women's Elite Soccer.

    Science.gov (United States)

    Zebis, Mette K; Andersen, Christoffer H; Bencke, Jesper; Ørntoft, Christina; Linnebjerg, Connie; Hölmich, Per; Thorborg, Kristian; Aagaard, Per; Andersen, Lars L

    2017-01-01

    The aim of the present single-case study was to investigate the effect of 6 weeks' kettlebell training on the neuromuscular risk profile for ACL injury in a high-risk athlete returning to sport after ACL reconstruction. A female elite soccer player (age 21 years) with no previous history of ACL injury went through neuromuscular screening as measured by EMG preactivity of vastus lateralis and semitendinosus during a standardized sidecutting maneuver. Subsequently, the player experienced a noncontact ACL injury. The player was screened again following postreconstruction rehabilitation, then underwent 6-week kettlebell training, and was subsequently screened again at 6-week follow-up. Prior to and after postreconstruction rehabilitation the player demonstrated a neuromuscular profile during sidecutting known to increase the risk for noncontact ACL injury, that is, reduced EMG preactivity for semitendinosus and elevated EMG preactivity for vastus lateralis. Subsequently, the 6-week kettlebell training increased semitendinosus muscle preactivity during sidecutting by 38 percentage points to a level equivalent to a neuromuscular low-risk profile. An ACL rehabilitated female athlete with a high-risk neuromuscular profile changed to low-risk in response to 6 weeks of kettlebell training. Thus, short-term kettlebell exercise with documented high levels of medial hamstring activation was found to transfer into high medial hamstring preactivation during a sidecutting maneuver.

  18. Hydrogel fibers for ACL prosthesis: design and mechanical evaluation of PVA and PVA/UHMWPE fiber constructs.

    Science.gov (United States)

    Bach, Jason S; Detrez, Fabrice; Cherkaoui, Mohammed; Cantournet, Sabine; Ku, David N; Corté, Laurent

    2013-05-31

    Prosthetic devices for anterior cruciate ligament (ACL) reconstruction have been unsuccessful due to mechanical failure or chronic inflammation. Polymer hydrogels combine biocompatibility and unique low friction properties; however, their prior use for ligament reconstruction has been restricted to coatings due to insufficient tensile mechanics. Here, we investigate new constructs of polyvinyl alcohol (PVA) hydrogel fibers. In water, these fibers swell to an equilibrium water content of 50% by weight, retaining a tensile modulus greater than 40 MPa along the fiber axis at low strain. Rope constructs were assembled for ACL replacement and mechanical properties were compared with data from the literature. Pure PVA hydrogel constructs closely reproduce the non-linear tensile stiffness of the native ACL with an ultimate strength of about 2000 N. An additional safety factor in tensile strength was achieved with composite braids by adding ultrahigh molecular weight polyethylene (UHMWPE) fibers around a core of PVA cords. Composition and braiding angle are adjusted to produce a non-linear tensile behavior within the range of the native ligament that can be predicted by a simple rope model. This design was found to sustain over one million cycles between 50 and 450 N with limited damage and less than 20% creep. The promising mechanical performances of these systems provide justification for more extensive in vivo evaluation. Copyright © 2013. Published by Elsevier Ltd.

  19. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

    Science.gov (United States)

    Ekås, Guri Ranum; Grindem, Hege; Moksnes, Håvard; Anderson, Allen F; Chotel, Franck; Cohen, Moises; Forssblad, Magnus; Ganley, Theodore J; Feller, Julian A; Karlsson, Jón; Kocher, Minider S; LaPrade, Robert F; McNamee, Michael; Mandelbaum, Bert; Micheli, Lyle; Mohtadi, Nicholas; Reider, Bruce; Roe, Justin; Seil, Romain; Siebold, Rainer; Witvrouw, Erik; Engebretsen, Lars

    2018-01-01

    In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions. PMID:29478021

  20. Can a tibial tunnel in ACL surgery be placed anatomically without impinging on the femoral notch? A risk factor analysis.

    Science.gov (United States)

    Van der Bracht, H; Bellemans, J; Victor, J; Verhelst, L; Page, B; Verdonk, P

    2014-02-01

    To analyze anatomical risk factors and surgical technique dependent variables, which determine the risk for femoral notch impingement in anatomically correct placed tibial tunnels for anterior cruciate ligament (ACL) surgery. Twenty fresh frozen adult human knee specimens under the age of 65 years were used. Digital templates mimicking a tibial tunnel aperture at the tibia plateau were designed for different tibial tunnel diameters and different drill-guide angles. The centres of these templates were placed over the geometric centre of the native tibial ACL footprint. The distances between the anterior borders of the templates and the anterior borders of the footprints (graft free zone) were measured and compared. Furthermore, anatomic risk factors for femoral notch impingement were determined. The graft free zone was statistically significantly longer for larger drill-guide angles compared to smaller drill-guide angles (p footprint (p footprint and surgery-related factors. Therefore, in anatomical tibial tunnel placement in single bundle ACL reconstruction surgery, particular attention should be paid to size of the tunnel and drill-guide angle to minimize the risk of femoral notch impingement.

  1. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries.

    Science.gov (United States)

    Ardern, Clare L; Ekås, Guri Ranum; Grindem, Hege; Moksnes, Håvard; Anderson, Allen F; Chotel, Franck; Cohen, Moises; Forssblad, Magnus; Ganley, Theodore J; Feller, Julian A; Karlsson, Jón; Kocher, Minider S; LaPrade, Robert F; McNamee, Michael; Mandelbaum, Bert; Micheli, Lyle; Mohtadi, Nicholas; Reider, Bruce; Roe, Justin; Seil, Romain; Siebold, Rainer; Silvers-Granelli, Holly J; Soligard, Torbjørn; Witvrouw, Erik; Engebretsen, Lars

    2018-04-01

    In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Management of Sexual Disorders in Spinal Cord Injured Patients

    Directory of Open Access Journals (Sweden)

    Alexander R Vaccaro

    2012-05-01

    Full Text Available Spinal cord injured (SCI patients have sexual disorders including erectile dysfunction (ED, impotence, priapism, ejaculatory dysfunction and infertility. Treatments for erectile dysfunction include four steps. Step 1 involves smoking cessation, weight loss, and increasing physical activity. Step 2 is phosphodiesterase type 5 inhibitors (PDE5I such as Sildenafil (Viagra, intracavernous injections of Papaverine or prostaglandins, and vacuum constriction devices. Step 3 is a penile prosthesis, and Step 4 is sacral neuromodulation (SNM. Priapism can be resolved spontaneously if there is no ischemia found on blood gas measurement or by Phenylephrine. For anejaculatory dysfunction, massage, vibrator, electrical stimulation and direct surgical biopsy can be used to obtain sperm which can then be used for intra-uterine or in-vitro fertilization. Infertility treatment in male SCI patients involves a combination of the above treatments for erectile and anejaculatory dysfunctions. The basic approach to and management of sexual dysfunction in female SCI patients are similar as for men but do not require treatment for erectile or ejaculatory problems.

  3. Relationship between stress ankle radiographs and injured ligaments on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyoung Min; Chung, Chin Youb; Chung, Myung Ki; Won, Sung Hun; Lee, Seung Yeol; Park, Moon Seok [Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, Kyungki (Korea, Republic of); Kwon, Soon-Sun [Seoul National University Bundang Hospital, Biomedical Research Institute, Kyungki (Korea, Republic of)

    2013-11-15

    This study was performed to investigate the relationship between the injured lateral ankle ligaments on MRI and stress ankle radiographs. Two hundred and twenty-nine consecutive patients (mean age 35.5 years, SD 14.6 years; 136 males and 93 females) that underwent ankle stress radiographs and MRI for lateral ankle instability were included. Tibiotalar tilt angle and anterior translation of talus were measured on stress ankle radiographs. Degree of lateral ligaments (anterior talofibular, calcaneofibular, and posterior talofibular) and deltoid ligament injuries were evaluated and scored as intact (0), partial injury (1), and complete injury (2) on MR images. Effusion of ankle joint was also recorded. The effects of gender, age, injuries of ligaments, and ankle joint effusion on stress radiographs were statistically analyzed. Gender (p = 0.010), age (p = 0.020), and anterior talofibular ligament (ATFL) injury (p < 0.001) were the factors significantly affecting tibiotalar tilt angle. Posterior talofibular ligament (PTFL) injury (p = 0.014) was found to be the only significant factor affecting the anterior translation on the anterior drawer radiographs. ATFL injury and PTFL injury on MRI significantly affected tibiotalar tilt angle and anterior drawer on stress radiographs. Other factors, such as age and gender, need to be considered in evaluating radiographic lateral ankle instability. (orig.)

  4. Wound healing process of injured pulp tissues with emdogain gel.

    Science.gov (United States)

    Kaida, Hikaru; Hamachi, Takafumi; Anan, Hisashi; Maeda, Katsumasa

    2008-01-01

    This study aimed to investigate the wound healing process of injured pulp tissues with Emdogain gel (EMD). Pulpotomy was performed for the first molars of the mandibles in rats. EMD or Vitapex (VIT)-containing calcium hydroxide was applied to the exposed pulp tissues. The treated teeth were extracted after 7, 14, and 28 days and prepared for histologic examination. In the VIT-treated group, the number of interleukin-1 beta (IL-1 beta)-expressing macrophages initially increased, followed by that of transforming growth factor-beta1 (TGF-beta1)-expressing macrophages. The number of cells expressing bone morphogenetic proteins (BMPs) gradually increased with reparative dentin formation. Meanwhile, in the EMD-treated group, cells expressing IL-1 beta or TGF-beta1 were few. However, the number of BMP-expressing cells, partly macrophages, increased in the early phase, and large amounts of reparative dentin were observed. This study demonstrated that different healing processes existed for EMD and VIT. BMP-expressing macrophages might play important roles in reparative dentin formation.

  5. Corps de ballet: the case of the injured ballet dancer.

    Science.gov (United States)

    Turner, Bryan S; Wainwright, Steven P

    2003-05-01

    This paper contributes to debate on social constructionism in the sociology of health and illness through a study of injury among ballet dancers. In this empirical study of classical ballet dancers, we outline a phenomenology of the injured and ageing body in terms of a critical commentary on constructionism. We explore dancers' experiences of embodiment to illustrate our critique of recent interpretations of dance as a textual practice. Those forms of social constructionism that define the body as a text provide a forceful attack on discourses of authority and legitimation, but we argue that they are problematic as epistemologies and ontologies of embodiment. Through a phenomenological understanding of the experiences of embodiment, we observe how injury and ageing disrupt the practical accomplishments that underpin the ballet habitus and the dancer's identity. Although ballet injuries can terminate a dancing career, they are accepted as an inevitable part of the vocation of ballet. Our aim is to understand the interaction between injuries, dancers' experiences of discomfort and the social support that emerges from the ballet dancers as a social group. We draw on the concepts of social solidarity and collective consciousness in Emile Durkheim to show that injury is mediated through the social bonding of dancers into a professional ballet company, where injury is accepted as a sign of vocational commitment, and suggest that this 'collective effervescence' gives a novel meaning to the idea of a corps de ballet.

  6. Maladaptation of cerebral perfusion in the spinal cord injured individuals

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Ihn Ho; Chun, Kyung A.; Lee, Hyoung Woo; Ahn, Sang Ho; Hayashida, Kohei [National Cardiovascular Center, Osaka (Korea, Republic of)

    2001-07-01

    The aim of this study was to evaluate the tilt-induced alteration of cerebral perfusion of spinal cord injured individuals. Supine and upright sitting brain SPECT was performed using a 1-day protocol with {sup 99m}Tc-ethylcysteinate dimer (ECD) in 11 SCI individuals (mean age, 32.6 y), with lesions between C3 and T4, ad 5 AB individuals (mean age, 31.4 y). The patients rested on a wheelchair in the supine position. Then, they sat up and, at the same time 555MBq of ECD was injected. The upright SPECT was done. Finally, 740MBq of ECD was injected and supine SPECT was performed again. The SPECT data were acquired with dual head gamma camera (E-cam, Siemens). For semiquantitative analysis, 14 ROIs were drawn on the brain. In the SCI individuals, the radiotracer uptake in the frontal, temporal and parietal areas were significantly decreased in the upright SPECT. No postural changes was evident in the occipital lobe, basal ganglia and thalamus in the SCI individuals. In the AB individuals, there were no such changes on the upright SPECT. Postural cerebral hypoperfusion in the frontal, temporal and parietal areas in the SCI individuals might relate to maladaptation of the vascular response during the upright position.

  7. Relationship between stress ankle radiographs and injured ligaments on MRI

    International Nuclear Information System (INIS)

    Lee, Kyoung Min; Chung, Chin Youb; Chung, Myung Ki; Won, Sung Hun; Lee, Seung Yeol; Park, Moon Seok; Kwon, Soon-Sun

    2013-01-01

    This study was performed to investigate the relationship between the injured lateral ankle ligaments on MRI and stress ankle radiographs. Two hundred and twenty-nine consecutive patients (mean age 35.5 years, SD 14.6 years; 136 males and 93 females) that underwent ankle stress radiographs and MRI for lateral ankle instability were included. Tibiotalar tilt angle and anterior translation of talus were measured on stress ankle radiographs. Degree of lateral ligaments (anterior talofibular, calcaneofibular, and posterior talofibular) and deltoid ligament injuries were evaluated and scored as intact (0), partial injury (1), and complete injury (2) on MR images. Effusion of ankle joint was also recorded. The effects of gender, age, injuries of ligaments, and ankle joint effusion on stress radiographs were statistically analyzed. Gender (p = 0.010), age (p = 0.020), and anterior talofibular ligament (ATFL) injury (p < 0.001) were the factors significantly affecting tibiotalar tilt angle. Posterior talofibular ligament (PTFL) injury (p = 0.014) was found to be the only significant factor affecting the anterior translation on the anterior drawer radiographs. ATFL injury and PTFL injury on MRI significantly affected tibiotalar tilt angle and anterior drawer on stress radiographs. Other factors, such as age and gender, need to be considered in evaluating radiographic lateral ankle instability. (orig.)

  8. Characteristics of meniscus progenitor cells migrated from injured meniscus.

    Science.gov (United States)

    Seol, Dongrim; Zhou, Cheng; Brouillette, Marc J; Song, Ino; Yu, Yin; Choe, Hyeong Hun; Lehman, Abigail D; Jang, Kee W; Fredericks, Douglas C; Laughlin, Barbara J; Martin, James A

    2017-09-01

    Serious meniscus injuries seldom heal and increase the risk for knee osteoarthritis; thus, there is a need to develop new reparative therapies. In that regard, stimulating tissue regeneration by autologous stem/progenitor cells has emerged as a promising new strategy. We showed previously that migratory chondrogenic progenitor cells (CPCs) were recruited to injured cartilage, where they showed a capability in situ tissue repair. Here, we tested the hypothesis that the meniscus contains a similar population of regenerative cells. Explant studies revealed that migrating cells were mainly confined to the red zone in normal menisci: However, these cells were capable of repopulating defects made in the white zone. In vivo, migrating cell numbers increased dramatically in damaged meniscus. Relative to non-migrating meniscus cells, migrating cells were more clonogenic, overexpressed progenitor cell markers, and included a larger side population. Gene expression profiling showed that the migrating population was more similar to CPCs than other meniscus cells. Finally, migrating cells equaled CPCs in chondrogenic potential, indicating a capacity for repair of the cartilaginous white zone of the meniscus. These findings demonstrate that, much as in articular cartilage, injuries to the meniscus mobilize an intrinsic progenitor cell population with strong reparative potential. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1966-1972, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  9. Day Center experience in rehabilitation of craniocerebral injured patients.

    Science.gov (United States)

    Stern, J M; Groswasser, Z; Alis, R; Geva, N; Hochberg, J; Stern, B; Yardeni, Y

    1985-01-01

    The Day Center for head-injured patients specialises in treating patients at later stages following brain trauma. The goal of therapy is social reintegration as measured by the quality of family and social life and by actual occupational status. At this later stage, a year or more since injury, the cognitive and behavioral aspects of brain damage determine the outcome of rehabilitation. The therapy aims at preserving as well as improving patients' overall performance including family life and therefore their families are treated as well. As the patients are not hospitalised at this stage, the asset of this model is that it constitutes an arresting factor in preventing regressive attitudes acquired during hospitalisation which is a sheltered framework. The Day Center System encourages the patients to cope "in vivo" with reality, while the therapy given strives at providing them with the instruments needed for coping in actual life situations. We present here our experience in 38 patients admitted consecutively during the course of a year. The results show that the therapeutic milieu was of great help in preserving as well as improvement patients' performance; furthermore, it is evident that some improvement was achieved even after several years post trauma.

  10. The difference in centre position in the ACL femoral footprint inclusive and exclusive of the fan-like extension fibres.

    Science.gov (United States)

    Iriuchishima, Takanori; Ryu, Keinosuke; Aizawa, Shin; Fu, Freddie H

    2016-01-01

    The purpose of this study was to compare the centre position of each anterior cruciate ligament bundle in its femoral footprint in measurements including and excluding the fan-like extension fibres. Fourteen non-paired human cadaver knees were used. All soft tissues around the knee were resected except the ligaments. The ACL was divided into antero-medial (AM) and postero-lateral (PL) bundles according to the difference in tension patterns. The ACL was carefully dissected, and two outlines were made of the periphery of each bundle insertion site: those which included and those which excluded the fan-like extension fibres. An accurate lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The centre position of each bundle, including and excluding the fan-like extension fibres, was measured with ImageJ software (National Institution of Health). Evaluation of the centre position was performed using the modified quadrant method. The centre of the femoral AM bundle including the fan-like extension was located at 28.8% in a shallow-deep direction and 37.2% in a high-low direction. When the AM bundle was evaluated without the fan-like extension, the centre was significantly different at 34.6% in a shallow-deep direction (p = 0.000) and 36% in a high-low direction. The centre of the PL bundle including the fan-like extension was found at 37.1% in a shallow-deep direction and 73.4% in a high-low direction. When the PL bundle was evaluated without the fan-like extension, the centre was significantly different at 42.7% in a shallow-deep direction (p = 0.000) and 69.3% in a high-low direction (p = 0.000). The centre position of the AM and PL bundles in the femoral ACL footprint was significantly different depending on the inclusion or exclusion of the fan-like extension fibres. For the clinical relevance, to reproduce the direct femoral insertion in the anatomical ACL reconstruction, tunnels should be

  11. Healing or harming? Healthcare provider interactions with injured workers and insurers in workers' compensation systems.

    Science.gov (United States)

    Kilgour, Elizabeth; Kosny, Agnieszka; McKenzie, Donna; Collie, Alex

    2015-03-01

    Healthcare providers (HCPs) are influential in the injured worker's recovery process and fulfil many roles in the delivery of health services. Interactions between HCPs and insurers can also affect injured workers' engagement in rehabilitation and subsequently their recovery and return to work. Consideration of the injured workers' perceptions and experiences as consumers of medical and compensation services can provide vital information about the quality, efficacy and impact of such systems. The aim of this systematic review was to identify and synthesize published qualitative research that focused on the interactions between injured workers, HCPs and insurers in workers' compensation systems in order to identify processes or interactions which impact injured worker recovery. A search of six electronic databases for literature published between 1985 and 2012 revealed 1,006 articles. Screening for relevance identified 27 studies which were assessed for quality against set criteria. A final 13 articles of medium and high quality were retained for data extraction. Findings were synthesized using a meta-ethnographic approach. Injured workers reported that HCPs could play both healing and harming roles in their recovery. Supportive patient-centred interaction with HCPs is important for injured workers. Difficult interactions between HCPs and insurers were highlighted in themes of adversarial relations and organisational pressures. Insurer and compensation system processes exerted an influence on the therapeutic relationship. Recommendations to improve relationships included streamlining administrative demands and increasing education and communication between the parties. Injured workers with long term complex injuries experience difficulties with healthcare in the workers' compensation context. Changes in insurer administrative demands and compensation processes could increase HCP participation and job satisfaction. This in turn may improve injured worker recovery

  12. Abnormal Mechanical Loading Induces Cartilage Degeneration by Accelerating Meniscus Hypertrophy and Mineralization After ACL Injuries In Vivo.

    Science.gov (United States)

    Du, Guoqing; Zhan, Hongsheng; Ding, Daofang; Wang, Shaowei; Wei, Xiaochun; Wei, Fangyuan; Zhang, Jianzhong; Bilgen, Bahar; Reginato, Anthony M; Fleming, Braden C; Deng, Jin; Wei, Lei

    2016-03-01

    Although patients with an anterior cruciate ligament (ACL) injury have a high risk of developing posttraumatic osteoarthritis (PTOA), the role of meniscus hypertrophy and mineralization in PTOA after an ACL injury remains unknown. The purpose of this study was to determine if menisci respond to abnormal loading and if an ACL injury results in meniscus hypertrophy and calcification. The hypotheses were that (1) abnormal mechanical loading after an ACL injury induces meniscus hypertrophy and mineralization, which correlates to articular cartilage damage in vivo, and (2) abnormal mechanical loading on bovine meniscus explants induces the overexpression of hypertrophic and mineralization markers in vitro. Controlled laboratory study. In vivo guinea pig study (hypothesis 1): Three-month-old male Hartley guinea pigs (n = 9) underwent ACL transection (ACLT) on the right knee; the left knee served as the control. Calcification in the menisci was evaluated by calcein labeling 1 and 5 days before knee harvesting at 5.5 months. Cartilage and meniscus damage and mineralization were quantified by the Osteoarthritis Research Society International score and meniscus grade, respectively. Indian hedgehog (Ihh), matrix metalloproteinase-13 (MMP-13), collagen type X (Col X), progressive ankylosis homolog (ANKH), ectonucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1), alkaline phosphatase (ALP), inorganic pyrophosphate (PPi), and inorganic phosphate (Pi) concentrations were evaluated by immunohistochemistry and enzyme-linked immunosorbent assay. In vitro bovine meniscus explant study (hypothesis 2): Bovine meniscus explants were subjected to 25% strain at 0.3 Hz for 1, 2, and 3 hours. Cell viability was determined using live/dead staining. The levels of mRNA expression and protein levels were measured using real-time quantitative reverse transcription polymerase chain reaction and Western blot after 24, 48, and 72 hours in culture. The conditioned medium was collected for sulfated

  13. Ultrasonographic appearance of normal and injured lateral patellar ligaments in the equine stifle.

    Science.gov (United States)

    Gottlieb, R; Whitcomb, M B; Vaughan, B; Galuppo, L D; Spriet, M

    2016-05-01

    Ultrasound is widely used in horses with stifle lameness, yet limited information is available regarding the appearance of normal and injured lateral patellar ligaments (LPL). To map the normal ultrasonographic appearance of the LPL. To describe the clinical and ultrasonographic features of LPL injuries. Descriptive study of healthy horses and retrospective case series. Twelve horses without stifle lameness underwent ultrasonographic examination of bilateral LPLs and ultrasonographic features were recorded. Eighteen horses with LPL injury were identified from 1999 to 2011. The normal LPL changes in appearance from origin to insertion. It shows ill-defined margins at the patella, becomes flattened and bilobed over the lateral trochlear ridge, is oval-triangular shaped with variable echogenicity and fibre pattern distal to the LTR, and becomes tapered with striations at the tibial insertion. LPL injury was identified in 18 horses of multiple breeds and uses. All injuries were acute, and 12 had wounds. Eleven horses were severely lame (grade 4-5/5). Ultrasonographic lesions were severe in 78% of cases. The mid to insertional portion of the LPL was most often affected. Radiography showed fractures of the tibial tuberosity (n = 6), patella (n = 4) and lateral trochlear ridge (n = 1). Fractures involved LPL attachments in 9 horses. Five were treated for osteomyelitis and one for synovial sepsis. Recheck ultrasound in 4 horses showed minimal to no change in the appearance of LPL injuries. Nine horses returned to riding, one continued as a broodmare, 2 were retired, one became a broodmare, 2 were lost to follow-up and 3 were subjected to euthanasia owing to concurrent injuries. Normal variations in shape, echogenicity and fibre pattern of the LPL are important considerations to prevent false positive diagnoses during ultrasonography. LPL injuries were often severe and associated with craniolateral stifle trauma. Prognosis varied from good to guarded in horses without

  14. Can molecular motors drive distance measurements in injured neurons?

    Directory of Open Access Journals (Sweden)

    Naaman Kam

    2009-08-01

    Full Text Available Injury to nerve axons induces diverse responses in neuronal cell bodies, some of which are influenced by the distance from the site of injury. This suggests that neurons have the capacity to estimate the distance of the injury site from their cell body. Recent work has shown that the molecular motor dynein transports importin-mediated retrograde signaling complexes from axonal lesion sites to cell bodies, raising the question whether dynein-based mechanisms enable axonal distance estimations in injured neurons? We used computer simulations to examine mechanisms that may provide nerve cells with dynein-dependent distance assessment capabilities. A multiple-signals model was postulated based on the time delay between the arrival of two or more signals produced at the site of injury-a rapid signal carried by action potentials or similar mechanisms and slower signals carried by dynein. The time delay between the arrivals of these two types of signals should reflect the distance traversed, and simulations of this model show that it can indeed provide a basis for distance measurements in the context of nerve injuries. The analyses indicate that the suggested mechanism can allow nerve cells to discriminate between distances differing by 10% or more of their total axon length, and suggest that dynein-based retrograde signaling in neurons can be utilized for this purpose over different scales of nerves and organisms. Moreover, such a mechanism might also function in synapse to nucleus signaling in uninjured neurons. This could potentially allow a neuron to dynamically sense the relative lengths of its processes on an ongoing basis, enabling appropriate metabolic output from cell body to processes.

  15. Can molecular motors drive distance measurements in injured neurons?

    Science.gov (United States)

    Kam, Naaman; Pilpel, Yitzhak; Fainzilber, Mike

    2009-08-01

    Injury to nerve axons induces diverse responses in neuronal cell bodies, some of which are influenced by the distance from the site of injury. This suggests that neurons have the capacity to estimate the distance of the injury site from their cell body. Recent work has shown that the molecular motor dynein transports importin-mediated retrograde signaling complexes from axonal lesion sites to cell bodies, raising the question whether dynein-based mechanisms enable axonal distance estimations in injured neurons? We used computer simulations to examine mechanisms that may provide nerve cells with dynein-dependent distance assessment capabilities. A multiple-signals model was postulated based on the time delay between the arrival of two or more signals produced at the site of injury-a rapid signal carried by action potentials or similar mechanisms and slower signals carried by dynein. The time delay between the arrivals of these two types of signals should reflect the distance traversed, and simulations of this model show that it can indeed provide a basis for distance measurements in the context of nerve injuries. The analyses indicate that the suggested mechanism can allow nerve cells to discriminate between distances differing by 10% or more of their total axon length, and suggest that dynein-based retrograde signaling in neurons can be utilized for this purpose over different scales of nerves and organisms. Moreover, such a mechanism might also function in synapse to nucleus signaling in uninjured neurons. This could potentially allow a neuron to dynamically sense the relative lengths of its processes on an ongoing basis, enabling appropriate metabolic output from cell body to processes.

  16. Dual-energy computed tomography of cruciate ligament injuries in acute knee trauma

    Energy Technology Data Exchange (ETDEWEB)

    Peltola, Erno K. [Helsinki University Hospital, Toeoeloe Trauma Center, Department of Radiology, Helsinki Medical Imaging Center, Helsinki (Finland); Koskinen, Seppo K. [Karolinska Universitetssjukhuset, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden)

    2015-09-15

    To examine dual-energy computed tomography (DECT) in evaluating cruciate ligament injuries. More specifically, the purpose was to assess the optimal keV level in DECT gemstone spectral imaging (GSI) images and to examine the usefulness of collagen-specific color mapping and dual-energy bone removal in the evaluation of cruciate ligaments and the popliteus tendon. At a level 1 trauma center, a 29-month period of emergency department DECT examinations for acute knee trauma was reviewed by two radiologists for presence of cruciate ligament injuries, visualization of the popliteus tendon and the optimal keV level in GSI images. Three different evaluating protocols (GSI, bone removal and collagen-specific color mapping) were rated. Subsequent MRI served as a reference standard for intraarticular injuries. A total of 18 patients who had an acute knee trauma, DECT and MRI were found. On MRI, six patients had an ACL rupture. DECT's sensitivity and specificity to detect ACL rupture were 79 % and 100 %, respectively. The DECT vs. MRI intra- and interobserver proportions of agreement for ACL rupture were excellent or good (kappa values 0.72-0.87). Only one patient had a PCL rupture. In GSI images, the optimal keV level was 63 keV. GSI of 40-140 keV was considered to be the best evaluation protocol in the majority of cases. DECT is a usable method to evaluate ACL in acute knee trauma patients with rather good sensitivity and high specificity. GSI is generally a better evaluation protocol than bone removal or collagen-specific color mapping in the evaluation of cruciate ligaments and popliteus tendon. (orig.)

  17. EXERCISES THAT FACILITATE OPTIMAL HAMSTRING AND QUADRICEPS CO-ACTIVATION TO HELP DECREASE ACL INJURY RISK IN HEALTHY FEMALES: A SYSTEMATIC REVIEW OF THE LITERATURE.

    Science.gov (United States)

    Dedinsky, Rachel; Baker, Lindsey; Imbus, Samuel; Bowman, Melissa; Murray, Leigh

    2017-02-01

    Anterior cruciate ligament (ACL) injury is common among females due to many anatomic, hormonal, and neuromuscular risk factors. One modifiable risk factor that places females at increased risk of ACL injury is a poor hamstrings: quadriceps (H:Q) co-activation ratio, which should be 0.6 or greater in order to decrease the stress placed on the ACL. Exercises that produce more quadriceps dominant muscle activation can add to the tension placed upon the ACL, potentially increasing the risk of ACL injury. The purpose of this systematic review was to compare quadriceps and hamstring muscle activation during common closed kinetic chain therapeutic exercises in healthy female knees to determine what exercises are able to produce adequate H:Q co-activation ratios. Systematic Review. Multiple online databases were systematically searched and screened for inclusion. Eight articles were identified for inclusion. Data on mean electromyography (EMG) activation of both quadriceps and hamstring muscles, % maximal voluntary isometric contraction (MVIC), and H:Q co-activation ratios were extracted from the studies. Quality assessment was performed on all included studies. Exercises analyzed in the studies included variations of the double leg squat, variations of the single leg squat, lateral step-up, Fitter, Stairmaster® (Core Health and Fitness, Vancouver, WA), and slide board. All exercises, except the squat machine with posterior support at the level of the scapula and feet placed 50 cm in front of the hips, produced higher quadriceps muscle activation compared to hamstring muscle activation. Overall, two leg squats demonstrate poor H:Q co-activation ratios. Single leg exercises, when performed between 30 and 90 degrees of knee flexion, produce adequate H:Q ratios, thereby potentially reducing the risk of tensile stress on the ACL and ACL injury. 2a- Systematic Review of Cohort Studies.

  18. Collegiate ACL Injury Rates Across 15 Sports: National Collegiate Athletic Association Injury Surveillance System Data Update (2004-2005 Through 2012-2013).

    Science.gov (United States)

    Agel, Julie; Rockwood, Todd; Klossner, David

    2016-11-01

    To present data on the rate of anterior cruciate ligament (ACL) injury in 15 collegiate sports from 2004 to 2005 through 2012 to 2013 updating the 1988-1989 to 2003-2004 data. Prospectively designed descriptive epidemiology study. National Collegiate Athletic Association Schools. National Collegiate Athletic Association School athletes. Injury rate by year and sport. Most ACL injuries to women occurred by a noncontact mechanism (60%) versus a contact mechanism for men (59%). The highest average annual rate of ACL injury for men was found in football (0.17 per 1000 athlete-exposure [A-E]). The highest average annual rate of ACL injury for women was found in lacrosse (0.23 per 1000 A-E). There were statistically significant increases in average annual injury rate for men's (P = 0.04) and women's soccer (P = 0.01) and a statistically significant decrease in women's gymnastics over the 9 years (=0.009). Controlling for exposures, there were statistically significant increases in the average annual number of injuries for men's and women's basketball, ice hockey, field hockey, football, and volleyball and a decrease in the average annual number of injuries for baseball and women's gymnastics. Women continue to sustain ACL injuries at higher rates than men in the comparable sports of soccer, basketball, and lacrosse. Anterior cruciate ligament injury rates continue to rise in men's and women's soccer. Some sports have shown absolute increases in ACL rates, which persist even after exposure rates are taken into account. Despite extensive research and development of prevention programs before and during the time of this study, very few sports showed a reduction in ACL injury rates in this data set.

  19. Concurrent assessments of lower limb loading patterns, mechanical muscle strength and functional performance in ACL-patients--a cross-sectional study.

    Science.gov (United States)

    Holsgaard-Larsen, A; Jensen, C; Mortensen, N H M; Aagaard, P

    2014-01-01

    Full recovery in muscle strength and functional performance may not be achieved after ACL-injury. The aim of this study is to investigate loading patterns during jumping, muscle function and functional performance in ACL-reconstructed patients and to investigate the origin of between-limb asymmetry by means of a 3-dimensional movement analysis. Design is cross-sectional. 23 ACL-reconstructed men (27.2±7.5 years, BMI: 25.4±3.2) 27±7 month post-surgery and 25 matched controls (27.2±5.4 years, BMI: 24.1±1.8) were included. Participants performed (i) bilateral and (ii) unilateral counter movement jumps (CMJ). A 3-D movement analysis was performed by a six-camera Vicon MX-system. Subsequently, jump height (JH), knee joint range of motion (ROM), peak and mean sagittal knee moments were analyzed (iii) one-leg maximal jump for distance was performed, and (iv) maximal unilateral isometric knee extensor and flexor strength (MVC) were measured using stabilized dynamometry. No in-between group differences in age or BMI were observed. CMJ: Between-limb asymmetry ratios for ROM differed (p<0.01) between patients and controls in both types of CMJ (96.1% vs. 102.6% and 87.0% vs. 99.9% in bilateral and single-leg CMJs, respectively). Jump for distance: Patients demonstrated greater (p<0.01) asymmetry for jump length (92.9% vs. 98.6%). MVC: Asymmetry in hamstring MVC was greater (p<0.001) for patients than controls (77.4% vs. 101.3%). ACL-patients showed reduced function of the operated leg~2 years post ACL-reconstruction, especially for hamstring MVC. Hamstrings are important protagonists to the ACL, thus representing a potential risk factor for secondary ACL-rupture and/or osteoarthritis. Copyright © 2013 Elsevier B.V. All rights reserved.

  20. EXERCISES THAT FACILITATE OPTIMAL HAMSTRING AND QUADRICEPS CO-ACTIVATION TO HELP DECREASE ACL INJURY RISK IN HEALTHY FEMALES: A SYSTEMATIC REVIEW OF THE LITERATURE.

    Science.gov (United States)

    Dedinsky, Rachel; Baker, Lindsey; Imbus, Samuel; Bowman, Melissa

    2017-01-01

    Background Anterior cruciate ligament (ACL) injury is common among females due to many anatomic, hormonal, and neuromuscular risk factors. One modifiable risk factor that places females at increased risk of ACL injury is a poor hamstrings: quadriceps (H:Q) co-activation ratio, which should be 0.6 or greater in order to decrease the stress placed on the ACL. Exercises that produce more quadriceps dominant muscle activation can add to the tension placed upon the ACL, potentially increasing the risk of ACL injury. Hypothesis/Purpose The purpose of this systematic review was to compare quadriceps and hamstring muscle activation during common closed kinetic chain therapeutic exercises in healthy female knees to determine what exercises are able to produce adequate H:Q co-activation ratios. Study Design Systematic Review Methods Multiple online databases were systematically searched and screened for inclusion. Eight articles were identified for inclusion. Data on mean electromyography (EMG) activation of both quadriceps and hamstring muscles, % maximal voluntary isometric contraction (MVIC), and H:Q co-activation ratios were extracted from the studies. Quality assessment was performed on all included studies. Results Exercises analyzed in the studies included variations of the double leg squat, variations of the single leg squat, lateral step-up, Fitter, Stairmaster® (Core Health and Fitness, Vancouver, WA), and slide board. All exercises, except the squat machine with posterior support at the level of the scapula and feet placed 50 cm in front of the hips, produced higher quadriceps muscle activation compared to hamstring muscle activation. Conclusion Overall, two leg squats demonstrate poor H:Q co-activation ratios. Single leg exercises, when performed between 30 and 90 degrees of knee flexion, produce adequate H:Q ratios, thereby potentially reducing the risk of tensile stress on the ACL and ACL injury. Level of Evidence 2a- Systematic Review of Cohort Studies PMID

  1. Translation, cultural adaptation and validation of simplified Chinese version of the anterior cruciate ligament return to sport after injury (ACL-RSI) scale.

    Science.gov (United States)

    Chen, Tianwu; Zhang, Peng; Li, Yunxia; Webster, Kate; Zhang, Jian; Yao, Wei; Yin, Yue; Ai, Chingchong; Chen, Shiyi

    2017-01-01

    To translate and cross-culturally adapt the anterior cruciate ligament-return to sport after injury (ACL-RSI) into simplified Chinese [ACL-RSI (Cn)]. In this diagnostic study, the translation, cross-culturally adaptation, and validation of the ACL-RSI was performed according to international guidelines. A total of 112 patients with ACL reconstruction participated in this study. All were capable of competitive sports before the injury and completed the Knee Injury and Osteoarthritis Outcome (KOOS), the International Knee Documentation Committee (IKDC), the Tampa Scale of Kinesiophobia (TSK), and the Tegner activity score. Forty-eight patients completed the ACL-RSI (Cn) twice within two weeks. The validity was tested using seven premade hypotheses. Internal consistency, reliability, and measurement error was assessed. At meanly 15.6 months postoperative, 81 (72.3%) patients returned to sport, with 57 (50.9%) to competitive sport and 24 (21.4%) to recreational sport. Thirty-one (27.7%) patients didn't return to any sport, with 19 (17.0%) still had planned to return, and 12 (10.7%) gave up sport. The ACL-RSI (Cn) demonstrated excellent validity with all hypotheses confirmed. The outcome of ACL-RSI (Cn) was strongly correlated the KOOS subscale quality of life (r = 0.66, psport (41.3 ± 17.7), psport (62.9 ± 10.5), (P = 0.002); between cases who planned to return (50.7 ± 14.1) and gave up sport (26.5 ± 11.7), (Psport.

  2. Jogging biomechanics after exercise in individuals with ACL-reconstructed knees.

    Science.gov (United States)

    Kuenze, Christopher; Hertel, Jay; Weltman, Arthur; Diduch, David R; Saliba, Susan; Hart, Joseph M

    2014-06-01

    Return to recreational activity is a common goal for the clinician and patient after ACL reconstruction (ACLR) and structured rehabilitation. Decreased peak knee flexion angle and external knee flexion moment during walking and jogging have been indicated as significant contributors to cartilage degeneration over time after knee joint injury. The purpose of this investigation was to measure the effects of 30 min of exercise on knee joint kinetics and kinematics in participants with a history of ACLR. ACLR participants (n = 20, 9 females and 11 males) and healthy controls (n = 23, 11 females and 12 males) participated in an observational laboratory study. Gait analysis was performed on all subjects before and after a 30-min exercise protocol. Sagittal and frontal plane kinematics and kinetics were measured in the involved limb in the ACLR group and compared with healthy control participants across the gait cycle using 90% confidence intervals. Significant differences between groups were established as a consecutive 3% of the gait cycle in which 90% confidence interval did not overlap. Preexercise, ACLR participants were more hip flexed with higher magnitude external hip flexion moments and lower magnitude external knee flexion moments during the stance phase compared with healthy controls. ACLR participants experienced preexercise to postexercise declines in hip flexion angle and external hip flexion moment along with increases in external knee flexion moment when compared with healthy controls. Exercise-related adaptations in hip and knee biomechanics are different in individuals with a history ACLR when compared with healthy controls despite a return to recreational activity. The biomechanical response to fatiguing exercise observed in this investigation may provide insight into one potential source of elevated knee injury risk and reduced long-term knee joint health after ACLR.

  3. ACL reconstruction in 11 children using the Clocheville surgical technique: Objective and subjective evaluation.

    Science.gov (United States)

    Severyns, M; Lucas, G; Jallageas, R; Briand, S; Odri, G; Fraisse, B; Marleix, S; Rochcongar, P; Violas, P

    2016-06-01

    The over-the-top position of the femoral metaphyseal tunnel during extraphyseal ligament reconstruction of the anterior cruciate ligament (ACL) according to Clocheville may be responsible for negative anisometry. Until now, the follow-up of children operated using this pediatric technique was limited to screening for iatrogenic epiphysiodesis and the search for postoperative clinical instability. The objective of this study was to measure residual laxity using objective tests, to quantify muscle recovery, and to evaluate the quality of life of these patients in terms of the sports activities. Eleven patients with a mean age of 13.5years were seen at a mean 2.1years of follow-up. They underwent objective clinical tests (GNRB(®) arthrometer and CON-TREX(®) dynamometer) as well as subjective questionnaires (IKDC and KOOS). No significant difference was found between the healthy knee and the operated knee for either the GNRB(®) at 134N (P=0.79) or at 200N (P=0.98). The CON-TREX(®) system allowed us to measure a median percentage of quadriceps recovery of 80.7% (range, 52.2-114.5) in terms of muscle power (60°/s) and 81.2% (range, 51.6-109.6) for muscle response (180°/s). The median subjective IKDC score was 94.73/100 (range, 73.68-98.93); 72.7% of the patients resumed competitive sports. This study's lack of statistical power did not show a significant difference in terms of residual laxity at rest of GNRB(®) transplants, while a mean differential of +0.4mm was observed. Although pediatric transphyseal ligament reconstruction techniques are increasingly used, the Clocheville technique remains, in our opinion, an attractive surgical alternative in the youngest subjects, with no major risk of iatrogenic epiphysiodesis even though it is theoretically anisometric. IV. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. Biomechanical Deficiencies in Women with Semitendinosus-Gracilis ACL Reconstruction During Drop Jumps

    Science.gov (United States)

    Ortiz, Alexis; Capo-Lugo, Carmen E.; Venegas-Rios, Heidi L.

    2014-01-01

    Objective To compare landing mechanics and neuromuscular recruitment strategies between women with semitendinosus-gracilis anterior cruciate ligament reconstruction (SG-ACLr) and non-injured women during double and single-legged drop jumps. Design Cross-sectional biomechanical study Setting Single university-based biomechanics laboratory Participants Fourteen women 1–5 years post SG-ACLr and 16 non-injured women participated in this study. Methods After anthropometric measurements, warm-up, and familiarization procedures, participants performed five trials of a double and single-legged drop jumps. Main Outcome Measurements Dynamic knee valgus was measured as the distance between knee joints during the landing phase of the double-leg drop jumps. Medial knee displacement was the outcome considered during the landing phase of the single-leg drop jumps. For both drop jumps tasks neuromuscular recruitment was evaluated through rectified normalized electromyography (EMG) activity of the quadriceps and hamstrings (amplitude and latency), and quadriceps/hamstrings EMG co-contraction ratio. Results Although the SG- ACLr group demonstrated a tendency towards a greater dynamic knee valgus during both drop jumps, these differences did not reach statistical significance. EMG data revealed different neuromuscular strategies for each group depending on the specific jump. Conclusions These findings suggest that women with SG-ACLr have a tendency towards greater dynamic knee valgus which could predispose to additional knee injuries. Rehabilitation specialists need to be aware of existing kinematic and neuromuscular deficiencies years after SG-ACLr. Taking this into consideration will aid in prescribing appropriate interventions designed to prevent re-injury. PMID:25043260

  5. Differences in kinetic variables between injured and noninjured novice runners : A prospective cohort study

    NARCIS (Netherlands)

    Bredeweg, Steef W.; Kluitenberg, Bas; Bessem, Bram; Buist, Ida

    Objectives: This prospective study examined differences in kinetic variables between injured and noninjured novice female and male runners and their potential contribution to RRIs. Design: A prospective cohort study. Methods: At baseline vertical ground reaction forces were assessed with an

  6. Evaluation of bronchiectasis in war chemically-injured patients via high resolution computed tomography

    Directory of Open Access Journals (Sweden)

    Reza Jalli

    2017-12-01

    Discussion and conclusion: Findings of chest HRCT demonstrated tubular bronchiectasis was the most frequent type of this disease that involve the chemically injured patients and RLL had been the most frequently involved lobe of the lung with bronchiectasis.

  7. Discrimination of intact and injured Listeria monocytogenes by Fourier transform infrared spectroscopy and principal component analysis.

    Science.gov (United States)

    Lin, Mengshi; Al-Holy, Murad; Al-Qadiri, Hamzah; Kang, Dong-Hyun; Cavinato, Anna G; Huang, Yiqun; Rasco, Barbara A

    2004-09-22

    Fourier transform infrared spectroscopy (FT-IR, 4000-600 cm(-)(1)) was used to discriminate between intact and sonication-injured Listeria monocytogenes ATCC 19114 and to distinguish this strain from other selected Listeria strains (L. innocua ATCC 51742, L. innocua ATCC 33090, and L. monocytogenes ATCC 7644). FT-IR vibrational overtone and combination bands from mid-IR active components of intact and injured bacterial cells produced distinctive "fingerprints" at wavenumbers between 1500 and 800 cm(-)(1). Spectral data were analyzed by principal component analysis. Clear segregations of different intact and injured strains of Listeria were observed, suggesting that FT-IR can detect biochemical differences between intact and injured bacterial cells. This technique may provide a tool for the rapid assessment of cell viability and thereby the control of foodborne pathogens.

  8. Central sensitization in spinal cord injured humans assessed by reflex receptive fields

    DEFF Research Database (Denmark)

    Biurrun Manresa, José Alberto; Finnerup, Nanna Susanne Brix; Johannesen, Inger Lauge

    2014-01-01

    OBJECTIVE: To investigate the effects of central sensitization, elicited by intramuscular injection of capsaicin, by comparing the reflex receptive fields (RRF) of spinally-intact volunteers and spinal cord injured volunteers that present presensitized spinal nociceptive mechanisms. METHODS: Fift...

  9. The effect of anterior cruciate ligament injury on bone curvature

    DEFF Research Database (Denmark)

    Hunter, D J; Lohmander, Stefan; Makovey, J

    2014-01-01

    OBJECTIVE: Investigate the 5-year longitudinal changes in bone curvature after acute anterior cruciate ligament (ACL) injury, and identify predictors of such changes. METHODS: In the KANON-trial (ISRCTN 84752559), 111/121 young active adults with an acute ACL tear to a previously un-injured knee...... had serial 1.5 T MR images from baseline (within 5 weeks from injury) to 5 years after injury. Of these, 86 had ACL reconstruction (ACLR) performed early or delayed, 25 were treated with rehabilitation alone. Measures of articulating bone curvature were obtained from computer-assisted segmentation...

  10. Synaptic inputs from stroke-injured brain to grafted human stem cell-derived neurons activated by sensory stimuli.

    Science.gov (United States)

    Tornero, Daniel; Tsupykov, Oleg; Granmo, Marcus; Rodriguez, Cristina; Grønning-Hansen, Marita; Thelin, Jonas; Smozhanik, Ekaterina; Laterza, Cecilia; Wattananit, Somsak; Ge, Ruimin; Tatarishvili, Jemal; Grealish, Shane; Brüstle, Oliver; Skibo, Galina; Parmar, Malin; Schouenborg, Jens; Lindvall, Olle; Kokaia, Zaal

    2017-03-01

    Transplanted neurons derived from stem cells have been proposed to improve function in animal models of human disease by various mechanisms such as neuronal replacement. However, whether the grafted neurons receive functional synaptic inputs from the recipient's brain and integrate into host neural circuitry is unknown. Here we studied the synaptic inputs from the host brain to grafted cortical neurons derived from human induced pluripotent stem cells after transplantation into stroke-injured rat cerebral cortex. Using the rabies virus-based trans-synaptic tracing method and immunoelectron microscopy, we demonstrate that the grafted neurons receive direct synaptic inputs from neurons in different host brain areas located in a pattern similar to that of neurons projecting to the corresponding endogenous cortical neurons in the intact brain. Electrophysiological in vivo recordings from the cortical implants show that physiological sensory stimuli, i.e. cutaneous stimulation of nose and paw, can activate or inhibit spontaneous activity in grafted neurons, indicating that at least some of the afferent inputs are functional. In agreement, we find using patch-clamp recordings that a portion of grafted neurons respond to photostimulation of virally transfected, channelrhodopsin-2-expressing thalamo-cortical axons in acute brain slices. The present study demonstrates, for the first time, that the host brain regulates the activity of grafted neurons, providing strong evidence that transplanted human induced pluripotent stem cell-derived cortical neurons can become incorporated into injured cortical circuitry. Our findings support the idea that these neurons could contribute to functional recovery in stroke and other conditions causing neuronal loss in cerebral cortex. © The Author (2017). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. Sphincter (ring muscle) gymnastics for spinal cord injured and spinal cord transected patients.

    Science.gov (United States)

    Yom-Tov, S

    2000-07-01

    Sphincter gymnastics seem to be able to recruit central pattern generators--networks of neurons that generate motor patterns--through peripheral rhythmic stimuli and to activate them without supraspinal signals. This physical therapy method is thus suitable for treating spinal cord injured and spinal cord transected patients, for it can reach below the injured segment and feed signals into the central nervous system, thus activating vital organs. This article presents some observations and discusses a possible mechanism.

  12. Changing insurance company claims handling processes improves some outcomes for people injured in road traffic crashes

    OpenAIRE

    Schaafsma, Frederieke; De Wolf, Annelies; Kayaian, Areen; Cameron, Ian D

    2012-01-01

    Abstract Background Regaining good health and returning to work are important for people injured in road traffic crashes and for society. The handling of claims by insurance companies may play an important role in the rate at which health recovers and return to work is actually attained. Methods A novel approach towards claims handling for people injured in road traffic accidents was compared to the standard approach. The setting was a large insurance company (NRMA Insurance) in the state of ...

  13. Proximal and distal effects of play on child compliance with a brain-injured parent.

    OpenAIRE

    Ducharme, J M; Rushford, N

    2001-01-01

    Individuals with brain injury may experience severe cognitive and other impairments. For brain-injured parents, such deficits may be associated with child behavior problems, including noncompliance. We assessed the effects of a play period conducted by a brain-injured father on the compliance of his son, who had become uncooperative with his father after the injury. The child consistently demonstrated improved compliance during proximal and distal compliance sessions that followed father-son ...

  14. First clinical experience with intranasal cooling for hyperthermia in brain-injured patients

    DEFF Research Database (Denmark)

    Springborg, Jacob Bertram; Springborg, Karoline Kanstrup; Romner, Bertil

    2013-01-01

    Hyperthermia is common in brain-injured patients and associated with a worse outcome. As brain rather than body temperature reduction, theoretically, is the most important in cerebral protection, there is logic in targeting cooling at the brain. Selective brain cooling can, in theory, be obtained...... by cooling the skull or by heat loss from the upper airways. In this preliminary safety and efficacy study, we report clinical data from brain-injured patients who because of hyperthermia were treated with intranasal cooling....

  15. Acute Bronchitis

    Science.gov (United States)

    ... Table of Contents1. Overview2. Symptoms3. Diagnosis4. Prevention5. Treatment6. Everyday Life7. Questions8. Resources What is acute bronchitis? Acute ... heartburn, you can get acute bronchitis when stomach acid gets into the bronchial tree. How is acute ...

  16. Safety knowledge and risk behaviour of injured and uninjured young skiers and snowboarders.

    Science.gov (United States)

    Macnab, A J; Cadman, R E; Greenlaw, J V

    1998-09-01

    Earlier studies of ski injury indicated that youths were at increased risk of injury, that males were most likely to injure the head or face, and that females were most likely to injure the knee. To obtain information about safety knowledge and risk behaviour that might contribute to injury among young skiers and snow-boarders. Survey of knowledge and behaviour in injured and noninjured cohorts. Blackcomb Mountain, Whistler, British Columbia. A total of 863 noninjured and 118 injured skiers and snowboarders aged five to 17 years using Blackcomb during 1993/94. Skier Knowledge Inventory Questionnaire. The injured cohort had less knowledge of the Skiers Responsibility Code. In both groups, almost half had had no lessons, 31% had had bindings adjusted by nonprofessionals and chair lift safety bars were used one ride in four by children age 13 to 17 years. The injuried cohort wore helmets slightly less often. Both groups regularly skied through the trees (60% to 70%), and one-thirds had skied on closed runs. Excessive speed was identified as the major cause of injury. Skiers did not recognize jumping as contributing to injury. Lack of knowledge of safety rules was more prevalent among the injured cohort. Skiing without due care - including skiing through tress, skiing on closed runs, skiing with excessive speed and jumping, particularly by snowboarders - were identified as potential causes of injury.

  17. Characteristics of electrically injured skin from human hand tissue samples using Fourier transform infrared microspectroscopy.

    Science.gov (United States)

    Li, Shi-Ying; Zou, Dong-Hua; Luo, Yi-Wen; Sun, Qi-Ran; Deng, Kai-Fei; Chen, Yi-Jiu; Huang, Ping

    2014-01-01

    This technical note describes a method for distinguishing normal skin tissue samples from those electrically injured by Fourier transform infrared microspectroscopy (FTIR MSP). Furthermore, the infrared spectral features of electrically injured cells and tissues were evaluated to identify molecular changes in epidermal cells. In the present study, 20 human hand tissue samples were evaluated macroscopically and histopathologically. The electrically injured skin samples were subdivided into 2 regions [normal cell regions (NCRs) and polarized cell regions (PCRs)] and 14 major spectral absorption bands were selected. The spectral results showed that the band absorbance at 1080, 1126, 1172, 1242, 1307, 1403, 1456, 1541, 2852, 2925, 2957, 3075, and 3300cm(-1) increased significantly both in the stratum and non-stratum corneum of the PCRs in electrically injured skin tissues samples. No significant difference was found between normal skin and the NCR of the electrically injured skin samples. The band absorbance ratios of A1172/A1126, A1456/A1403, and A2925/A2957 were significantly increased, whereas the A1652/A1541 ratio was decreased in the PCR of the stratum corneum and non-stratum corneum. Baseline changes from 4000 to near 1737cm(-1) were observed in the spectra of the electrically injured skin samples, which were interpreted in terms of the pathological process involved in electrical injury. FTIR-MSP presents a useful method to provide objective spectral markers for the assisted diagnosis of electrical marks. © 2013.

  18. Screening for ASD in adults with ID-moving toward a standard using the DiBAS-R and the ACL.

    Science.gov (United States)

    Mutsaerts, C G; Heinrich, M; Sterkenburg, P S; Sappok, T

    2016-05-01

    Identification of Autism Spectrum Disorder (ASD) in persons with intellectual disability (ID) is challenging but essential to allow adequate treatment to be given. This study examines whether the combination of two ASD screening instruments specifically developed for persons with ID, namely, the Diagnostic Behavioral Assessment for ASD-Revised (DiBAS-R) and the Autism Checklist (ACL), improves diagnostic accuracy when used in combination compared to the application of the single instrument. A clinical sample of adults with ID who are suspected of having ASD (N =148) was assessed using two ID specific screening scales (DiBAS-R and ACL). The diagnostic validity of the single instruments and of their combination was assessed. While both instruments showed acceptable diagnostic validity when applied alone (DiBAS-R/ACL: sensitivity: 75%/91%; specificity: 75%/75%; overall agreement: 75%/83%), specificity increased when two positive screening results were used (88%), and sensitivity increased (95%) when at least one positive screening result was used. Different combinations of the ASD screening instruments DiBAS-R and ACL lead to improvements in sensitivity and specificity. The complementary use of the ACL in addition to the sole use of the DiBAS-R improves overall accuracy. © 2016 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  19. MUSCLE STRENGTH AND QUALITATIVE JUMP-LANDING DIFFERENCES IN MALE AND FEMALE MILITARY CADETS: THE JUMP-ACL STUDY

    Directory of Open Access Journals (Sweden)

    Barry P. Boden

    2009-12-01

    Full Text Available Recent studies have focused on gender differences in movement patterns as risk factors for ACL injury. Understanding intrinsic and extrinsic factors which contribute to movement patterns is critical to ACL injury prevention efforts. Isometric lower- extremity muscular strength, anthropometrics, and jump-landing technique were analyzed for 2,753 cadets (1,046 female, 1,707 male from the U.S. Air Force, Military and Naval Academies. Jump- landings were evaluated using the Landing Error Scoring System (LESS, a valid qualitative movement screening tool. We hypothesized that distinct anthropometric factors (Q-angle, navicular drop, bodyweight and muscle strength would predict poor jump-landing technique in males versus females, and that female cadets would have higher scores (more errors on a qualitative movement screen (LESS than males. Mean LESS scores were significantly higher in female (5.34 ± 1.51 versus male (4.65 ± 1.69 cadets (p < 0.001. Qualitative movement scores were analyzed using factor analyses, yielding five factors, or "patterns", contributing to poor landing technique. Females were significantly more likely to have poor technique due to landing with less hip and knee flexion at initial contact (p < 0.001, more knee valgus with wider landing stance (p < 0. 001, and less flexion displacement over the entire landing (p < 0.001. Males were more likely to have poor technique due to landing toe-out (p < 0.001, with heels first, and with an asymmetric foot landing (p < 0.001. Many of the identified factor patterns have been previously proposed to contribute to ACL injury risk. However, univariate and multivariate analyses of muscular strength and anthropometric factors did not strongly predict LESS scores for either gender, suggesting that changing an athlete's alignment, BMI, or muscle strength may not directly improve his or her movement patterns

  20. Clinical Efficacy of Jump Training Augmented With Body Weight Support After ACL Reconstruction: A Randomized Controlled Trial.

    Science.gov (United States)

    Elias, Audrey R C; Harris, Kari J; LaStayo, Paul C; Mizner, Ryan L

    2018-03-01

    Limited knee flexion and increased muscle co-contraction during jump landing are believed to diminish outcomes after anterior cruciate ligament (ACL) reconstruction. The efficacy of jump training to improve patients' mechanical and neuromuscular deficits is understudied. Jump training will improve functional, mechanical, and neuromuscular outcomes and higher repetition training augmented by body weight support will result in better retention of gains. Randomized controlled trial; Level of evidence, 1. Thirty athletes (18 months after surgery) were screened, and 19 with mechanical deficits and limited clinical outcomes were enrolled in the trial. Testing included the International Knee Documentation Committee (IKDC) questionnaire, leg landing mechanics via motion analysis, knee joint effusion using a stroke test, and a surface electromyography-generated co-contraction index during a single-legged landing. Participants were randomly assigned to 1 of 2 groups: jump training with normal body weight (JTBW) and high-repetition jump training with body weight support (JTBWS). Knee effusion grading throughout training was used to assess joint tolerance. Changes in outcomes over time were analyzed with mixed-effects modeling. Immediate outcomes were compared with retention testing at 8 weeks after training by use of 2-way analyses of variance with effects of time and group. Significant effects of time were found during the training phase for all outcome measures, but no effects of group or sex were found. IKDC score (pooled; mean ± SD) increased from 76 ± 12 to 87 ± 8 ( P training mitigated some risk factors for second injury and osteoarthritis in patients after ACL reconstruction. Training made lasting improvements in physical function measures as well as mechanical and neuromuscular coordination deficits. Higher repetitions used with body weight support did not improve retention but substantially reduced risk for effusion. Jump training is an efficacious intervention

  1. Effects of foot rotation positions on knee valgus during single-leg drop landing: Implications for ACL injury risk reduction.

    Science.gov (United States)

    Teng, P S P; Kong, P W; Leong, K F

    2017-06-01

    Non-contact anterior cruciate ligament (ACL) injuries commonly occur when athletes land in high risk positions such as knee valgus. The position of the foot at landing may influence the transmission of forces from the ankle to the knee. Using an experimental approach to manipulate foot rotation positions, this study aimed to provide new insights on how knee valgus during single-leg landing may be influenced by foot positions. Eleven male recreational basketball players performed single-leg drop landings from a 30-cm high platform in three foot rotation positions (toe-in, toe-forward and toe-out) at initial contact. A motion capture system and a force plate were used to measure lower extremity kinematics and kinetics. Knee valgus angles at initial contact (KVA) and maximum knee valgus moments (KVM), which were known risk factors associated with ACL injury, were measured. A one-way repeated measures Analysis of Variance was conducted (α=0.05) to compare among the three foot positions. Foot rotation positions were found to have a significant effect on KVA (p<0.001, η 2 =0.66) but the difference between conditions (about 1°) was small and not clinically meaningful. There was a significant effect of foot position on KVM (p<0.001, η 2 =0.55), with increased moment observed in the toe-out position as compared to toe-forward (p=0.012) or toe-in positions (p=0.002). When landing with one leg, athletes should avoid extreme toe-out foot rotation positions to minimise undesirable knee valgus loading associated with non-contact ACL injury risks. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Assessment of the Anterolateral Ligament of the Knee by Magnetic Resonance Imaging in Acute Injuries of the Anterior Cruciate Ligament.

    Science.gov (United States)

    Helito, Camilo Partezani; Helito, Paulo Victor Partezani; Costa, Hugo Pereira; Demange, Marco Kawamura; Bordalo-Rodrigues, Marcelo

    2017-01-01

    To evaluate the epidemiology of injuries and abnormalities of the anterolateral ligament (ALL) by magnetic resonance imaging (MRI) in cases of acute anterior cruciate ligament (ACL) injury. MRIs of patients with acute ACL injury were evaluated. Acute injuries of the ACL were considered in cases in which the patient reported knee trauma occurring less than 3 weeks prior and when bone bruise in the femoral condyles and tibial plateau was identified. ALL abnormality was considered when it showed proximal or distal bone detachment, discontinuity of fibers, or irregular contour associated with periligamentous edema. The ALL was divided into femoral, tibial, and meniscal portions, and the lesions and/or abnormalities of each portion were characterized. The correlation of ALL injury with injuries of the lateral meniscus was evaluated. A total of 101 MRIs were initially evaluated. The ALL was not characterized in 13 (12.8%) examinations, resulting in 88 (87.1%) cases of injury evaluation. Of these, 55 (54.4%) patients had a normal ALL, and 33 (32.6%) showed signs of injury. Among the cases with injury, 24 (72%) patients showed proximal lesions, 7 (21%) showed distal lesions, and 2 (6.0%) patients presented both proximal and distal lesions. The meniscal portion of the ALL appeared abnormal in 16 (48%) patients. No relationship was found between ALL injury and lateral meniscus injury. Based on MRI analysis of acute ACL injuries with bone bruising of the lateral femoral condyle and lateral tibial plateau, approximately a third demonstrated ALL injuries of which the majority was proximal. Level IV, case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  3. Does the FIFA 11+ Injury Prevention Program Reduce the Incidence of ACL Injury in Male Soccer Players?

    Science.gov (United States)

    Silvers-Granelli, Holly J; Bizzini, Mario; Arundale, Amelia; Mandelbaum, Bert R; Snyder-Mackler, Lynn

    2017-10-01

    The FIFA 11+ injury prevention program has been shown to decrease the risk of soccer injuries in men and women. The program has also been shown to decrease time loss resulting from injury. However, previous studies have not specifically investigated how the program might impact the rate of anterior cruciate ligament (ACL) injury in male soccer players. The purpose of this study was to examine if the FIFA 11+ injury prevention program can (1) reduce the overall number of ACL injuries in men who play competitive college soccer and whether any potential reduction in rate of ACL injuries differed based on (2) game versus practice setting; (3) player position; (4) level of play (Division I or II); or (5) field type. This study was a prospective cluster randomized controlled trial, which was conducted in 61 Division I and Division II National Collegiate Athletic Association men's soccer teams over the course of one competitive soccer season. The FIFA 11+ is a 15- to 20-minute on-the-field dynamic warm-up program used before training and games and was utilized as the intervention throughout the entire competitive season. Sixty-five teams were randomized: 34 to the control group (850 players) and 31 to the intervention group (675 players). Four intervention teams did not complete the study and did not submit their data, noting insufficient time to complete the program, reducing the number for per-protocol analysis to 61. Compliance to the FIFA 11+ program, athletic exposures, specific injuries, ACL injuries, and time loss resulting from injury were collected and recorded using a secure Internet-based system. At the end of the season, the data in the injury surveillance system were crosshatched with each individual institution's internal database. At that time, the certified athletic trainer signed off on the injury collection data to confirm their accuracy and completeness. A lower proportion of athletes in the intervention group experienced knee injuries (25% [34 of

  4. Do Newer-Generation Bioabsorbable Screws Become Incorporated into Bone at Two Years After ACL Reconstruction with Patellar Tendon Graft?

    Science.gov (United States)

    Cox, Charles L.; Spindler, Kurt P.; Leonard, James P.; Morris, Brent J.; Dunn, Warren R.; Reinke, Emily K.

    2014-01-01

    Background: Bioabsorbable interference screws are used frequently for graft fixation in ACL (anterior cruciate ligament) reconstruction. The resorption properties of many available screws that are marketed as bioabsorbable are not well defined. The CALAXO (Smith & Nephew Endoscopy) and MILAGRO (DePuy Synthes) bioabsorbable screws contain polymers of poly(lactic-co-glycolic acid) (PLGA) plus additives to encourage osseointegration over time. The purpose of this study was to evaluate radiographic and magnetic resonance imaging (MRI) properties and compare patient-reported outcomes at a minimum of two years of follow-up after ACL reconstruction using CALAXO or MILAGRO bioabsorbable interference screws. Methods: A cohort of patients who underwent ACL reconstruction in which the fixation used was either CALAXO or MILAGRO screws returned for repeat radiographs for evaluation of tunnel widening, repeat MRI for evaluation of graft integrity and screw breakdown, and completion of the pain and symptom items of the KOOS (Knee injury and Osteoarthritis Outcome Score) questionnaire. Results: At a mean of three years (range, 2.5 to 4.0 years) after surgery, thirty-one patients with sixty-two CALAXO screws and thirty-six patients with seventy-two MILAGRO screws returned for repeat evaluation. Two blinded, independent reviewers found no significant differences between the two screw types when comparing radiographs for tibial or femoral tunnel widening or MRIs for graft integrity, tibial and femoral foreign body reactions, or femoral screw degradation. Both reviewers found a significant difference between the two screw types when comparing tibial screw degradation properties (p MILAGRO screws were more likely to be rated as intact. No significant differences were noted between the two screw types when comparing the two KOOS subscales. Conclusions: CALAXO screws in the tibial tunnel were more likely to be rated as degraded or partially degraded compared with MILAGRO screws at a mean

  5. Impact of quadriceps strengthening on response to fatiguing exercise following ACL reconstruction.

    Science.gov (United States)

    Kuenze, Christopher; Eltoukhy, Moataz; Kelly, Adam; Kim, Chang-Young

    2017-01-01

    Patients commonly experience altered response to fatiguing exercise after ACL reconstruction (ACLR). The objective of this study was to assess the impact of quadriceps strengthening on response to exercise after ACLR. Clinical trial. Ten participants with a history of primary, unilateral ACLR (sex=9F/1M, age=21.0±2.8 years, BMI=23.7±2.7kg/m 2 ) and 10 healthy participants (sex=9F/1M, age=22.2±3.2 years, BMI=23.8±3.9kg/m 2 ) participated. ACLR participants completed a 2-week quadriceps strengthening intervention including 14 progressive strengthening exercise sessions. Normalized knee extension maximum voluntary isometric contraction (MVIC) torque (Nm/kg) and quadriceps central activation ratio (%, CAR) were measured before and after a 30-minute fatiguing exercise protocol. ACLR participants completed testing before and after the 2-week intervention while control participants completed a single testing session. The intervention significantly improved normalized knee extension MVIC torque (pre-intervention=1.85±0.67Nm/kg, post-intervention=2.09±0.81Nm/kg, p=0.04) and quadriceps CAR in the ACLR involved limb (pre-intervention=86.51±5.03%, post-intervention=92.94±5.99%, p=0.02). Quadriceps CAR (pre-intervention=1.13±9.04%, post-intervention=-3.97±4.59%, p=0.16) and normalized knee extension MVIC torque (pre-intervention=0.26±20.90%, post-intervention=-8.02±12.82%, p=0.30) response to exercise did not significantly change from pre-intervention to post-intervention conditions. Two weeks of quadriceps strengthening reduced this between group difference in the involved limb which may indicate restoration of more optimal quadriceps neuromuscular function and increased demand on the quadriceps during physical activity. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  6. How is cardiac troponin released from injured myocardium?

    DEFF Research Database (Denmark)

    Mair, Johannes; Lindahl, Bertil; Hammarsten, Ola

    2017-01-01

    Cardiac troponin I and cardiac troponin T are nowadays the criterion biomarkers for the laboratory diagnosis of acute myocardial infarction due to their very high sensitivities and specificities for myocardial injury. However, still many aspects of their degradation, tissue release and elimination...... from the human circulation are incompletely understood. Myocardial injury may be caused by a variety of different mechanisms, for example, myocardial ischaemia, inflammatory and immunological processes, trauma, drugs and toxins, and myocardial necrosis is preceded by a substantial reversible prelethal...... phase. Recent experimental data in a pig model of myocardial ischaemia demonstrated cardiac troponin release into the circulation from apoptotic cardiomyocytes as an alternative explanation for clinical situations with increased cardiac troponin without any other evidence for myocardial necrosis...

  7. COMPARISON OF PROPRIOCEPTION IN INJURED AND UNINJURED KNEE JOINTS AMONG MALE PROFESSIONAL FOOTBALLERS

    Directory of Open Access Journals (Sweden)

    Dr. M S Nagarajan

    2015-02-01

    Full Text Available Background: Football is the world's most popular sport. There are over 240 million registered players worldwide and many more recreational footballers. The knee is a complex joint with many components making it vulnerable to a variety of injuries. The study has investigated the effect of knee proprioception error on injured and uninjured male professional footballers. Methods: This was a cross sectional comparative study with hundred and six (106 male professional footballers were selected for the study as per the selection criteria. Hundred and eighteen injured and ninety four uninjured knee samples were analysed for this study. Photographic analysis method was used to evaluate proprioception error at inner, middle and outer range of knee joint. Proprioception error of knee joint was measured at inner range, middle range and outer range for injured and uninjured groups. Data analysis found that there is significant difference in proprioception error between the groups. Result: Comparative study was performed using independent t’ test for proprioception error between knee injured and uninjured groups. P<0.05 were considered as significant difference in effect for this study. The means of knee injured and uninjured groups were 6.08 and 5.55 respectively with t’ value 2.21 and degree of freedom 634. The study found that proprioception error has significant difference in effect on knee injury, with P< 0.03*. Conclusion: The study concluded that proprioception error was varied between knee injured and uninjured groups. Proprioception error of knee joint was more among injured male professional footballers compared to the uninjured footballers.

  8. Region-specific disruption of synapsin phosphorylation following ethanol administration in brain-injured mice

    Directory of Open Access Journals (Sweden)

    James P Caruso

    2016-01-01

    Full Text Available Introduction: Civilians and military personnel develop a range of physical and psychosocial impairments following traumatic brain injury (TBI, including alcohol abuse. As a consequence, increased rates of alcohol misuse magnify TBI-induced pathologies and impede rehabilitation efforts. Therefore, a developed understanding of the mechanisms that foster susceptibility of the injured brain to alcohol sensitivity and the response of the injured brain to alcohol is imperative for the treatment of TBI patients. Alcohol sensitivity has been demonstrated to be increased following experimental TBI and, in additional studies, regulated by presynaptic vesicle release mechanisms, including synapsin phosphorylation. Materials and Methods: Mice were exposed to controlled midline impact of the intact skull and assessed for cortical, hippocampal, and striatal expression of phosphorylated synapsin I and II in response to high-dose ethanol exposure administered 14 days following injury, a time point at which injured mice demonstrate increased sedation after ethanol exposure. Results and Discussion: Immunoblot quantitation revealed that TBI alone, compared to sham controls, significantly increased phosphorylated synapsin I and II protein expression in the striatum. In sham controls, ethanol administration significantly increased phosphorylated synapsin I and II protein expression compared to saline-treated sham controls; however, no significant increase in ethanol-induced phosphorylated synapsin I and II protein expression was observed in the striatum of injured mice compared to saline-treated TBI controls. A similar expression pattern was observed in the cortex although restricted to increases in phosphorylated synapsin II. Conclusion: These data show that increased phosphorylated synapsin expression in the injured striatum may reflect a compensatory neuroplastic response to TBI which is proposed to occur as a result of a compromised presynaptic response of the

  9. Acute Pancreatitis and Pregnancy

    Science.gov (United States)

    ... Information Acute Pancreatitis Acute Pancreatitis and Pregnancy Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is ... of acute pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for ...

  10. Investigating physical fitness and race performance as determinants for the ACL injury risk in Alpine ski racing.

    Science.gov (United States)

    Schmitt, Kai-Uwe; Hörterer, Nicole; Vogt, Michael; Frey, Walter O; Lorenzetti, Silvio

    2016-01-01

    ACL ruptures in Alpine ski racers are frequently observed. This study analysed the association between physical fitness, race performance and the knee injury history. A retrospective study was conducted to investigate the influence of physical fitness and performance on the knee injury outcome. As part of this study an injury data base (covering 2004-2013) was established that recorded information about the athletes, their fitness status as determined by a standardised fitness test (Swiss Ski Power Test, SSPT) as well as medical information related to injuries. The performance of athletes who sustained knee injury was compared to athletes who suffered no injury or a different injury. Twenty-seven (19f, 8 m) of 70 athletes sustained a knee injury. ACL ruptures accounted for 71 % of these knee injuries. While more females sustained a knee injury, the difference between males and females was not statistically significant. It was shown that athletes with a better FIS (Fédération Internationale de Ski) rank were more prone to knee injury. However, none of the parameters related to physical fitness was linked to a history of knee injury. A general fitness test as SSPT is not associated with a history of knee injury in Alpine skiing. More specific physical fitness test procedures should be investigated to determine relevant fitness factors.

  11. Assessing the progress of rehabilitation in patients with ACL reconstruction using the International Knee Documentation Committee Subjective Knee Form

    International Nuclear Information System (INIS)

    Leguizamon, J H; Braidot, A; Catalfamo Formento, P

    2011-01-01

    There are numerous assessment tools designed to provide information on the results of reconstructive surgery of anterior cruciate ligament (ACL). They are also used for monitoring progress and facilitating clinical decision-making during the rehabilitation process. A brief summary of some existing tools specifically designed to evaluate knee ligament injuries is presented in this article. Then, one of those outcome measures, the International Knee Documentation Committee Subjective Knee Form (IKDC) was applied to a group of patients (N = 10) who had undergone surgery for ACL reconstruction. The patients attended the same physiotherapy service and followed a unified rehabilitation protocol. The assessment was performed twice: four and six months after surgery. The results showed an improvement in the rehabilitation of most patients tested (verified by a difference equal to or greater than 9 points on the IKDC outcome between measurements 1 and 2). The IKDC probed to be an instrument of quick and easy application. It provided quantitative data about the progress of rehabilitation and could be applied in everyday clinical physiotherapy practice. However, the results suggested considering the IKDC as one component of an evaluation kit to make decisions regarding the progress of the rehabilitation treatment.

  12. Translation, cultural adaptation and validation of simplified Chinese version of the anterior cruciate ligament return to sport after injury (ACL-RSI scale.

    Directory of Open Access Journals (Sweden)

    Tianwu Chen

    Full Text Available To translate and cross-culturally adapt the anterior cruciate ligament-return to sport after injury (ACL-RSI into simplified Chinese [ACL-RSI (Cn].In this diagnostic study, the translation, cross-culturally adaptation, and validation of the ACL-RSI was performed according to international guidelines. A total of 112 patients with ACL reconstruction participated in this study. All were capable of competitive sports before the injury and completed the Knee Injury and Osteoarthritis Outcome (KOOS, the International Knee Documentation Committee (IKDC, the Tampa Scale of Kinesiophobia (TSK, and the Tegner activity score. Forty-eight patients completed the ACL-RSI (Cn twice within two weeks. The validity was tested using seven premade hypotheses. Internal consistency, reliability, and measurement error was assessed.At meanly 15.6 months postoperative, 81 (72.3% patients returned to sport, with 57 (50.9% to competitive sport and 24 (21.4% to recreational sport. Thirty-one (27.7% patients didn't return to any sport, with 19 (17.0% still had planned to return, and 12 (10.7% gave up sport. The ACL-RSI (Cn demonstrated excellent validity with all hypotheses confirmed. The outcome of ACL-RSI (Cn was strongly correlated the KOOS subscale quality of life (r = 0.66, p<0.001, the TSK (r = -0.678, p<0.001, the Tegner score (r = 0.695, p<0.001. There was statistic difference between cases returned (68.6 ± 10.1 and didn't return to sport (41.3 ± 17.7, p<0.001; between cases returned to competitive (71.1 ± 8.9 and recreational sport (62.9 ± 10.5, (P = 0.002; between cases who planned to return (50.7 ± 14.1 and gave up sport (26.5 ± 11.7, (P<0.001. The internal consistency (Cronbach's α = 0.96 and test-retest reliability [intra-class correlation coefficient (ICC = 0.90] was excellent. The measurement error, floor and ceiling effect was satisfactory. Administration time was 3.2 minutes, and no item was missed.The ACL-RSI (Cn scale was confirmed as a valid

  13. Association between maximal hamstring muscle strength and hamstring muscle pre-activity during a movement associated with non-contact ACL injury

    DEFF Research Database (Denmark)

    Zebis, M. K.; Sorensen, R. S.; Thorborg, K.

    2015-01-01

    Background: Reduced hamstring pre-activity during sidecutting increases the risk for non-contact ACL injury. During the last decade resistance training of the lower limb muscles has become an integral part ofACLinjury prevention in e.g. soccer and handball. However, it is not known whether a strong...... levels of muscle pre-activity during movements like the sidecutting maneuver. Implications: Other exercise modalities (i.e. neuromuscular training) are needed to optimize hamstring muscle pre-activity during movements associated with non-contact ACL injury....

  14. Differences in kinetic asymmetry between injured and noninjured novice runners: a prospective cohort study.

    Science.gov (United States)

    Bredeweg, S W; Buist, I; Kluitenberg, B

    2013-09-01

    The purpose of this prospective study was to describe natural levels of asymmetry in running, compare levels of asymmetry between injured and noninjured novice runners and compare kinetic variables between the injured and noninjured lower limb within the novice runners with an injury. At baseline vertical ground reaction forces and symmetry angles (SA) were assessed with an instrumented treadmill equipped with three force measuring transducers. Female participants ran at 8 and 9 km h(-1) and male runners ran at 9 and 10 km h(-1). Participants were novice female and male recreational runners and were followed during a 9-week running program. Two hundred and ten novice runners enrolled this study, 133 (63.3%) female and 77 (36.7%) male runners. Thirty-four runners reported an RRI. At baseline SA values varied widely for all spatio-temporal and kinetic variables. The inter-individual differences in SA were also high. No significant differences in SA were found between female and male runners running at 9 km h(-1). In injured runners the SA of the impact peak was significantly lower compared to noninjured runners. Natural levels of asymmetry in running were high. The SA of impact peak in injured runners was lower compared to noninjured runners and no differences were seen between the injured and noninjured lower limbs. Copyright © 2013 Elsevier B.V. All rights reserved.

  15. Bronchoalveolar Lavage Microvesicles Protect Burn-Injured Mice from Pulmonary Infection.

    Science.gov (United States)

    Rice, Teresa C; Pugh, Amanda M; Xia, Brent T; Seitz, Aaron P; Whitacre, Brynne E; Gulbins, Erich; Caldwell, Charles C

    2017-10-01

    Pseudomonas aeruginosa is a major cause of morbidity and mortality among burn patients, despite antibiotic therapy. There is a need to identify innate immune defenses that prevent P aeruginosa infection in injured adults in an effort to find therapeutic alternatives to antibiotics. Here, we tested our hypothesis that microvesicles (MVs) in bronchoalveolar (BAL) fluid have a role in the immunity of the lung in response to pathogens. Microvesicles were isolated from murine BAL fluid, quantified using Nanoparticle Tracking Analysis, and injected into burn-injured mice before P aeruginosa infection. Survival was assessed and BAL bacterial loads enumerated. Neutrophil number and interleukin 6 activity were determined. Lungs were harvested and sphingosine (SPH) content analyzed via immunohistochemistry. Antimicrobial effects of MVs and SPH-enriched MVs were assessed in an in vitro assay. Burn-injured mice have reduced BAL MV number and SPH content compared with sham. When BAL MVs from healthy mice are administered to injured mice, survival and bacterial clearance are improved robustly. We also observed that intranasal administration of MVs restores SPH levels after burn injury, MVs kill bacteria directly, and this bacterial killing is increased when the MVs are supplemented with SPH. Using a preclinical model, BAL MVs are reduced after scald injury and BAL MV restoration to injured mice improves survival and bacterial clearance. The antimicrobial mechanisms leading to improved survival include the quantity and SPH content of BAL MVs. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Specialist team retrieval of head injured patients: fact, fiction, or formula?

    Science.gov (United States)

    Dieppe, Clare; Lo, T Y Milly; McFadzean, Jillian; Rowney, David A

    2009-02-01

    This feasibility study aimed to determine the maximum theoretical distance the Edinburgh Paediatric Retrieval Team (EPRT) could travel to retrieve head injured children without additional delay in reaching definitive care. A prospective audit was conducted over 2 years to determine the current practice for paediatric head injury transfers (stabilisation, referral, and transfer time) undertaken by primary hospital staff, and the performance (mobilisation and travel time) of the EPRT. A novel formula was devised and used to determine the theoretical maximum radius within which the EPRT could reach a referring hospital during their stabilisation of head injured patients. During the study period, 27 head injured patients were transferred to our unit by road and the EPRT conducted 194 road retrievals. The median stabilisation time for the head injured patients was 3.6 h. Median time to refer these patients to neurosurgical services was 1 h after presenting to primary hospitals. Median mobilisation time for EPRT was 1 h. Using our novel formula, 67 miles was the theoretical maximum radius within which the EPRT could reach a referring hospital during their stabilisation of head injured patients. Specialist team retrieval of paediatric head injury is a possibility, but not without significant organisational changes such as availability of second teams, early referral of patients and utilisation of the mobilisation time as a cancellation window. Our novel formula offers other teams a starting point to assess their own performance and to develop services.

  17. A prospective study on time to recovery in 254 injured novice runners.

    Directory of Open Access Journals (Sweden)

    Rasmus Oestergaard Nielsen

    Full Text Available Describe the diagnoses and the time to recovery of running-related injuries in novice runners.Prospective cohort study on injured runners.This paper is a secondary data analysis of a 933-person cohort study (DANO-RUN aimed at characterizing risk factors for injury in novice runners. Among those sustaining running-related injuries, the types of injuries and time to recovery is described in the present paper. All injured runners were diagnosed after a thorough clinical examination and then followed prospectively during their recovery. If they recovered completely from injury, time to recovery of each injury was registered.A total of 254 runners were injured. The proportion of runners diagnosed with medial tibial stress syndrome was 15%, 10% for patellofemoral pain, 9% for medial meniscal injury, 7% for Achilles tendinopathy and 5% for plantar fasciitis. Among the 220 runners (87% recovering from their injury, the median time to recovery was 71 days (minimum  = 9 days, maximum  = 617 days.Medial tibial stress syndrome was the most common injury followed by patellofemoral pain, medial meniscal injury and Achilles tendinopathy. Half of the injured runners were unable to run 2×500 meters without pain after 10 weeks. Almost 5% of the injured runners received surgical treatment.

  18. Marked asymmetry in vertical force (but not contact times) during running in ACL reconstructed athletes sport.

    Science.gov (United States)

    Thomson, Athol; Einarsson, Einar; Hansen, Clint; Bleakley, Chris; Whiteley, Rod

    2018-03-01

    Compare maximum plantar force (Fmax) during running in soccer players following anterior cruciate ligament reconstruction (ACLR) as they pass return to sport (RTS) criteria. Case control study. Soccer players after ACLR (n=16) and matched healthy controls (n=16) ran on a treadmill at 12, 14 and 16km/h while plantar loading data was measured using an in-shoe pressure system (Pedar-X, Novel). Fmax and contact time of the injured and uninjured limbs in athletes <9months post-ACLR and those ≥9months ACLR were compared to healthy players (no ACLR). Significant differences with large effect sizes in Fmax asymmetry were seen at all running speeds for the athletes <9months ACLR compared to those ≥9months, and the healthy subjects. Fmax difference peaked at 16km/h; 32±11%BW in <9months ACLR group compared to 6±5%BW in ≥9months group; ES=1.67, p<0.01. There was a non-significant trend for increasing asymmetry with increasing speed for subjects who were <9months after ACLR while the reverse was true for those ≥9 months and the healthy subjects. Relatively large unloading of the ACLR limb (but not differences in contact times) are seen during running for athletes <9months post-ACLR despite having completed functional criteria required to permit RTS training. These asymmetries appear to slightly increase with increasing speed, and the reverse is true for healthy controls and those ≥9months after ACLR surgery. Copyright © 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  19. Accumulating microglia phagocytose injured neurons in hippocampal slice cultures: involvement of p38 MAP kinase.

    Directory of Open Access Journals (Sweden)

    Takahiro Katayama

    Full Text Available In this study, microglial migration and phagocytosis were examined in mouse organotypic hippocampal slice cultures, which were treated with N-methyl-D-aspartate (NMDA to selectively injure neuronal cells. Microglial cells were visualized by the expression of enhanced green fluorescent protein. Daily observation revealed microglial accumulation in the pyramidal cell layer, which peaked 5 to 6 days after NMDA treatment. Time-lapse imaging showed that microglia migrated to the pyramidal cell layer from adjacent and/or remote areas. There was no difference in the number of proliferating microglia between control and NMDA-treated slices in both the pyramidal cell layer and stratum radiatum, suggesting that microglial accumulation in the injured areas is mainly due to microglial migration, not to proliferation. Time-lapse imaging also showed that the injured neurons, which were visualized by propidium iodide (PI, disappeared just after being surrounded by microglia. Daily observation revealed that the intensity of PI fluorescence gradually attenuated, and this attenuation was suppressed by pretreatment with clodronate, a microglia toxin. These findings suggest that accumulating microglia phagocytosed injured neurons, and that PI fluorescence could be a useful indicator for microglial phagocytosis. Using this advantage to examine microglial phagocytosis in living slice cultures, we investigated the involvements of mitogen-activated protein (MAP kinases in microglial accumulation and phagocytosis. p38 MAP kinase inhibitor SB203580, but not MAP kinase/extracellular signal-regulated kinase inhibitor PD98059 or c-Jun N-terminal kinase inhibitor SP600125, suppressed the attenuation of PI fluorescence. On the other hand, microglial accumulation in the injured areas was not inhibited by any of these inhibitors. These data suggest that p38 MAP kinase plays an important role in microglial phagocytosis of injured neurons.

  20. Prevalence and Classification of Injuries of Anterolateral Complex in Acute Anterior Cruciate Ligament Tears.

    Science.gov (United States)

    Ferretti, Andrea; Monaco, Edoardo; Fabbri, Mattia; Maestri, Barbara; De Carli, Angelo

    2017-01-01

    To report on the prevalence of injuries of the lateral compartment occurring in cases of apparently isolated acute anterior cruciate ligament (ACL) tears and to present a classification system of anterolateral complex injuries based on the data obtained. Sixty patients operated on for an acute apparently isolated ACL tear, revealed by clinical examination and confirmed by magnetic resonance imaging, were prospectively selected. The lateral compartment was exposed and injuries were detected. Based on the data obtained, lesions of the anterolateral complex were classified as follows: Type I: multilevel rupture with individual layers torn at different levels with macroscopic hemorrhage involving the area of the anterolateral ligament (ALL) and extended to the anterolateral capsule. Type II: multilevel rupture with individual layers torn at different levels with macroscopic hemorrhage extended from the area of the ALL and capsule to the posterolateral capsule. Type III: complete transverse tear involving the area of the ALL near its insertion to the lateral tibial plateau, distal to the lateral meniscus. Type IV: bony avulsion (Segond fracture). The pivot-shift test was repeated intraoperatively after repair of lateral tears before the ACL reconstruction. Although magnetic resonance imaging was able to detect only bony injuries (Segond fracture), macroscopic tears of the lateral capsule were clearly identified at surgery in 54 of 60 patients and classified as follows: Type I: 19/60 Type II: 16/60 Type III: 13/60 Type IV: 6/60 In all cases, repair resulted in a marked reduction or apparent disappearance of the pivot-shift phenomenon. Statistical analysis showed a positive correlation between lesions of the lateral compartment, regardless of the type described, and a pivot shift graded 2 or 3. Because injuries of secondary restraints often occur in cases of acute ACL tears, recognition and repair of such lesions could be considered to help ACL reconstruction to better

  1. An oscillating extracellular voltage gradient reduces the density and influences the orientation of astrocytes in injured mammalian spinal cord.

    Science.gov (United States)

    Moriarty, L J; Borgens, R B

    2001-01-01

    We have studied the cellular basis for recovery from acute spinal cord injury induced by applied electric fields. We have emphasized this recovery is due to the regeneration of spinal axons around and through the lesion, and have begun to evaluate the contribution of other cells to the recovery process. We have imposed a voltage gradient of about 320 microV/mm across puncture wounds to the adult rat spinal cord in order to study the accumulation and orientation of GFAP+ astrocytes within and adjacent to the lesion. This electric field was imposed by a miniaturized electronic implant designed to alternate the polarity of the field every 15 minutes. Astrocytes are known to undergo hyperplastic transformation within injured mammalian cords forming a major component of the scar that forms in response to injury. We have made three observations using a new computer based morphometry technique: First, we note a slight shift in the orientation of astrocytes parallel to the long axis of the spinal cord towards an imaginary reference perpendicular to this axis by approximately 10 degrees--but only in undamaged white matter near the lesion. Second, the relative number of astrocytes was markedly, and statistically significantly, reduced within electrically--treated spinal cords, particularly in the lesion. Third, the imposed voltage gradient statistically reduced the numbers of astrocytes possessing oriented cell processes within the injury site compared to adjacent undamaged regions of spinal cord.

  2. The enhanced epithelialization potential of the aqueous extract of Prunella vulgaris in thermally injured rats

    OpenAIRE

    Li Cheng-Cun; Meng Qing-Guo; Liang Xiu-Qin; Xiao Ji-Zhou

    2016-01-01

    The aim of the present study was to assess the wound-healing efficiency of the Prunella vulgaris extract (PVE) on thermally injured rats. Sixty adult, female rats were divided into four groups, with group I serving as a sham control (without a burn injury). A burn was inflicted on the dorsum of all the rats in the second, third and fourth groups. Group II rats served as the burn-injury control group without any treatment. The burn-injured areas of the rats ...

  3. Artificial gait in complete spinal cord injured subjects: how to assess clinical performance

    OpenAIRE

    Pithon, Karla Rocha; Abreu, Daniela Cristina Carvalho de; Vasconcelos-Neto, Renata; Martins, Luiz Eduardo Barreto; Cliquet-Jr, Alberto

    2015-01-01

    Objective Adapt the 6 minutes walking test (6MWT) to artificial gait in complete spinal cord injured (SCI) patients aided by neuromuscular electrical stimulation. Method Nine male individuals with paraplegia (AIS A) participated in this study. Lesion levels varied between T4 and T12 and time post injured from 4 to 13 years. Patients performed 6MWT 1 and 6MWT 2. They used neuromuscular electrical stimulation, and were aided by a walker. The differences between two 6MWT were assessed by using a...

  4. The diagnostic and prognostic value of ultrasonography in soccer players with acute hamstring injuries.

    Science.gov (United States)

    Petersen, Jesper; Thorborg, Kristian; Nielsen, Michael Bachmann; Skjødt, Thomas; Bolvig, Lars; Bang, Niels; Hölmich, Per

    2014-02-01

    An injury to the hamstring muscle complex is the most common injury in soccer. Ultrasound of acute hamstring injuries is often used as a clinical tool for diagnosing hamstring injuries and guiding players in when they can return to play. To (1) investigate the characteristic sonographic findings of acute hamstring injuries in soccer players, (2) compare the mean injury severity (time to return to play) in injured players with and without sonographically verified abnormalities, and (3) correlate the length of the injured area and absence from soccer play (time to return to play) to investigate if ultrasonography can be used as a prognostic indicator of time to return to play. Case series; Level of evidence, 4. Players from 50 teams participating in 1 of the top 5 Danish soccer divisions were followed in the period from January to December 2008. Of 67 players with acute hamstring injuries, 51 underwent ultrasonographic examination of the injured thigh and were included in this study. Ultrasonographic examinations were performed 1 to 10 days after injury (mean, 5.2 ± 3.0 days), and sonographic findings were present in 31 of 51 cases (61%). Two thirds of the injuries were to the biceps femoris muscle and one third to the semitendinosus muscle. No total ruptures were documented. The 51 acute hamstring injuries resulted in absence from soccer of a mean 25.4 ± 15.7 days per injury, with no significant difference between players with and without sonographically verified abnormalities (P = .41). No correlation existed between the length of the injured area and injury severity (r = 0.19, P = .29). The biceps femoris is the most commonly injured hamstring muscle detected by ultrasound, and more than half of the injuries are intramuscular. Because neither the presence of sonographic findings nor the size of the findings was correlated with time to return to play in injured soccer players, the prognosis of hamstring injuries should not be guided by these findings alone.

  5. An unusual case of partial Anterior Cruciate ligament (ACL) tear secondary to a glass foreign body in an adolescent knee joint.

    Science.gov (United States)

    S M, Shishir; K, Abhay Harsh; R, Kanagasabai; Gnanadoss, James J

    2016-01-01

    Various types of foreign bodies have been removed from the knee joint. We report an unusual case of partial anterior cruciate ligament (ACL) tear secondary to a glass foreign body in an adolescent knee joint. A 13-year-old boy presented with pain, swelling and deformity of the left knee since 4 days. X-Ray revealed a foreign body in the left knee joint. The glass foreign body remained in the subcutaneous tissue for few days and later migrated into the knee joint. Arthroscopy revealed partial tear in the ACL at the femoral attachment with about 10-20 % of fibres being involved. The glass piece was removed arthroscopically and the ACL fibres were trimmed. Arthroscopic removal of foreign bodies from the knee is a very simple procedure and has the advantages of avoiding large incision, shorter stay in the hospital, faster recovery and reduced infection rates. Glass foreign bodies were previously implicated in cartilage damage and meniscal injuries but a foreign body resulting in ACL tear has not been reported in literature.

  6. Immersive virtual reality improves movement patterns in patients after ACL reconstruction : implications for enhanced criteria-based return-to-sport rehabilitation

    NARCIS (Netherlands)

    Gokeler, Alli; Bisschop, Marsha; Myer, Gregory D.; Benjaminse, Anne; Dijkstra, Pieter U.; van Keeken, Helco G.; van Raay, Jos J. A. M.; Burgerhof, Johannes G. M.; Otten, Egbert

    PURPOSE: The purpose of this study was to evaluate the influence of immersion in a virtual reality environment on knee biomechanics in patients after ACL reconstruction (ACLR). It was hypothesized that virtual reality techniques aimed to change attentional focus would influence altered knee flexion

  7. Computer-assisted anatomical placement of a double-bundle ACL through 3D-fitting of a statistically generated femoral template into individual knee geometry

    NARCIS (Netherlands)

    Luites, J. W. H.; Wymenga, A. B.; Sati, M.; Bourquin, Y.; Blankevoort, L.; van der Venne, R.; Kooloos, J. G. M.; Staubli, H. U.

    2000-01-01

    Femoral graft placement is an important factor in the success of ACL-reconstruction. Besides improving the accuracy of femoral tunnel placement, Computer Assisted Surgery (CAS) can be used to determine the anatomical Location. This requires a 3D femoral template with the position of the anatomical

  8. Constitutive modeling of the human Anterior Cruciate Ligament (ACL) under uniaxial loading using viscoelastic prony series and hyperelastic five parameter Mooney-Rivlin model

    Science.gov (United States)

    Chakraborty, Souvik; Mondal, Debabrata; Motalab, Mohammad

    2016-07-01

    In this present study, the stress-strain behavior of the Human Anterior Cruciate Ligament (ACL) is studied under uniaxial loads applied with various strain rates. Tensile testing of the human ACL samples requires state of the art test facilities. Furthermore, difficulty in finding human ligament for testing purpose results in very limited archival data. Nominal Stress vs. deformation gradient plots for different strain rates, as found in literature, is used to model the material behavior either as a hyperelastic or as a viscoelastic material. The well-known five parameter Mooney-Rivlin constitutivemodel for hyperelastic material and the Prony Series model for viscoelastic material are used and the objective of the analyses comprises of determining the model constants and their variation-trend with strain rates for the Human Anterior Cruciate Ligament (ACL) material using the non-linear curve fitting tool. The relationship between the model constants and strain rate, using the Hyperelastic Mooney-Rivlin model, has been obtained. The variation of the values of each coefficient with strain rates, obtained using Hyperelastic Mooney-Rivlin model are then plotted and variation of the values with strain rates are obtained for all the model constants. These plots are again fitted using the software package MATLAB and a power law relationship between the model constants and strain rates is obtained for each constant. The obtained material model for Human Anterior Cruciate Ligament (ACL) material can be implemented in any commercial finite element software package for stress analysis.

  9. Anterior-Posterior Instability of the Knee Following ACL Reconstruction with Bone-Patellar Tendon-Bone Ligament in Comparison with Four-Strand Hamstrings Autograft

    Directory of Open Access Journals (Sweden)

    A. G. Angoules

    2013-01-01

    Full Text Available Purpose. To evaluate anterior-posterior knee laxity using two different autografts. Material-Methods. 40 patients, (34 males and 6 women, 17–54 years old (mean: 31, were included in the present study. Group A (4SHS = 20 underwent reconstruction using four-strand hamstrings, and group B (BPBT = 20 underwent reconstruction using bone-patellar tendon-bone autograft. Using the KT-1000 arthrometer, knee instability was calculated in both knees of all patients preoperatively and 3, 6, and 12 months after surgery at the ACL-operated knee. The contralateral healthy knee was used as an internal control group. Results. Anterior-posterior instability using the KT1000 Arthrometer was found to be increased after ACL insufficiency. The recorded laxity improved after arthroscopic ACL reconstruction in both groups. However, statistically significant greater values were detected in the bone-patellar tendon-bone group, which revealed reduction of anteroposterior stability values to an extent, where no statistical significance with the normal values even after 3 months after surgery was observed. Conclusions. Anterior-Posterior instability of the knee improved significantly after arthroscopic ACL reconstruction. The bone-patellar tendon-bone graft provided an obvious greater stability.

  10. Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? A prospective observational study

    DEFF Research Database (Denmark)

    Johansson, Per Ingemar; Sorensen, Anne Marie; Perner, Anders

    2011-01-01

    ABSTRACT: INTRODUCTION: It is debated whether the early trauma induced coagulopathy (TIC) in severely injured patients reflects disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype, acute coagulopathy of trauma shock (ACoTS) or yet other entities. This study investigated the...

  11. Delaying ACL reconstruction and treating with exercise therapy alone may alter prognostic factors for 5-year outcome

    DEFF Research Database (Denmark)

    Filbay, Stephanie R; Roos, Ewa M; Frobell, Richard B

    2017-01-01

    analysis of the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) trial (ISRCTN84752559). Relationships between prognostic factors (baseline cartilage, meniscus and osteochondral damage, baseline extension deficit, baseline patient-reported outcomes, number of rehabilitation...... was a prognostic factor for less knee symptoms compared with early reconstruction plus exercise therapy (regression coefficient 10.1, 95% CI 2.3 to 17.9). Baseline meniscus lesion was associated with worse sport/recreation function (-14.4, 95% CI -27.6 to -1.3) and osteochondral lesions were associated with worse...... QOL (-12.3, 95% CI -24.3 to -0.4) following early reconstruction plus exercise therapy. In the same group, undergoing additional non-ACL surgery and worse baseline KOOS scores were prognostic for worse outcome on all KOOS subscales. Following delayed reconstruction, baseline meniscus damage...

  12. Magnetic resonance angiography evaluation of the bone tunnel and graft following ACL reconstruction with a hamstring tendon autograft.

    Science.gov (United States)

    Terauchi, Ryu; Arai, Yuji; Hara, Kunio; Minami, Ginjiro; Nakagawa, Shuji; Takahashi, Takeshi; Ikoma, Kazuya; Ueshima, Keiichiro; Shirai, Toshiharu; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2016-01-01

    In this study, magnetic resonance angiography (MRA) was performed in the early phase after anterior cruciate ligament (ACL) reconstruction to analyse the changes in nutrient blood vessels and blood flow to the femoral and tibial tunnels and the intraosseous tendon grafts. The subjects were 30 patients who underwent single-bundle ACL reconstruction with an autogenous hamstring tendon. MRA was performed at 2, 3, and 6 months postoperatively (n = 10 at each time point). The mean overall signal-to-noise ratios (SNRs) in the tunnel regions and in the region of the tendon graft were compared in each femur and tibia. Blood vessels from arteries reached the femoral and tibial tunnels 2 months postoperatively. The tunnel walls showed high signal intensity, while the intraosseous tendon grafts had lower intensity. SNRs showed significant differences between the femoral and tibial tunnels overall and the intraosseous tendon grafts. At 3 and 6 months postoperatively, the signal intensity of the tunnel walls was decreased significantly, while that of the intraosseous tendon grafts was also decreased, but not significantly. At these times, the SNRs of the femoral and tibial tunnels did not differ significantly, both overall and in the region of the intraosseous tendon grafts. Revascularization around the femoral and tibial tunnels occurred at 2 months postoperatively, with blood flow subsequently decreasing over time until 6 months. This revascularization may be involved in bone tendon healing and maturation of the tendon graft within the bone tunnels. Evaluations of revascularization by MRA may show the maturation stage of the graft and guide medical rehabilitation. IV.

  13. Motor learning strategies in basketball players and its implications for ACL injury prevention: a randomized controlled trial.

    Science.gov (United States)

    Benjaminse, Anne; Otten, Bert; Gokeler, Alli; Diercks, Ron L; Lemmink, Koen A P M

    2017-08-01

    Adding external focus of attention (EF, focus on the movement effect) may optimize current anterior cruciate ligament (ACL) injury prevention programmes. The purpose of the current study was to investigate the effects of an EF, by a visual stimulus and an internal focus, by a verbal stimulus during unexpected sidestep cutting in female and male athletes and how these effects remained over time. Ninety experienced basketball athletes performed sidestep cutting manoeuvres in three sessions (S1, S2 and S3). In this randomized controlled trial, athletes were allocated to three groups: visual (VIS), verbal (VER) and control (CTRL). Kinematics and kinetics were collected at the time of peak knee frontal plane moment. Males in the VIS group showed a larger vertical ground reaction force (S1: 25.4 ± 3.1 N/kg, S2: 25.8 ± 2.9 N/kg, S3: 25.2 ± 3.2 N/kg) and knee flexion moments (S1: -3.8 ± 0.9 Nm/kg, S2: -4.0 ± 1.2 Nm/kg, S3: -3.9 ± 1.3 Nm/kg) compared to the males in the VER and CTRL groups and to the females in the VIS group (p knee valgus moment and the females in the VER group reduced knee varus moment over time (n.s.). Male subjects clearly benefit from visual feedback. Females may need different feedback modes to learn a correct movement pattern. Sex-specific learning preferences may have to be acknowledged in day by day practice. Adding video instruction or feedback to regular training regimens when teaching athletes safe movement patterns and providing individual feedback might target suboptimal long-term results and optimize ACL injury prevention programmes. I.

  14. Comparison of femoral tunnel widening between outside-in and trans-tibial double-bundle ACL reconstruction.

    Science.gov (United States)

    Lee, Yong Seuk; Lee, Beom Koo; Oh, Won Seok; Cho, Yong Kyun

    2014-09-01

    The objectives of this study were to compare (1) the degree of widening by comparing the diameter at the most widened area and the site of widening by measuring the distance from the tunnel entrance to the most widened area in two femoral tunnels (anteromedial and posterolateral), and (2) the morphologic change at the tunnel entrance between outside-in and trans-tibial double-bundle anterior cruciate ligament (ACL) reconstruction. A retrospective study that included 17 trans-tibial and 19 outside-in double-bundle ACL reconstructed patients was conducted for evaluation of serial computed tomography (CT) scan (immediate post-operation and post-operative 1 year). Digital image communication in medicine (DICOM) data was extracted from the PiViewSTAR and imported into OsiriX, which was installed on a Macbook Pro laptop computer. Diameter of the most widened area and distance from the entrance to this point were measured from each of two perpendicular (sagittal and coronal) planes that were accurately realigned parallel to the tunnel direction. Change in the morphology of the tunnel entrance between immediate post-operation and 1-year post-operation was evaluated. Widening was observed in both planes of both tunnels in the two techniques. However, no statistical significances in the diameter of most widened area and distance from the tunnel entrance to the most widened point were observed between the both techniques (n.s.). Distances from the centre point to each four sections showed an increase in all four sections of all both tunnels in both techniques. However, no statistical significance was observed between the two techniques (n.s.). Widening was observed in all tunnels using both techniques and degrees, and sites of the widening did not differ between groups. Morphologic change at the tunnel entrance was not limited to the specific direction and occurred in all directions without significant difference between groups. Retrospective comparative study, Level III.

  15. Comparative adaptations of lower limb biomechanics during unilateral and bilateral landings after different neuromuscular-based ACL injury prevention protocols.

    Science.gov (United States)

    Brown, Tyler N; Palmieri-Smith, Riann M; McLean, Scott G

    2014-10-01

    Potentially valuable anterior cruciate ligament (ACL) injury prevention strategies are lengthy, limiting training success. Shorter protocols that achieve beneficial biomechanical adaptations may improve training effectiveness. This study examined whether core stability/balance and plyometric training can modify female landing biomechanics compared with the standard neuromuscular and no training models. Forty-three females had lower limb biomechanics analyzed during unilateral and bilateral landings immediately before and after a 6-week neuromuscular or no training programs. Sagittal and frontal plane hip and knee kinematics and kinetics were submitted to 3-way repeated-measures analyses of variance to test for the main and interaction effects of training group, landing type, and testing time. Greater peak knee flexion was evident in the standard neuromuscular group following training, during both bilateral (p = 0.027) and unilateral landings (p = 0.076 and d = 0.633). The plyometric group demonstrated reduced hip adduction (p = 0.010) and greater knee flexion (p = 0.065 and d = 0.564) during bilateral landings following training. The control group had significant reduction in peak stance knee abduction moment (p = 0.003) posttraining as compared with pretraining. The current outcomes suggest that significant biomechanical changes are possible by an isolated plyometric training component. The benefits, however, may not be evident across all landing types, seemingly limited to simplistic, bilateral landings. Integrated training protocols may still be the most effective training model, currently improving knee flexion posture during both bilateral and unilateral landings following training. Future prevention efforts should implement integrated training protocols that include plyometric exercises to reduce ACL injury risk of female athletes.

  16. A cross-sectional study of psychological complaints and quality of life in severely injured patients

    NARCIS (Netherlands)

    van Delft-Schreurs, C. C. H. M.; van Bergen, J. J. M.; van de Sande, P.; Verhofstad, M. H. J.; de Vries, J.; de Jongh, M. A. C.

    2014-01-01

    Purpose The purpose of this study was to examine the incidence of psychological complaints and the relationship of these complaints with the quality of life (QOL) and accident- and patient-related factors among severely injured patients after the rehabilitation phase. Methods Patients of 18 years or

  17. [Modern methods of the treatment of injured persons with combined vertebrospinal trauma].

    Science.gov (United States)

    Zamiatin, P N

    2005-01-01

    The issues of rehabilitational treatment of injured persons after polytrauma occurrence with compressive fracture of spine using electrostimulation were considered. The application of such an approach have had promoted the essential lowering of traumaticity and the treatment duration as well, the prognosis improvement, the length of temporary disability period reduction.

  18. Therapeutic electrical stimulation of injured peripheral nerve tissue using implantable thin-film wireless nerve stimulators.

    Science.gov (United States)

    MacEwan, Matthew R; Gamble, Paul; Stephen, Manu; Ray, Wilson Z

    2018-02-09

    OBJECTIVE Electrical stimulation of peripheral nerve tissue has been shown to accelerate axonal regeneration. Yet existing methods of applying electrical stimulation to injured peripheral nerves have presented significant barriers to clinical translation. In this study, the authors examined the use of a novel implantable wireless nerve stimulator capable of simultaneously delivering therapeutic electrical stimulation of injured peripheral nerve tissue and providing postoperative serial assessment of functional recovery. METHODS Flexible wireless stimulators were fabricated and implanted into Lewis rats. Thin-film implants were used to deliver brief electrical stimulation (1 hour, 20 Hz) to sciatic nerves after nerve crush or nerve transection-and-repair injuries. RESULTS Electrical stimulation of injured nerves via implanted wireless stimulators significantly improved functional recovery. Brief electrical stimulation was observed to increase the rate of functional recovery after both nerve crush and nerve transection-and-repair injuries. Wireless stimulators successfully facilitated therapeutic stimulation of peripheral nerve tissue and serial assessment of nerve recovery. CONCLUSIONS Implantable wireless stimulators can deliver therapeutic electrical stimulation to injured peripheral nerve tissue. Implantable wireless nerve stimulators might represent a novel means of facilitating therapeutic electrical stimulation in both intraoperative and postoperative settings.

  19. Missed posterior dislocation of the hip in a head-injured patient with ...

    African Journals Online (AJOL)

    Background: Head injury increases the risk of missed diagnosis by making patient-derived history impossible. The risk of missing a posterior dislocation of the hip in a head-injured patient is aggravated when an ipsilateral femoral shaft fracture co-exists. Adequate radiological evaluation of bone and joints is therefore of ...

  20. Effectiveness of a web-based intervention for injured claimants: A randomized controlled trial

    NARCIS (Netherlands)

    Elbers, N.A.; Akkermans, A.J.; Cuijpers, P.; Bruinvels, D.J.

    2013-01-01

    Background: There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process. One explanation for this reduced recovery is that the legal

  1. Fire-injured ponderosa pine provide a pulsed resource for bark beetles

    Science.gov (United States)

    Ryan S. Davis; Sharon Hood; Barbara J. Bentz

    2012-01-01

    Bark beetles can cause substantial mortality of trees that would otherwise survive fire injuries. Resin response of fire-injured northern Rocky Mountain ponderosa pine (Pinus ponderosa Douglas ex P. Lawson & C. Lawson) and specific injuries that contribute to increased bark beetle attack susceptibility and brood production are unknown. We monitored ponderosa pine...

  2. Slow elimination of injured liver DNA bases of γ-irradiated old mice

    International Nuclear Information System (INIS)

    Gaziev, A.I.; Malakhov, L.V.; Fomenko, L.A.

    1982-01-01

    The paper presents a study of the elimination of injured bases from the liver DNA of old and young mice after their exposure to γ rays. The presented data show that if DNA from the liver of irradiated mice is treated with incision enzymes, its priming activity is increased. In the case of enzymatic treatment of DNA isolated 5 h after irradiation we find a great difference between the priming activity of the liver DNA of old and young mice. The reason for this difference is that the liver DNA of 20-month old mice 5 h after irradiation still has many unrepaired injured bases. These data indicated that the rate of incision of γ-injured DNA bases in the liver of old mice is lower than in the liver of young mice. In the liver of mice of different age the rate of restitution of DNA, single-strand breaks induced by γ rays in doses up to 100 Gy is the same. At the same time, the level of induced reparative synthesis of DNA in cells of an old organism is lower than in cells of a young organism. The obtained data suggest that reduction of the rate of elimination of modified bases from the cell DNA of 20-month old mice is due to reduction of the activity of the DNA repair enzymes or to restrictions in the chromatin in the access of these enzymes to the injured regions of DNA in the cells of old animals

  3. Rehabilitation Counselor Competencies When Working With Hispanic/Latino Immigrant Injured Workers: A Delphi Study

    Science.gov (United States)

    Santos Román, Leslie M.; Estrada-Hernández, Noel

    2017-01-01

    Purpose: To explore and identify attitudes, knowledge, and skills rehabilitation practitioners in the private sector need when working with Hispanic/Latino immigrant injured workers. Methods: This study employed a 3-round Delphi study to obtain a consensus of 8 rehabilitation practitioners who had experience and expertise working with…

  4. [What kind of health information search the spinal cord injured patients from Spain on the internet?].

    Science.gov (United States)

    Bea-Muñoz, Manuel; Medina-Sánchez, María; Flórez-García, Mariano

    2015-04-16

    Internet is an alternative for health education to the population. Spinal cord injured individuals usually consult the Internet about their health problems. To identify the health information sources, the more consulted items and the confidence in Internet information of a group of spinal cord injured individuals from Spain. A survey to spinal cord injured individuals from Spain was conducted, with a questionnaire in Google Drive. It was accessible with a link in ASPAYM-Asturias web page. The questionnaire included epidemiological data and information about Internet use and confidence in its contents. 121 individuals answered the survey, 64% male, with an average age of 45 years. The predominant aetiology was traumatic (70%) and 72% were paraplegics. 83% prefer to consult health care providers directly. More of 70% of the sample searches health problems on the Internet, mostly web pages in Spanish. The preferred item was 'orthopaedic materials and wheelchairs'. 27% of the sample trusts in the Internet information and 32% don't. This research provides information about Internet use of spinal cord injured individuals in Spain. Although we have to admit some bias in the study, more than 70% of the sample searches health problems on the Internet, mostly web pages in Spanish. About one in four individuals trust in information from Internet and most of the sample prefers recommendations directly from healthcare professionals.

  5. Perspective of young drivers towards the care of the road traffic injured

    African Journals Online (AJOL)

    user

    2014-12-09

    Dec 9, 2014 ... some form of training in first aid care of the injured. Only 0.5% (2) of the total respondents knew the universal telephone number of 112 or 911 to call in the event of road traffic crash. Young drivers are well motivated and are more likely to confront emergency situations in road traffic crashes. Training them to.

  6. What Is the Relationship of Fear Avoidance to Physical Function and Pain Intensity in Injured Athletes?

    NARCIS (Netherlands)

    Fischerauer, Stefan F.; Talaei-Khoei, Mojtaba; Bexkens, Rens; Ring, David C.; Oh, Luke S.; Vranceanu, Ana-Maria

    2018-01-01

    Fear avoidance can play a prominent role in maladaptive responses to an injury. In injured athletes, such pain-related fear or fear avoidance behavior may have a substantial influence on the recovery process. Specifically, it may explain why some are able to reach their preinjury abilities, whereas

  7. Prevalence of alcohol and other psychoactive substances in injured and killed drivers

    DEFF Research Database (Denmark)

    Isalberti, Cristina; Linden, Trudy Van der; Legrand, Sara-Ann

    2011-01-01

    regarding the prevalence of alcohol and other psychoactive substances in drivers who have been injured/killed in traffic accidents. Part 1 of this report presents the general results of the hospital & killed driver studies. After a short introduction, the representativeness of the populations in the EU...

  8. Preserved alpha-adrenergic tone in the leg vascular bed of spinal cord-injured individuals.

    NARCIS (Netherlands)

    Kooijman, H.M.; Rongen, G.A.P.J.M.; Smits, P.; Hopman, M.T.E.

    2003-01-01

    BACKGROUND: Supraspinal sympathetic control of leg vascular tone is lost in spinal cord-injured individuals, but this does not result in a reduced leg vascular tone: Leg vascular resistance is even increased. The aim of this study was to assess the alpha-adrenergic contribution to the increased

  9. Sites of inhibition of mitochondrial electron transport in macrophage-injured neoplastic cells.

    Science.gov (United States)

    Granger, D L; Lehninger, A L

    1982-11-01

    Previous work has shown that injury of neoplastic cells by cytotoxic macrophages (CM) in cell culture is accompanied by inhibition of mitochondrial respiration. We have investigated the nature of this inhibition by studying mitochondrial respiration in CM-injured leukemia L1210 cells permeabilized with digitonin. CM-induced injury affects the mitochondrial respiratory chain proper. Complex I (NADH-coenzyme Q reductase) and complex II (succinate-coenzyme Q reductase) are markedly inhibited. In addition a minor inhibition of cytochrome oxidase was found. Electron transport from alpha-glycerophosphate through the respiratory chain to oxygen is unaffected and permeabilized CM-injured L1210 cells oxidizing this substrate exhibit acceptor control. However, glycerophosphate shuttle activity was found not to occur within CM-injured or uninjured L1210 cells in culture hence, alpha-glycerophosphate is apparently unavailable for mitochondrial oxidation in the intact cell. It is concluded that the failure of respiration of intact neoplastic cells injured by CM is caused by the nearly complete inhibition of complexes I and II of the mitochondrial electron transport chain. The time courses of CM-induced electron transport inhibition and arrest of L1210 cell division are examined and the possible relationship between these phenomena is discussed.

  10. Supervisor Autonomy and Considerate Leadership Style are Associated with Supervisors’ Likelihood to Accommodate Back Injured Workers

    Science.gov (United States)

    McGuire, Connor; Kristman, Vicki L; Williams-Whitt, Kelly; Reguly, Paula; Shaw, William; Soklaridis, Sophie

    2015-01-01

    PURPOSE To determine the association between supervisors’ leadership style and autonomy and supervisors’ likelihood of supporting job accommodations for back-injured workers. METHODS A cross-sectional study of supervisors from Canadian and US employers was conducted using a web-based, self-report questionnaire that included a case vignette of a back-injured worker. Autonomy and two dimensions of leadership style (considerate and initiating structure) were included as exposures. The outcome, supervisors’ likeliness to support job accommodation, was measured with the Job Accommodation Scale. We conducted univariate analyses of all variables and bivariate analyses of the JAS score with each exposure and potential confounding factor. We used multivariable generalized linear models to control for confounding factors. RESULTS A total of 796 supervisors participated. Considerate leadership style (β= .012; 95% CI: .009–.016) and autonomy (β= .066; 95% CI: .025–.11) were positively associated with supervisors’ likelihood to accommodate after adjusting for appropriate confounding factors. An initiating structure leadership style was not significantly associated with supervisors’ likelihood to accommodate (β = .0018; 95% CI: −.0026–.0061) after adjusting for appropriate confounders. CONCLUSIONS Autonomy and a considerate leadership style were positively associated with supervisors’ likelihood to accommodate a back-injured worker. Providing supervisors with more autonomy over decisions of accommodation and developing their considerate leadership style may aid in increasing work accommodation for back-injured workers and preventing prolonged work disability. PMID:25595332

  11. Supervisor Autonomy and Considerate Leadership Style are Associated with Supervisors' Likelihood to Accommodate Back Injured Workers.

    Science.gov (United States)

    McGuire, Connor; Kristman, Vicki L; Shaw, William; Williams-Whitt, Kelly; Reguly, Paula; Soklaridis, Sophie

    2015-09-01

    To determine the association between supervisors' leadership style and autonomy and supervisors' likelihood of supporting job accommodations for back-injured workers. A cross-sectional study of supervisors from Canadian and US employers was conducted using a web-based, self-report questionnaire that included a case vignette of a back-injured worker. Autonomy and two dimensions of leadership style (considerate and initiating structure) were included as exposures. The outcome, supervisors' likeliness to support job accommodation, was measured with the Job Accommodation Scale (JAS). We conducted univariate analyses of all variables and bivariate analyses of the JAS score with each exposure and potential confounding factor. We used multivariable generalized linear models to control for confounding factors. A total of 796 supervisors participated. Considerate leadership style (β = .012; 95% CI .009-.016) and autonomy (β = .066; 95% CI .025-.11) were positively associated with supervisors' likelihood to accommodate after adjusting for appropriate confounding factors. An initiating structure leadership style was not significantly associated with supervisors' likelihood to accommodate (β = .0018; 95% CI -.0026 to .0061) after adjusting for appropriate confounders. Autonomy and a considerate leadership style were positively associated with supervisors' likelihood to accommodate a back-injured worker. Providing supervisors with more autonomy over decisions of accommodation and developing their considerate leadership style may aid in increasing work accommodation for back-injured workers and preventing prolonged work disability.

  12. Imaging corticospinal tract connectivity in injured rat spinal cord using manganese-enhanced MRI

    International Nuclear Information System (INIS)

    Bilgen, Mehmet

    2006-01-01

    Manganese-enhanced MRI (MEI) offers a novel neuroimaging modality to trace corticospinal tract (CST) in live animals. This paper expands this capability further and tests the utility of MEI to image axonal fiber connectivity in CST of injured spinal cord (SC). A rat was injured at the thoracic T4 level of the SC. The CST was labeled with manganese (Mn) injected intracortically at two weeks post injury. Next day, the injured SC was imaged using MEI and diffusion tensor imaging (DTI) modalities. In vivo MEI data obtained from cervical SC confirmed that CST was successfully labeled with Mn. Ex vivo MEI data obtained from excised SC depicted Mn labeling of the CST in SC sections caudal to the lesion, which meant that Mn was transported through the injury, possibly mediated by viable CST fibers present at the injury site. Examining the ex vivo data from the injury epicenter closely revealed a thin strip of signal enhancement located ventrally between the dorsal horns. This enhancement was presumably associated with the Mn accumulation in these intact fibers projecting caudally as part of the CST. Additional measurements with DTI supported this view. Combining these preliminary results collectively demonstrated the feasibility of imaging fiber connectivity in experimentally injured SC using MEI. This approach may play important role in future investigations aimed at understanding the neuroplasticity in experimental SCI research

  13. Psychometric properties of the Dutch Short Musculoskeletal Function Assessment (SMFA) questionnaire in severely injured patients

    NARCIS (Netherlands)

    C.C.H.M. van Delft-Schreurs (C. C H M); M.A.C. van Son; M.A.C. de Jongh (Mariska); T. Gosens; M.H.J. Verhofstad (Michiel); J. de Vries (Jolanda)

    2016-01-01

    textabstractIn this cross-sectional study the psychometric properties are examined of the adapted Dutch translation of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in severely injured patients (ISS. >. 15). Patients and methods: Patients (N = 173) completed the SMFA, the World

  14. Psychometric properties of the Dutch Short Musculoskeletal Function Assessment (SMFA) questionnaire in severely injured patients

    NARCIS (Netherlands)

    van Delft-Schreurs, C. C. H. M.; van Son, M.A.C.; de Jongh, M.A.C.; Gosens, T.; Verhofstad, M. H. J.; de Vries, J.

    2016-01-01

    In this cross-sectional study the psychometric properties are examined of the adapted Dutch translation of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in severely injured patients (ISS > 15). Patients and methods Patients (N = 173) completed the SMFA, the World Health

  15. Return to work and quality of life in severely injured patients

    NARCIS (Netherlands)

    Post, R. B.; Van der Sluis, C. K.; Ten Duis, H. J.

    2006-01-01

    Background. Little is known about the long-term consequences of severe injuries in terms of return to productivity and quality of life. Methods. In this study we focused on the return to work status and quality of life in 53 severely injured patients (AIS/ISS >= 16, mean ISS 24, range 16 - 54), mean

  16. Work safety climate, musculoskeletal discomfort, working while injured, and depression among migrant farmworkers in North Carolina.

    Science.gov (United States)

    Arcury, Thomas A; O'Hara, Heather; Grzywacz, Joseph G; Isom, Scott; Chen, Haiying; Quandt, Sara A

    2012-05-01

    This analysis described Latino migrant farmworkers' work safety climate and its association with musculoskeletal discomfort, working while injured or ill, and depressive symptoms. Data were from a cross-sectional survey of 300 farmworkers conducted in North Carolina in 2009. Generalized estimating equations models were used to investigate the association of work safety climate with health and safety outcomes. Farmworkers perceived their work safety climate to be poor. About 40% had elevated musculoskeletal discomfort, 5.0% had worked at least 1 day while injured or ill, and 27.9% had elevated depressive symptoms. The odds of elevated musculoskeletal discomfort were 12% lower and the odds of working while injured or ill were 15% lower with each 1-unit increase in the work safety climate. Work safety climate was not associated with depressive symptoms. Work safety climate was important for agricultural workers. Poor work safety climate was associated with health outcomes (musculoskeletal discomfort) and safety (working while injured or ill). Interventions to improve work safety climate in agriculture are needed, with these interventions being directed to employers and workers.

  17. Pattern of Pressure Sores in Spinal Injured Patients with in the First ...

    African Journals Online (AJOL)

    Background: Before 2006, all our spinal injured patients were nursed on conventional form mattress without pressure redistributing support surface. Pressure sore was a common complication and was a major contributing factor to prolonged hospitalization. Aim: The aim of this study is to determine the pattern of pressure ...

  18. Sexuality and sexual dysfunction in spinal cord-injured men in Turkey.

    Science.gov (United States)

    Akman, Ramazan Yavuz; Coşkun Çelik, Evrim; Karataş, Metin

    2015-01-01

    To provide a comprehensive evaluation of sexual function and dysfunction in spinal cord-injured men based on self-reports of patients. Forty-seven spinal cord-injured men who completed the spinal shock and rehabilitation period were included. Patients were asked to complete a questionnaire developed to assess social status, sexual activities, abilities, and sexuality education after injury. Neurologic levels of patients were classified according to American Spinal Cord Injury Association protocol. Erectile function was evaluated by International Index of Erectile Function-5 (IIEF-5) questionnaire. Patients were aged between 20 and 62 years (mean: 35.2). Twenty-eight patients had T10 and above, 15 between T11 and L2, and 4 cauda conus injury. While 61.7% of the patients declared sexual activity, 93.6% declared some degree of erection. Mean IIEF-5 score was 5.3 and 87.3% of the patients had moderate to severe erectile dysfunction. Continuation of sexual activity after injury is very important and has a great impact on quality of life and interpersonal relationships for spinal cord-injured men. More attention must be given to sexuality after spinal cord injury. A very high rate of sexual dysfunction in spinal cord-injured patients was found and the importance of sexual education was emphasized in this study.

  19. Multisensory training for postural sway control in non-injured elderly ...

    African Journals Online (AJOL)

    The findings demonstrated that the trained ETG improved in their total Berg Balance Test (BBT) scores indicated that the training program successfully improved postural sway control for non-injured elderly females. Keywords: multisensory training, postural sway control, balance ability, visual input; vestibular input ...

  20. The impact of exercise training on oxidative stress in spinal cord injured individuals

    NARCIS (Netherlands)

    Van Duijnhoven, N. T L; Hesse, E. O.; Janssen, T. W J; Knippenberg, M.; Scheffer, P.; Hopman, M. T E

    2010-01-01

    Spinal cord-injured (SCI) individuals have a high risk for cardiovascular diseases. An imbalance in (anti)oxidative status would be associated with an increased cardiovascular risk. OBJECTIVE: To compare baseline levels of oxidative stress and antioxidative capacity in SCI individuals and

  1. Key Considerations for Using No-Harm Contracts with Clients Who Self-Injure

    Science.gov (United States)

    Hyldahl, Rebecca S.; Richardson, Brent

    2011-01-01

    One of the more controversial issues in working with people who self-injure is whether counselors should use no-harm contracts. Important therapeutic considerations include the efficacy of such contracts or agreements in preventing self-injury, the emotional and behavioral responses of clients, and the perceived protection these contracts or…

  2. Do workers' compensation laws protect industrial hygienists from lawsuits by injured workers?

    Science.gov (United States)

    Stout, N C

    1993-11-01

    Workers' compensation laws provide injured employees with a swifter, more certain, and less litigious system of compensation than existed under the common law. Although workers' compensation is almost always an injured employee's exclusive remedy against the employer, the employee may bring a common-law tort action against a "third party" who may be liable in whole or in part for the employee's injury. This article investigates whether industrial hygienists are "third parties" and therefore subject to suit by injured employees who claim that industrial hygienists negligently caused their injuries. The author concludes that in most states, where the industrial hygienist and the injured worker are fellow employees, the industrial hygienist shares the employer's immunity from suit. As to the consultant who performs industrial hygiene services as an independent contractor, the author concludes that the employer's nondelegable duty to provide a safe workplace offers industrial hygiene consultants an argument that they share the employer's immunity from suit. Countervailing arguments, however, leave the industrial hygiene consultant vulnerable to negligence claims in many jurisdictions. There is a trend among the states to extend the employer's immunity to those who provide safety and health services to the employer.

  3. Efficient delivery of small interfering RNA into injured spinal cords in rats by photomechanical waves

    Science.gov (United States)

    Ando, Takahiro; Sato, Shunichi; Toyooka, Terushige; Kobayashi, Hiroaki; Nawashiro, Hiroshi; Ashida, Hiroshi; Obara, Minoru

    2011-03-01

    In the central nervous system, lack of axonal regeneration leads to permanent functional disabilities. In spinal cord injury (SCI), the over-expressions of intermediate filament (IF) proteins, such as glial fibrillary acidic protein (GFAP) and vimentin, are mainly involved in glial scar formation; these proteins work as both physical and biochemical barriers to axonal regeneration. Thus, silencing of these IF proteins would be an attractive strategy to treat SCI. In this study, we first attempted to deliver fluorescent probe-labeled siRNAs into injured spinal cords in rats by applying photomechanical waves (PMWs) to examine the capability of PMWs as a tool for siRNA delivery. Intense fluorescence from siRNAs was observed in much broader regions in the spinal cords with PMW application when compared with those with siRNA injection alone. Based on this result, we delivered siRNAs for GFAP and vimentin into injured spinal tissues in rats by applying PMWs. The treatment resulted in efficient silencing of the proteins at five days after SCI and a decrease of the cavity area in the injured tissue at three weeks after SCI when compared with those with siRNA injection alone. These results demonstrate the capability of PMWs for efficient delivery of siRNAs into injured spinal cords and treatment of SCIs.

  4. Use of healthcare services by injured people in Khartoum State, Sudan

    Science.gov (United States)

    El Tayeb, Sally; Abdalla, Safa; Van den Bergh, Graziella; Heuch, Ivar

    2015-01-01

    Background Trauma care is an important factor in preventing death and reducing disability. Injured persons in low- and middle-income countries are expected to use the formal healthcare system in increasing numbers. The objective of this paper is to examine use of healthcare services after injury in Khartoum State, Sudan. Methods A community-based survey using a stratified two-stage cluster sampling technique in Khartoum State was performed. Information on healthcare utilisation was taken from injured people. A logistic regression analysis was used to explore factors affecting the probability of using formal healthcare services. Results During the 12 months preceding the survey a total of 441 cases of non-fatal injuries occurred, with 260 patients accessing formal healthcare. About a quarter of the injured persons were admitted to hospital. Injured people with primary education were less likely to use formal healthcare compared to those with no education. Formal health services were most used by males and in cases of road traffic injuries. The lowest socio-economic strata were least likely to use formal healthcare. Conclusions Public health measures and social security should be strengthened by identifying other real barriers that prevent low socio-economic groups from making use of formal healthcare facilities. Integration and collaboration with traditional orthopaedic practitioners are important aspects that need further attention. PMID:25205849

  5. A comparison of acute and chronic anterior cruciate ligament reconstruction using LARS artificial ligaments: a randomized prospective study with a 5-year follow-up.

    Science.gov (United States)

    Chen, Jia; Gu, Aiqun; Jiang, Haitao; Zhang, Wenjie; Yu, Xiangrong

    2015-01-01

    This prospective randomized study compared acute and chronic anterior cruciate ligament (ACL) reconstruction using ligament advanced reinforcement system (LARS) artificial ligament in young active adults with a 5-year follow-up. Fifty-five patients were enrolled in this study and divided into two groups based on the elapsed time between the injury and reconstruction: the acute group (3-7 weeks) and the chronic group (6-11 months). The clinical outcomes were evaluated using the Lysholm knee scoring scale, the Tegner activity rating, a KT-1000 Arthrometer, and the International Knee Documentation Committee (IKDC) scoring system. Isokinetic strength of the quadriceps and hamstring was assessed using the Biodex System 3 isokinetic dynamometer. Anterior laxity was decreased and quadriceps/hamstring muscle strength was increased in the acute group compared to the chronic group (p > 0.05). There were no statistically significant differences in Lysholm scores, Tegner activity scores, and the IKDC evaluation form between the two groups. These results suggest that earlier ACL reconstruction using a LARS artificial ligament may provide an advantage in the treatment and rehabilitation of ACL rupture.

  6. 20 CFR 10.730 - What are the conditions of coverage for Peace Corps volunteers and volunteer leaders injured...

    Science.gov (United States)

    2010-04-01

    ... Corps volunteers and volunteer leaders injured while serving outside the United States? 10.730 Section... Corps volunteers and volunteer leaders injured while serving outside the United States? (a) Any injury sustained by a volunteer or volunteer leader while he or she is located abroad shall be presumed to have...

  7. The effect of computerized tailored brief advice on at-risk drinking in subcritically injured trauma patients

    DEFF Research Database (Denmark)

    Neumann, Tim; Neuner, Bruno; Weiss-Gerlach, Edith

    2006-01-01

    One-third of injured patients treated in the emergency department (ED) have an alcohol use disorder (AUD). Few are screened and receive counseling because ED staff have little time for additional tasks. We hypothesized that computer technology can screen and provide an intervention that reduces a......-risk drinking (British Medical Association criteria) in injured ED patients....

  8. Enumeration and Identification of Coliform Bacteria Injured by Chlorine or Fungicide Mixed with Agricultural Water.

    Science.gov (United States)

    Izumi, Hidemi; Nakata, Yuji; Inoue, Ayano

    2016-10-01

    Chemical sanitizers may induce no injury (bacteria survive), sublethal injury (bacteria are injured), or lethal injury (bacteria die). The proportion of coliform bacteria that were injured sublethally by chlorine and fungicide mixed with agricultural water (pond water), which was used to dilute the pesticide solution, was evaluated using the thin agar layer (TAL) method. In pure cultures of Enterobacter cloacae , Escherichia coli , and E. coli O157:H7 (representing a human pathogen), the percentage of chlorine-injured cells was 69 to 77% for dilute electrolyzed water containing an available chlorine level of 2 ppm. When agricultural water was mixed with electrolyzed water, the percentage of injured coliforms in agricultural water was 75%. The isolation and identification of bacteria on TAL and selective media suggested that the chlorine stress caused injury to Enterobacter kobei . Of the four fungicide products tested, diluted to their recommended concentrations, Topsin-M, Sumilex, and Oxirane caused injury to coliform bacteria in pure cultures and in agricultural water following their mixture with each pesticide, whereas Streptomycin did not induce any injury to the bacteria. The percentage of injury was 45 to 97% for Topsin-M, 80 to 87% for Sumilex, and 50 to 97% for Oxirane. A comparison of the coliforms isolated from the pesticide solutions and then grown on either TAL or selective media indicated the possibility of fungicide-injured Rahnella aquatilis , Yersinia mollaretii , and E. coli . These results suggest the importance of selecting a suitable sanitizer and the necessity of adjusting the sanitizer concentration to a level that will kill the coliforms rather than cause sanitizer-induced cell injury that can result in the recovery of the coliforms.

  9. Optimizing detection of heat-injured Listeria monocytogenes in pasteurized milk.

    Science.gov (United States)

    Teo, A Y; Ziegler, G R; Knabel, S J

    2001-07-01

    Optimal conditions for the detection of heat-injured cells of Listeria monocytogenes in modified Pennsylvania State University (mPSU) broth were determined using a response surface design generated by a computer program, EChip. Different combinations of incubation temperatures and lithium, magnesium, and D-serine concentrations were evaluated to determine the optimum conditions for the detection of heat-injured L. monocytogenes in filter-sterilized whole milk inoculated with selected problematic background microflora. A concentration of 212 mM lithium chloride completely inhibited the growth of Enterococcus faecium while permitting recovery and detection of L. monocytogenes. A concentration of 15.8 mM MgSO4 was found to be optimum for the recovery and detection of L. monocytogenes. A concentration of 140.2 mM D-serine was found to completely inhibit the germination of Bacillus subtilis var. globii spores but not recovery and detection of L. monocytogenes. Under optimum concentrations of LiCl, MgSO4, and D-serine and in the absence of background microflora, the effect of incubation temperature on percentage detection was described by a second-order polynomial model, and 28 degrees C was determined to be optimal. In the presence of background microflora, the effect of incubation temperature on percentage detection of heat-injured cells was described by a third-order polynomial model, and 30 degrees C was found to be optimal. Optimizing the levels of highly specific and selective agents, nutrients, and incubation temperature in one recovery enrichment system dramatically increased the Listeria/background microflora ratio. This resulting medium, optimized PSU (oPSU) broth, greatly improved the detection of heat-injured and nonheat-injured L. monocytogenes by both conventional and molecular methods (Oxoid's Listeria Rapid Test, Gen-Probe's Accuprobe Listeria monocytogenes Culture Identification Test, and Qualicon's BAX for screening Listeria monocytogenes).

  10. Morphological size evaluation of the mid-substance insertion areas and the fan-like extension fibers in the femoral ACL footprint.

    Science.gov (United States)

    Suruga, Makoto; Horaguchi, Takashi; Iriuchishima, Takanori; Yahagi, Yoshiyuki; Iwama, Genki; Tokuhashi, Yasuaki; Aizawa, Shin

    2017-08-01

    The purpose of this study was to evaluate the detailed anatomy of the femoral anterior cruciate ligament (ACL) insertion site, with special attention given to the morphology of the mid-substance insertion areas and the fan-like extension fibers. Twenty-three non-paired human cadaver knees were used (7 Males, 16 Females, median age 83, range 69-96). All soft tissues around the knee were resected except the ligaments. The ACL was divided into antero-medial (AM) and postero-lateral (PL) bundles according to the difference in macroscopic tension patterns. The ACL was carefully dissected and two outlines were made of the periphery of each bundle insertion site: those which included and those which excluded the fan-like extension fibers. An accurate lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The area of each bundle, including and excluding the fan-like extension fibers, was measured with Image J software (National Institution of Health). The width and length of the mid-substance insertion sites were also evaluated using same image. The femoral ACL footprint was divided into four regions (mid-substance insertion sites of the AM and PL bundles, and fan-like extensions of the AM and PL bundles). The measured areas of the mid-substance insertion sites of the AM and PL bundles were 35.5 ± 12.5, and 32.4 ± 13.8 mm 2 , respectively. Whole width and length of the mid-substance insertion sites were 5.3 ± 1.4, and 15.5 ± 2.9 mm, respectively. The measured areas of the fan-like extensions of the AM and PL bundles were 27 ± 11.5, and 29.5 ± 12.4 mm 2 , respectively. The femoral ACL footprint was divided into quarters of approximately equal size (mid-substance insertion sites of the AM and PL bundles, and fan-like extensions of the AM and PL bundles). For clinical relevance, to perform highly reproducible anatomical ACL reconstruction, the presence of the fan-like extension

  11. Stressors, social support, and tests of the buffering hypothesis: effects on psychological responses of injured athletes.

    Science.gov (United States)

    Mitchell, Ian; Evans, Lynne; Rees, Tim; Hardy, Lew

    2014-09-01

    The purpose of this article was to examine the main and stress-buffering effect relationships between social support and psychological responses to injury. The article presents two studies, both of which matched social support types with injury stressors. Study 1 used measures of stressors, perception of social support availability, and psychological responses of injured athletes. Study 2 utilized measures of stressors, received social support, and psychological responses of injured athletes. During physiotherapy clinic visits, injured athletes (Study 1, N = 319; Study 2, N = 302) completed measures of stressors, social support, and psychological responses to injury. Confirmatory factor analysis (CFA) and moderated hierarchical regression were used to analyse the data. In both studies, CFA suggested adequate model fit for measures of social support and psychological responses to injury. Moderated hierarchical regression analyses in Study 1 revealed significant (p social support in relation to injury stressors and psychological responses; that is, the relationships between social support, stressors, and psychological responses to sport injury may differ with regard to received or perceived available support. The findings have important implications for the design of social support interventions with injured athletes aimed at alleviating the detrimental effects of injury stressors. What is already known on this subject? The health, social, and sport-injury related research suggests that social support has the potential to moderate (i.e., buffer) those psychological responses to stress that are detrimental to health and well-being. Despite what is a growing body of empirical research that has explored the role of social support in a sport injury context, there has been a paucity of research that has examined how social support functions in relation to injury-related stressors and psychological responses, particularly with regard to the effect of perceived and received

  12. Shock induced endotheliopathy (SHINE) in acute critical illness

    DEFF Research Database (Denmark)

    Johansson, Pär Ingemar; Stensballe, Jakob; Ostrowski, Sisse Rye

    2017-01-01

    One quarter of patients suffering from acute critical illness such as severe trauma, sepsis, myocardial infarction (MI) or post cardiac arrest syndrome (PCAS) develop severe hemostatic aberrations and coagulopathy, which are associated with excess mortality. Despite the different types of injurious...... "hit", acutely critically ill patients share several phenotypic features that may be driven by the shock. This response, mounted by the body to various life-threatening conditions, is relatively homogenous and most likely evolutionarily adapted. We propose that shock-induced sympatho......-adrenal hyperactivation is a critical driver of endothelial cell and glycocalyx damage (endotheliopathy) in acute critical illness, with the overall aim of ensuring organ perfusion through an injured microvasculature. We have investigated more than 3000 patients suffering from different types of acute critical illness...

  13. Preventing non-contact ACL injuries in female athletes: What can we learn from dancers?

    Science.gov (United States)

    Turner, Catherine; Crow, Sarah; Crowther, Thomas; Keating, Brittany; Saupan, Trenton; Pyfer, Jason; Vialpando, Kimberly; Lee, Szu-Ping

    2017-12-23

    To investigate the effects of dance experience and movement instruction on lower extremity kinematics and muscle activation during a landing task. Cross-sectional case control. Laboratory setting. 27 female subjects (age 18-25) in 2 groups: dancers (n = 12) and non-dancers (n = 15). Lower extremity biomechanics during drop landing were analyzed. Subjects performed drop landings after watching an instructional video without verbal instructions (NI), followed by repeat assessment after watching the same videos with specific verbal instructions (VI). Surface electromyography (EMG) was used to measure the activation of gluteus maximus and medius during the deceleration phase of landings. Peak knee and hip frontal plane angles during landing were acquired using a 3-D motion capture system. Compared to non-dancers, dancers demonstrated generally greater gluteus maximus activation and a decreased knee abduction (i.e. valgus) angle during drop landing. A significant interaction showed that instruction led to increased knee valgus angle in non-dancers but not dancers (p = .014). Our findings suggest that experienced dancers demonstrate safer landing strategies compared to recreational athletes. Providing acute movement instruction was shown to disrupt the landing mechanics in those with no dance training experience. Copyright © 2018 Elsevier Ltd. All rights reserved.

  14. Quadriceps Strength Deficit at 6 Months After ACL Reconstruction Does Not Predict Return to Preinjury Sports Level.

    Science.gov (United States)

    Novaretti, João Victor; Franciozi, Carlos Eduardo; Forgas, Andrea; Sasaki, Pedro Henrique; Ingham, Sheila Jean McNeill; Abdalla, Rene Jorge

    2018-02-01

    There is a lack of literature-based objective criteria for return to sport after anterior cruciate ligament (ACL) injury. Establishing such objective criteria is crucial to improving return to sport after ACL reconstruction (ACLR). Patients who return to their preinjury level of sport will have higher isokinetic, postural stability, and drop vertical jump test scores 6 months after surgery and greater patient satisfaction compared with those who did not. Additionally, quadriceps strength deficit cutoff values of 80% and 90% would differentiate patients who returned to preinjury sports level from those who did not. Cohort study. Level 3. A retrospective search was conducted to identify all patients who underwent ACLR and completed isokinetic evaluation, postural stability analysis, and drop vertical jump testing at 6 months postoperatively. Patients were asked to complete 3 questionnaires at a minimum 1 year after surgery. Chi-square and logistic regression analyses were used for categorical dependent variables, while the Student t test, Pearson correlation, or analyses of variance with Bonferroni post hoc testing were used for continuous dependent variables. A post hoc power analysis was completed. Based on the results regarding correlations between return to preinjury level and all other variables, effect sizes from 0.24 to 3.03 were calculated. With these effect sizes, an alpha of 0.05 and sample size of 58, a power ranging from 0.15 to 0.94 was calculated. The rates of return to preinjury level and to any sports activity were 53.4% and 84.4%. Those who were able to return to their preinjury level of sport (n = 33) showed significantly higher Lysholm (91.6 ± 9.7 vs 76.7 ± 15.4) and International Knee Documentation Committee (IKDC) (83.6 ± 10.6 vs 69.8 ± 14.6) values compared with those who were unable to return to their preinjury level of sport (n = 25) ( P level for the clinical evaluations (isokinetic evaluation, postural stability, drop vertical jump test

  15. Role of Damage Control Orthopedics and Early Total Care in the Multiple Injured Trauma Patients

    Directory of Open Access Journals (Sweden)

    Robert W. Jordan

    2014-01-01

    Full Text Available The care of multiply injured patients with orthopedic injuries has evolved from prolonged periods in traction to early total care (ETC. ETC is advantageous in ease of nursing care and aiding patient recovery. However, concerns have been raised that this ‘second hit’ of surgery places these severely injured patients at risk of excessive inflammatory responses that can lead to systemic inflammatory response syndrome (SIRS. Damage control was initially used in abdominal trauma but has been adapted for use in orthopedics. The mainstay of treatment involves external fixation of long bone and pelvic fractures which acts to defer definitive fixation until physiologic stability is restored. The indications for implementing each approach are not clear and this article provides a narrative review of the topic.

  16. Effect of salt concentration in the recovery medium on heat-injured Streptococcus faecalis.

    Science.gov (United States)

    Beuchat, L R; Lechowich, R V

    1968-05-01

    Properties relating to the recovery of three heat-injured strains of Streptococcus faecalis were studied. All strains were cultured in all purpose plus Tween broth (APT) at 30 C for 24 hr before being subjected to heat in fresh APT broth. APT recovery medium containing various added amounts of NaCl, KCl, MgCl(2), or KCl and MgCl(2) was used to assess the effect of salts on the recovery of thermally injured S. faecalis. It was evident that, upon exposure to heat, S. faecalis cells became sensitive to increased salt concentrations. Analyses to determine the ribonucleic acid (RNA) content of heated cells showed a reduction of cellular RNA, but the per cent reduction was not directly proportional to the per cent reduction of the viable cells.

  17. Neurodevelopment. Live imaging of adult neural stem cell behavior in the intact and injured zebrafish brain.

    Science.gov (United States)

    Barbosa, Joana