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Sample records for contralateral anterior cruciate

  1. Physical therapy in the conservative treatment for anterior cruciate ligament rupture followed by contralateral rupture: case report

    OpenAIRE

    Almeida, Gabriel Peixoto Leão; Arruda, Gilvan de Oliveira; Marques, Amélia Pasqual

    2014-01-01

    Although the surgical reconstruction be the obvious indication for the anterior cruciate ligament (ACL) lesion, there is no consensus on whether the results of surgery are superior to those obtained with nonsurgical management. The objective of this report was to describe a case of nonsurgical treatment for ACL rupture followed by a contralateral rupture. A 28-year-old female practitioner of muay-thai and handball suffered a non-contact ACL rupture in the left knee, and three months after the...

  2. Anterior cruciate ligament (ACL) injury

    Science.gov (United States)

    Cruciate ligament injury - anterior; ACL injury; Knee injury - anterior cruciate ligament (ACL) ... knee. It prevents the knee from bending out. Anterior cruciate ligament (ACL) is in the middle of the knee. ...

  3. Anterior Cruciate Ligament (ACL) Injuries

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Anterior Cruciate Ligament (ACL) Injuries KidsHealth / For Teens / Anterior Cruciate Ligament (ACL) Injuries What's in this article? What Are ...

  4. Anterior cruciate ligament repair - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100230.htm Anterior cruciate ligament repair - Series—Normal anatomy To use the sharing ... to slide 5 out of 5 Overview The anterior cruciate ligament (ACL) is a ligament in the center of ...

  5. Bioengineered anterior cruciate ligament

    Science.gov (United States)

    Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

    2001-01-01

    The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the

  6. [Anterior cruciate ligament injuries].

    Science.gov (United States)

    Haim, Amir; Pritsch, Tamir; Yosepov, Lior; Arbel, Ron

    2006-03-01

    Anterior cruciate ligament (ACL) injuries are common, especially in young individuals who participate in sports activities associated with pivoting, decelerating and jumping. About 70% of ACL injuries do not result from direct contact. Establishing risk factors is important for prevention strategies. Risk factors for ACL injuries include environmental factors (e.g. high level of friction between shoes and the playing surface) and anatomical factors (e.g. narrow femoral intercondylar notch and increased joint laxity). History taking and physical examination provide the basis for diagnosis. Magnetic resonance imaging (MRI) is highly sensitive and specific and provides information about associated injuries such as meniscal tears. ACL-injury leads to knee instability which is associated with both acute dysfunction and long-term degenerative changes, such as osteoarthritis and meniscal damage. Surgical treatment of ACL-tears is effective in regard to short term rehabilitation but does not necessarily alter the natural course of this injury and its long-term complications. Therefore, surgical treatment should be reserved primarily for young individuals and for those who are high risk for ACL injury. ACL reconstruction is the standard surgery; however, a wide variety of reconstruction procedures is available and a gold standard procedure has not been defined. Nevertheless, arthroscopic reconstruction with either bone-patellar tendon-bone or a hamstring tendon graft is the most widely used method. Surgical timing is important. Early surgical intervention (i.e. within 4 weeks of injury) might increase complications.

  7. 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 ...

  8. Incidental Anterior Cruciate Ligament Calcification: Case Report.

    Science.gov (United States)

    Hayashi, Hisami; Fischer, Hans

    2016-03-01

    The calcification of knee ligaments is a finding noted only in a handful of case reports. The finding of an anterior cruciate ligament calcification has been reported once in the literature. Comparable studies involving the posterior cruciate ligament, medial collateral ligament and an ossicle within the anterior cruciate ligament are likewise discussed in reports of symptomatic patients. We report a case of incidentally discovered anterior cruciate ligament calcification. We discuss the likely etiology and clinical implications of this finding.

  9. Anterior Cruciate Reconstruction Using Bone-patellar Ligament ...

    African Journals Online (AJOL)

    Methods: Thirty five patients with anterior cruciate ligament tear in one knee and a normal contralateral knee were evaluated and followed up for six years. Clinical history, physical evaluation, X-ray and athroscopies were done to rule out concomitant meniscal lesions and facilitate their treatment accurately. Follow up ...

  10. Anterior cruciate ligament - updating article

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Malheiros Luzo

    2016-08-01

    Full Text Available ABSTRACT This updating article on the anterior cruciate ligament (ACL has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques.

  11. Guideline on anterior cruciate ligament injury

    NARCIS (Netherlands)

    Meuffels, Duncan E; Poldervaart, Michelle T; Diercks, Ronald; Fievez, Alex W F M; Patt, Thomas W; Hart, Cor P van der; Hammacher, Eric R; Meer, Fred van der; Goedhart, Edwin A; Lenssen, Anton F; Muller-Ploeger, Sabrina B; Pols, Margreet A; Saris, Daniel B F

    The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a

  12. Anterior Cruciate Ligament Reconstruction Rehabilitation

    Science.gov (United States)

    Wright, Rick W.; Haas, Amanda K.; Anderson, Joy; Calabrese, Gary; Cavanaugh, John; Hewett, Timothy E.; Lorring, Dawn; McKenzie, Christopher; Preston, Emily; Williams, Glenn; Amendola, Annunziato

    2015-01-01

    Context: Anterior cruciate ligament (ACL) reconstruction rehabilitation has evolved over the past 20 years. This evolution has been driven by a variety of level 1 and level 2 studies. Evidence Acquisition: The MOON Group is a collection of orthopaedic surgeons who have developed a prospective longitudinal cohort of the ACL reconstruction patients. To standardize the management of these patients, we developed, in conjunction with our physical therapy committee, an evidence-based rehabilitation guideline. Study Design: Clinical review. Level of Evidence: Level 2. Results: This review was based on 2 systematic reviews of level 1 and level 2 studies. Recently, the guideline was updated by a new review. Continuous passive motion did not improve ultimate motion. Early weightbearing decreases patellofemoral pain. Postoperative rehabilitative bracing did not improve swelling, pain range of motion, or safety. Open chain quadriceps activity can begin at 6 weeks. Conclusion: High-level evidence exists to determine appropriate ACL rehabilitation guidelines. Utilizing this protocol follows the best available evidence. PMID:26131301

  13. Revision Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

    2014-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

  14. Familial predisposition to anterior cruciate ligament injury

    Directory of Open Access Journals (Sweden)

    Kenichi Goshima

    2014-04-01

    Full Text Available Although several risk factors for anterior cruciate ligament (ACL injury have been evaluated in the literature, there are few reports on familial predisposition. This study investigated the familial predisposition to ACL injury. The study included 350 patients who underwent ACL reconstruction between January 2005 and September 2008. All patients were surveyed by telephone or a written questionnaire about family history (FH of ACL injury, sports played by family members, and mechanisms of injury. We also compared age, sex, height, weight, body mass index, Tegner activity score, general joint laxity, and tibial slope between an FH group (with FH and a control group (without FH. In addition, we compared the incidence of ACL graft rupture and contralateral ACL rupture 2 years after primary surgery. Complete information was obtained from 316 patients, 38 (12.0% of whom had FH of ACL injury. Two families had three members with ACL injuries. Of the 40 family members with ACL injuries, 38 (95% had noncontact injuries and 34 (85% shared a similar mechanism of injury with the related patient. No significant differences were identified between the two groups, except that tibial slope was significantly greater in the FH group than in the control group. Although the incidence of repeat ACL injury was greater in the FH group (23.7% than in the control group (16.4%, there was no significant difference. Our results indicated a high probability of familial predisposition to many of the identified risk factors for ACL injury. In addition, patients with FH of ACL injury might be at high risk for initial and repeat ACL injuries. Therefore, prevention programs should be implemented for patients with FH of ACL injury in order to decrease the risk of these injuries.

  15. Causes of anterior cruciate ligament injuries.

    Science.gov (United States)

    Ristić, Vladimir; Ninković, Srdan; Harhaji, Vladimir; Milankov, Miroslav

    2010-01-01

    In order to prevent anterior cruciate ligament injuries it is necessary to define risk factors and to analyze the most frequent causes of injuries--that being the aim of this study. The study sample consisted of 451 surgically treated patients, including 400 sportsmen (65% of them being active and 35% recreational sportsmen), 29% female and 71% male; of whom 90% were younger than 35. Sports injuries, as the most frequent cause of anterior cruciate ligament injuries, were recorded in 88% of patients (non-contact ones in 78% and contact ones in 22%), injuries occurring in everyday activities in 11% and in traffic in 1%. Among sportsmen, reconstruction of the anterior cruciate ligament was most frequently performed in football players (48%), then in handball players (22%), basketball players (13%), volleyball players (8%), martial arts fighters (4%). However, the injury incidence was the highest among the active basketball players (1 injured among 91 active players). Type of footwear, warming up before the activity, genetic predisposition and everyday therapy did not have a significant influence on getting injured. Anterior cruciate ligament injuries happened three times more often during matches, in the middle and at the end of a match and training session (79%), at landing after the jump or when changing direction of movement (75%) without a contact with other competitors, on dry surfaces (79%), among not so well prepared sportsmen.

  16. Novel Insights into Anterior Cruciate Ligament Injury

    NARCIS (Netherlands)

    D.E. Meuffels (Duncan)

    2011-01-01

    textabstractAnterior cruciate ligament (ACL) injury is one of the most common sports injuries of the knee. ACL reconstruction has become, standard orthopaedic practice worldwide with an estimated 175,000 reconstructions per year in the United States.6 The ACL remains the most frequently studied

  17. Treatment for acute anterior cruciate ligament tear

    DEFF Research Database (Denmark)

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

    2015-01-01

    STUDY QUESTION: In young active adults with an acute anterior cruciate ligament (ACL) rupture, do patient reported or radiographic outcomes after five years differ between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL...

  18. Tunnel widening in anterior cruciate ligament reconstruction

    DEFF Research Database (Denmark)

    Clatworthy, M G; Annear, P; Bulow, J U

    1999-01-01

    We report a prospective series evaluating the incidence and degree of tunnel widening in a well-matched series of patients receiving a hamstring or patella tendon graft for anterior cruciate ligament (ACL) deficiency. We correlated tunnel widening with clinical factors, knee scores, KT-1000...

  19. 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...

  20. Anterior Cruciate Ligament Injuries in Wakeboarding

    OpenAIRE

    Starr, Harlan M.; Sanders, Brett,

    2012-01-01

    Background: Wakeboarding is an increasingly popular sport that involves aggressive stunts with high risk for lower extremity injury, including anterior cruciate ligament (ACL) rupture. Little has been reported on prevalence or mechanism of ACL injury while wakeboarding. Hypothesis: The prevalence of ACL injury in wakeboarding approaches that of other high-risk sports. Analyzing the mechanism of ACL injury may aid in future efforts of prevention. Study Design: Descriptive epidemiology study. M...

  1. Imaging of the anterior cruciate ligament

    Science.gov (United States)

    Ng, Wing Hung Alex; Griffith, James Francis; Hung, Esther Hiu Yee; Paunipagar, Bhawan; Law, Billy Kan Yip; Yung, Patrick Shu Hang

    2011-01-01

    The anterior cruciate ligament (ACL) is an important structure in maintaining the normal biomechanics of the knee and is the most commonly injured knee ligament. However, the oblique course of the ACL within the intercondylar fossa limits the visualization and assessment of the pathology of the ligament. This pictorial essay provides a comprehensive and illustrative review of the anatomy and biomechanics as well as updated information on different modalities of radiological investigation of ACL, particularly magnetic resonance imaging. PMID:22474639

  2. Risk Factors for Anterior Cruciate Ligament Injury

    OpenAIRE

    Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra; Beynnon, Bruce D.

    2012-01-01

    Context: Injuries to the anterior cruciate ligament (ACL) of the knee are immediately debilitating and can cause long-term consequences, including the early onset of osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 1 of a 2-part series, highlights what is known an...

  3. Risk Factors for Anterior Cruciate Ligament Injury

    OpenAIRE

    Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra; Beynnon, Bruce D.

    2012-01-01

    Context: Injuries to the anterior cruciate ligament (ACL) are immediately disabling and are associated with long-term consequences, such as posttraumatic osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 2 of a 2-part series, highlights what is known and still unkn...

  4. Anterior cruciate ligament ganglion: case report

    Directory of Open Access Journals (Sweden)

    André Pedrinelli

    Full Text Available CONTEXT: A ganglion is a cystic formation close to joints or tendinous sheaths, frequently found in the wrist, foot or knee. Intra-articular ganglia of the knee are rare, and most of them are located in the anterior cruciate ligament. The clinical picture for these ganglia comprises pain and movement restrictions in the knee, causing significant impairment to the patient. Symptoms are non-specific, and anterior cruciate ligament ganglia are usually diagnosed through magnetic resonance imaging or arthroscopy. Not all ganglia diagnosed through magnetic resonance imaging need to undergo surgical treatment: only those that cause clinical signs and symptoms do. Surgical results are considered good or excellent in the vast majority of cases. CASE REPORT: A 29-year-old male presented with pain in the left knee during a marathon race. Physical examination revealed limitation in the maximum range of knee extension and pain in the posterior aspect of the left knee. Radiographs of the left knee were normal, but magnetic resonance imaging revealed a multi-lobed cystic structure adjacent to the anterior cruciate ligament, which resembled a ganglion cyst. The mass was removed through arthroscopy, and pathological examination revealed a synovial cyst. Patient recovery was excellent, and he resumed his usual training routine five months later.

  5. The normal anterior cruciate ligament as a model for tensioning strategies in anterior cruciate ligament grafts

    NARCIS (Netherlands)

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

    Background: There is some confusion about the relationship between the tension placed on the graft and the joint position used in the fixation of anterior cruciate ligament grafts. This is because of deficiency in accurate basic science about this important interaction in the normal and

  6. The normal anterior cruciate ligament as a model for tensioning strategies in anterior cruciate ligament grafts.

    NARCIS (Netherlands)

    Arnold, M.P.; Verdonschot, N.J.J.; Kampen, A. van

    2005-01-01

    BACKGROUND: There is some confusion about the relationship between the tension placed on the graft and the joint position used in the fixation of anterior cruciate ligament grafts. This is because of deficiency in accurate basic science about this important interaction in the normal and

  7. Specialized core stability exercise: a neglected component of anterior cruciate ligament rehabilitation programs.

    Science.gov (United States)

    Shi, Dong-liang; Li, Jing-long; Zhai, Hua; Wang, Hui-fang; Meng, Han; Wang, Yu-bin

    2012-01-01

    The incidence of anterior cruciate ligament injury has continued to increase over the last two decades. This injury is associated with abnormal gait patterns and osteoarthritis of the knee. In order to accelerate recovery, the introduction of core stability exercises into the rehabilitation program is proposed. The theory underlying the use of core stability exercise relates to the neuroplasticity that follows anterior cruciate ligament injury. Neuroplasticity in lumbar, thoracic, cervical and brain regions diminish activation in the contralateral thalamus, postparietal cortex, SM1, basal ganglia-external globus pallidus, SII, cingulated motor area, premotor cortex, and in the ipsilateral cerebellum and SM1 and increase activation in pre-SMA, SIIp, and pITG, indicating modifications of the CNS. In addition, the neuroplasticity can regulate the movement of trunk muscles, for example, sternocleidomastoid and lower trapezius muscles. Core stability also demonstrates a negative correlation with the incidence of anterior cruciate ligament injury. Therefore, we propose that core stability exercises may improve the rehabilitation of anterior cruciate ligament injuries by increasing core motor control. Specialized core stability exercises aimed at rectifying biomechanical problems associated with gait and core stability may play a key role in the management of anterior cruciate ligament injury.

  8. Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS)

    DEFF Research Database (Denmark)

    Roemer, Frank W; Frobell, Richard; Lohmander, Stefan

    2014-01-01

    OBJECTIVE: To develop a whole joint scoring system, the Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS), for magnetic resonance imaging (MRI)-based assessment of acute anterior cruciate ligament (ACL) injury and follow-up of structural sequelae, and to assess its reliability. DESIGN...... and longitudinal changes including osteoarthritis (OA) features. Joint features assessed were acute osteochondral injury, traumatic and degenerative bone marrow lesions (BMLs), meniscus morphology and extrusion, osteophytes, collateral and cruciate ligaments including ACL graft, Hoffa-synovitis and effusion...

  9. Bilateral agenesis of the anterior cruciate ligament: MRI evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Bedoya, Maria A.; Jaramillo, Diego [The Children' s Hospital of Philadelphia, Radiology Department, Philadelphia, PA (United States); McGraw, Michael H. [Hospitalof theUniversityof Pennsylvania, Divisionof Orthopaedics, Philadelphia, PA (United States); Wells, Lawrence [The Children' s Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA (United States)

    2014-09-15

    Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed. (orig.)

  10. Reconstruction of the Anterior Cruciate Ligament : Alternative Strategies

    NARCIS (Netherlands)

    van Eijk, F.

    2009-01-01

    This thesis describes the long-term results of reconstruction of the anterior cruciate ligament with an allograft. Due to the poor results found, further studies were performed to investigate alternative strategies for reconstruction of the anterior cruciate ligament in the field of tissue

  11. Outcomes in Anterior Cruciate Ligament Reconstruction Surgery

    Directory of Open Access Journals (Sweden)

    Roman Mihai

    2016-11-01

    Full Text Available Improving the outcomes in reconstructive surgery of the anterior cruciate ligament (ACL requires a rigorous and permanent assessment of specific parameters. Therefore, we can increase the degree of reproducibility of the procedure and identify particular aspects in order to achieve an adequate and individualized therapeutic approach for each case. In order to accomplish this goal, the use of complex means (scores of quantifying results is required. That includes objective means of verifying the parameters in knee surgery, and a subjective evaluation of the patient in order to compare the results.

  12. Anterior cruciate ligament reconstruction: principles of treatment

    Science.gov (United States)

    Paschos, Nikolaos K.; Howell, Stephen M.

    2016-01-01

    Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures in sports medicine. Several areas of controversy exist in ACL tear management which have engaged surgeons and researchers in debates towards identifying an ideal approach for these patients. This instructional review discusses the principles of ACL reconstruction in an attempt to provide guidelines and initiate a critical thinking approach on the most common areas of controversy regarding ACL reconstruction. Using high-level evidence from the literature, as presented in randomised controlled trials, systematic reviews, and meta-analyses, operative versus conservative treatment, timing of surgery, and rehabilitation are discussed. Also, the advantages and disadvantages of the most common types of autografts, such as patellar tendon and hamstrings as well as allografts are presented. Key considerations for the anatomical, histological, biomechanical and clinical data (‘IDEAL’) graft positioning are reviewed. Cite this article: Paschos NK, Howell SM. Anterior cruciate ligament reconstruction: principles of treatment. EFORT Open Rev 2016;398-408. DOI: 10.1302/2058-5241.1.160032. PMID:28461919

  13. Association of Anterior Cruciate Ligament Width With Anterior Knee Laxity.

    Science.gov (United States)

    Wang, Hsin-Min; Shultz, Sandra J; Schmitz, Randy J

    2016-06-02

    Greater anterior knee laxity (AKL) has been identified as an anterior cruciate ligament (ACL) injury risk factor. The structural factors that contribute to greater AKL are not fully understood but may include the ACL and bone geometry. To determine the relationship of ACL width and femoral notch angle to AKL. Cross-sectional study. Controlled laboratory. Twenty recreationally active females (age = 21.2 ± 3.1 years, height = 1.66.1 ± 7.3 cm, mass = 66.5 ± 12.0 kg). Anterior cruciate ligament width and femoral notch angle were obtained with magnetic resonance imaging of the knee and AKL was assessed. Anterior cruciate ligament width was measured as the width of a line that transected the ACL and was drawn perpendicular to the Blumensaat line. Femoral notch angle was formed by the intersection of the line parallel to the posterior cortex of the femur and the Blumensaat line. Anterior knee laxity was the anterior displacement of the tibia relative to the femur (mm) at 130 N of an applied force. Ten participants' magnetic resonance imaging data were assessed on 2 occasions to establish intratester reliability and precision. Using stepwise backward linear regression, we examined the extent to which ACL width, femoral notch angle, and weight were associated with AKL. Strong measurement consistency and precision (intraclass correlation coefficient [2,1] ± SEM) were established for ACL width (0.98 ± 0.3 mm) and femoral notch angle (0.97° ± 1.1°). The regression demonstrated that ACL width (5.9 ± 1.4 mm) was negatively associated with AKL (7.2 ± 2.0 mm; R(2) = 0.22, P = .04). Femoral notch angle and weight were not retained in the final model. A narrower ACL was associated with greater AKL. This finding may inform the development of ACL injury-prevention programs that include components designed to increase ACL size or strength (or both). Future authors should establish which other factors contribute to greater AKL in order to best inform injury-prevention efforts.

  14. [Diagnostic value of Blumensaat angle for anterior cruciate ligament injury].

    Science.gov (United States)

    Cheng, Xiang-Yun; Feng, Jiang-Feng; Lu, Yan-Hui; Zhao, Yong-Liang; Yang, Zi-Quan

    2017-08-25

    The receiver operator characteristic(ROC) curve was used to determine the best Blumensaat angle for the diagnosis of anterior cruciate ligament injury, so as to objectively evaluate the diagnostic value of Blumensaat angle for anterior cruciate ligament injury. Total 167 patients who had knee arthroscopic treatment in a hospital from January 2015 to January 2016 were retrospectively studied, and the patients' age, gender, left and right limb condition were recorded. The patients were divided into two groups according to Blumensaat angle measured on the MRI: group A(Blumensaat angle0°). The ROC curve was drawn from the statistical data of the group B to get the best critical value of the anterior cruciate ligament injury when the Blumensaat angle was more than 0°. According to the best critical value obtained by ROC curve, the coincidence rate of the total sample was obtained. There were no significant differences in patients' age, gender, and affected limbs. There were 51 patients in group A, in which 49 patients were diagnosed as anterior cruciate injury under arthroscopy(gold standard for diagnosis of anterior cruciate ligament injury), and 2 patients were diagnosed as no anterior cruciate injury under arthroscopy. When the Blumensaat angle was=15°, the probability of anterior cruciate ligament injury was greater. When the Blumensaat angle was 0° to 15°, the anterior cruciate ligament was more likely to be not injured. The Blumensaat angle=15° were used to diagnose the injury of anterior cruciate ligament. Compared with the results of arthroscopy, the coincidence rate of the total sample was 92.8%. Blumensaat angle is helpful to diagnose the ACL injuries. When the Blumensaat angle was =15°, the probability of ACL injury is greater.

  15. Anterior cruciate ligament remnant and its values for preservation

    Directory of Open Access Journals (Sweden)

    Takeshi Muneta

    2017-01-01

    Full Text Available Controversy surrounds the remnant-preserving anterior cruciate ligament surgery. Advantages of remnant preservation have been reported in regard to better healing and knee function, although no consensus has been reached. This review article discussed the value and meaning of anterior cruciate ligament remnant preservation in several sections such as effects on healing, remnant classification, biomechanical evaluation, relation to proprioception, animal studies, and clinical studies. We hope that this review will facilitate further discussion and investigation for better treatment of anterior cruciate ligament injuries. So far, the current reviews have not provided sufficient scientific evidence to support the value of preserving the remnant.

  16. Gross, Arthroscopic, and Radiographic Anatomies of the Anterior Cruciate Ligament: Foundations for Anterior Cruciate Ligament Surgery.

    Science.gov (United States)

    Irarrázaval, Sebastián; Albers, Marcio; Chao, Tom; Fu, Freddie H

    2017-01-01

    The anterior cruciate ligament (ACL) is one of the more studied structures in the knee joint. It is not a tubular structure, but is much narrower in its midsubstance and broader at its ends, producing an hourglass shape. The ACL is composed of 2 functional bundles, the anteromedial and posterolateral bundles, that are named for their location of insertion on the anterior surface of the tibial plateau. Although the relative contribution in terms of total cross-sectional area of the ACL has been noted to be equal in regards to each bundle, dynamically these bundles demonstrate different properties for knee function. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Essentials of anterior cruciate ligament rupture management.

    Science.gov (United States)

    Klinge, Stephen A; Sawyer, Gregory A; Hulstyn, Michael J

    2013-05-01

    Anterior cruciate ligament (ACL) rupture is a common knee injury and an understanding of current medical knowledge regarding its management is essential. Accurate and prompt diagnosis requires an awareness of injury mechanisms and risk factors, common symptoms and physical/radiologic findings. Early mobilization and physical therapy improves outcomes regardless of treatment modality. Many older patients regain sufficient stability and function after non-operative rehabilitation. Early ACL reconstruction is appropriate for younger patients and those who engage in activities requiring frequent pivoting and rapid direction changes. ACL surgery involves reconstruction of the torn ligament tissue with various replacement graft options, each with advantages and disadvantages. The guidance of a knowledgeable and experienced therapist is required throughout an intensive and prolonged rehabilitation course. Generally excellent outcomes and low complication rates are expected, but treatment does not prevent late osteoarthritis.

  18. Anterior cruciate ligament reconstruction and knee osteoarthritis.

    Science.gov (United States)

    Paschos, Nikolaos K

    2017-03-18

    Anterior cruciate ligament (ACL) injury is a traumatic event that can lead to significant functional impairment and inability to participate in high-level sports-related activities. ACL reconstruction is considered the treatment of choice for symptomatic ACL-deficient patients and can assist in full functional recovery. Furthermore, ACL reconstruction restores ligamentous stability to normal, and, therefore, can potentially fully reinstate kinematics of the knee joint. As a consequence, the natural history of ACL injury could be potentially reversed via ACL reconstruction. Evidence from the literature is controversial regarding the effectiveness of ACL reconstruction in preventing the development of knee cartilage degeneration. This editorial aims to present recent high-level evidence in an attempt to answer whether ACL injury inevitably leads to osteoarthritis and whether ACL reconstruction can prevent this development or not.

  19. Anterior cruciate ligament injuries: etiology and prevention.

    Science.gov (United States)

    Brophy, Robert H; Silvers, Holly J; Mandelbaum, Bert R

    2010-03-01

    The relatively high risk of noncontact anterior cruciate ligament (ACL) rupture among female athletes has been a major impetus for investigation into the etiology of this injury. A number of risk factors have been identified, both internal and external to the athlete, including neuromuscular, anatomical, hormonal, shoe-surface interaction, and environmental, such as weather. The anatomic and neuromuscular risk factors, often gender related, are the focus of most ACL injury prevention programs. Although studies have shown that biomechanic- centered prevention programs can reduce the risk of ACL injury, many questions remain unanswered. More research is needed to increase our understanding of the risk factors for ACL injury; how injury prevention programs work and can the clinical application of such programs be optimized.

  20. Anterior Cruciate Ligament Strain In Vivo

    Science.gov (United States)

    Luque-Seron, Juan Antonio; Medina-Porqueres, Ivan

    2016-01-01

    Context: Distinct exercises have been proposed for knee rehabilitation after anterior cruciate ligament (ACL) reconstruction. There is a need to understand ACL strain behavior during different rehabilitation exercises to protect the graft from excessive strain that could interfere with its healing process. Objective: To critically review studies that directly measured normal ACL strain in vivo during different movements, conditions, or exercises to gain insight into which of them may produce more strain on the ligament or the ligament graft in the case of reconstructed knees. Data Sources: A literature search of PubMed, CINAHL, SPORTDiscus, and PEDro databases was conducted. Keywords included anterior cruciate ligament, strain, stress, deformation, transducer, rehabilitation, rehabilitation exercise, physical therapy, and physiotherapy. Study Selection: Inclusion criteria were (1) peer-reviewed studies published in English or Spanish, (2) research conducted on adult human subjects with normal ACLs and healthy knees, and (3) ACL strain directly measured during different movements, conditions, or exercises by using a transducer. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Specific data were abstracted from the selected studies, including isometric quadriceps and hamstrings activity, active and passive flexion-extension of the knee, closed kinetic chain exercises, and application of joint compressive load. Results: A total of 10 studies met all criteria and were included in the final analysis. The strain values produced by closed kinetic chain and open kinetic chain exercises were similar. However, closed kinetic chain exercises appear to attenuate the strain increase that occurs in open kinetic chain exercises when increasing resistance. Conclusion: These data may be relevant to develop rehabilitation exercises or programs that do not endanger the healing ACL graft and to provide a basis for future clinical trials. PMID:27418161

  1. Anterior Cruciate Ligament Injuries and Outcome of Arthroscopic ...

    African Journals Online (AJOL)

    Objective: To study the results of arterior cruciate ligament (ACL) repairs using arthroscopic assisted reconstructions using harmstrings. A follow-up rehabilitation programme of immediate mobilisation, weight bearing and extension. Subjects: Twenty arthroscopic reconstructions of the anterior cruciate ligament using the ...

  2. Features extraction in anterior and posterior cruciate ligaments analysis.

    Science.gov (United States)

    Zarychta, P

    2015-12-01

    The main aim of this research is finding the feature vectors of the anterior and posterior cruciate ligaments (ACL and PCL). These feature vectors have to clearly define the ligaments structure and make it easier to diagnose them. Extraction of feature vectors is obtained by analysis of both anterior and posterior cruciate ligaments. This procedure is performed after the extraction process of both ligaments. In the first stage in order to reduce the area of analysis a region of interest including cruciate ligaments (CL) is outlined in order to reduce the area of analysis. In this case, the fuzzy C-means algorithm with median modification helping to reduce blurred edges has been implemented. After finding the region of interest (ROI), the fuzzy connectedness procedure is performed. This procedure permits to extract the anterior and posterior cruciate ligament structures. In the last stage, on the basis of the extracted anterior and posterior cruciate ligament structures, 3-dimensional models of the anterior and posterior cruciate ligament are built and the feature vectors created. This methodology has been implemented in MATLAB and tested on clinical T1-weighted magnetic resonance imaging (MRI) slices of the knee joint. The 3D display is based on the Visualization Toolkit (VTK). Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Anterior cruciate ligament reconstruction and joint dynamics during stair climbing.

    Science.gov (United States)

    Kowalk, D L; Duncan, J A; McCue, F C; Vaughan, C L

    1997-11-01

    Athletes with anterior cruciate ligament (ACL) deficiencies exert decreased knee extension moments during level walking (quadriceps avoidance gait), and yet within a few months of ACL reconstruction they are often expected to return to competitive sport. To investigate this issue further, 10 normal subjects and seven ACL deficient patients were evaluated both pre- and post-operatively (mean follow-up of 6 months), and each performed multiple trials ascending a staircase which consisted of three steps. Bilateral joint angles, moments, powers, and work were measured and the data were ensemble averaged and statistically analyzed (repeated measures ANOVA with significance level set at 0.05). Anterior-posterior knee laxity decreased significantly (from 7.9 mm to 5.8 mm) while subjective knee function also improved following ACL reconstruction (knee score increased from 70.4 to 88.5). Pre-operatively, there were no statistically significant differences in biomechanical parameters between the patients' ACL-deficient and intact sides and the normal subjects. Post-operatively, however, statistically significant reductions were seen for the peak moment (91.9 vs 22.5 Nm), power (181 vs 84 W), and work performed (28.0 vs -5.6 J) at the injured knee, which was also the knee from which the patellar tendon graft had been harvested. These reductions were accommodated by significant increases in excursion, moment, and power at the contralateral ankle joint. The results indicate that while the ACL reconstruction were successful in restoring anterior-posterior knee stability, the decrease in knee power and work performed post-operatively by the injured (i.e., donor) knee suggests that donor site morbidity may need to be critically evaluated over a long-term period.

  4. Femoropatellar radiographic alterations in cases of anterior cruciate ligament failure

    Directory of Open Access Journals (Sweden)

    Diego Protásio de Vasconcelos

    2015-02-01

    Full Text Available OBJECTIVE: To make a comparative analysis on three femoropatellar radiographic parameters, between knees with chronic failure of the anterior cruciate ligament (ACL and normal knees.METHODS: Thirty volunteer patients with a diagnosis of unilateral isolated chronic ACL injury for more than one year and a normal contralateral knee were selected. Digital radiographs were produced for all the patients, on both knees in absolute lateral view at 30° of flexion, with and without load-bearing on one leg, and in axial view of the patella at 30°. The Caton-Deschamps patellar height index, Merchant patellar congruence angle and Laurin lateral patellar tilt angle were measured on the radiographs obtained from the normal knees and knees with ACL injuries, and comparative analysis was performed between these two groups.RESULTS: The patellar height was statistically significantly lower (p< 0.001 in the knees with ACL failure than in the normal knees, both on radiographs without loading and on those with single-foot loading. The Merchant patellar congruence angle was significantly smaller (p < 0.001 in the normal knees and the lateral patellar tilt angle was smaller (p < 0.001 in the knees with ACL failure.CONCLUSION: Chronic ACL failure gave rise to a statistically significant change in the femoropatellar radiographic values studied (p < 0.001. Knees with injuries to this ligament presented lower patellar height values, greater tilt and lateral displacement of the patella, in relation to the femoral trochlea, in comparison with the normal contralateral knees.

  5. Knee Bracing After Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Rodríguez-Merchán, E Carlos

    2016-07-01

    Although some articles in the literature are in favor of the use of a postoperative brace after anterior cruciate ligament (ACL) reconstruction, this review found that several systematic reviews and other reports on the topic do not support the use of a postoperative brace after ACL reconstruction. There is no scientific evidence so far to support the routine use of a functional knee brace following a successful ACL reconstruction in the postoperative course. Most authors believe that bracing is not necessary. There is insufficient evidence to inform current practice. Good-quality randomized trials are required to remedy this situation. Future studies should better define the role of a brace following ACL surgery. A search of MEDLINE for articles published between January 1, 1995, and September 30, 2013, was performed. Key search terms used were ACL reconstruction and knee brace. Ninety-one articles were found, but only 28 focused on the subject of bracing after ACL reconstruction and were selected for this review. Several systematic reviews and randomized, controlled trials on the topic do not recommend the use of postoperative brace after ACL reconstruction. Postoperative bracing after ACL reconstruction does not seem to help with pain, function, rehabilitation, and stability. The literature does not support the use of a postoperative brace following ACL reconstruction. [Orthopedics. 2016; 39(4):e602-e609.]. Copyright 2016, SLACK Incorporated.

  6. Current trends in anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Duquin, Thomas R; Wind, William M; Fineberg, Marc S; Smolinski, Robert J; Buyea, Cathy M

    2009-01-01

    In 2006, a survey regarding anterior cruciate ligament (ACL) reconstruction was mailed to physician members of the American Orthopaedic Society for Sports Medicine. A total of 993 responses were received from 1747 possible respondents (57%). The number of ACL reconstructions per year ranged from 1 to 275 (mean=55). The most important factors in the timing of surgery were knee range of motion and effusion. Bone-patellar tendon-bone (BPTB) autograft was most commonly preferred (46%), followed by hamstring tendon autograft (32%) and allografts (22%). Five years earlier, BPTB grafts were more frequent and hamstring tendon and allografts were less frequent (63%, 25%, and 12%, respectively). A single-incision arthroscopic technique was used by 90%. Most allowed return to full activity at 5 to 6 months, with a trend toward earlier return for BPTB grafts; quadriceps strength was an important factor in the decision. There was limited experience (4%) with double-bundle and computer-assisted ACL reconstruction. Arthroscopic-assisted, single-incision reconstruction using a BPTB autograft fixed with metal interference screws remains the most common technique used for primary ACL reconstruction. In the past 5 years, the use of alternative graft sources and methods of fixation has increased. Consensus regarding the best graft type, fixation method, and postoperative protocol is still lacking.

  7. Failure of Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Samitier, Gonzalo; Marcano, Alejandro I.; Alentorn-Geli, Eduard; Cugat, Ramon; Farmer, Kevin W; Moser, Michael W

    2015-01-01

    The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL) surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient. PMID:26550585

  8. Guideline on anterior cruciate ligament injury

    Science.gov (United States)

    2012-01-01

    The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a steering group of the Dutch Orthopaedic Association. What is the role of physical examination and additional diagnostic tools? Which patient-related outcome measures should be used? What are the relevant parameters that influence the indication for an ACL reconstruction? Which findings or complaints are predictive of a bad result of an ACL injury treatment? What is the optimal timing for surgery for an ACL injury? What is the outcome of different conservative treatment modalities? Which kind of graft gives the best result in an ACL reconstruction? What is the optimal postoperative treatment concerning rehabilitation, resumption of sports, and physiotherapy? These 8 questions were answered and recommendations were made, using the “Appraisal of Guidelines for Research and Evaluation” instrument. This instrument seeks to improve the quality and effectiveness of clinical practical guidelines by establishing a shared framework to develop, report, and assess. The steering group has also developed 7 internal indicators to aid in measuring and enhancing the quality of the treatment of patients with an ACL injury, for use in a hospital or practice. PMID:22900914

  9. Failure of Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Gonzalo Samitier

    2015-10-01

    Full Text Available The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient.

  10. Failure of Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Gonzalo Samitier

    2015-09-01

    Full Text Available The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient.

  11. Biomechanics and anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Vercillo Fabio

    2006-09-01

    Full Text Available Abstract For years, bioengineers and orthopaedic surgeons have applied the principles of mechanics to gain valuable information about the complex function of the anterior cruciate ligament (ACL. The results of these investigations have provided scientific data for surgeons to improve methods of ACL reconstruction and postoperative rehabilitation. This review paper will present specific examples of how the field of biomechanics has impacted the evolution of ACL research. The anatomy and biomechanics of the ACL as well as the discovery of new tools in ACL-related biomechanical study are first introduced. Some important factors affecting the surgical outcome of ACL reconstruction, including graft selection, tunnel placement, initial graft tension, graft fixation, graft tunnel motion and healing, are then discussed. The scientific basis for the new surgical procedure, i.e., anatomic double bundle ACL reconstruction, designed to regain rotatory stability of the knee, is presented. To conclude, the future role of biomechanics in gaining valuable in-vivo data that can further advance the understanding of the ACL and ACL graft function in order to improve the patient outcome following ACL reconstruction is suggested.

  12. Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction and Its Effect on Subsequent Anterior Cruciate Ligament Injury.

    Science.gov (United States)

    Dekker, Travis J; Godin, Jonathan A; Dale, Kevin M; Garrett, William E; Taylor, Dean C; Riboh, Jonathan C

    2017-06-07

    Anterior cruciate ligament (ACL) graft failure and contralateral ACL tears are more frequent in children and adolescents than adults. The reasons for higher subsequent injury rates in this population are incompletely understood. We analyzed a continuous cohort of patients who were physical therapy), and patients' preoperative and postoperative sports involvement (primary and secondary sports, number of sports). A total of 112 subjects met inclusion criteria; of these patients, 85 (76%) had complete follow-up data and were analyzed. The mean age (and standard deviation) was 13.9 ± 2.1 years (range, 6 to 17 years); 77% had open physes. The mean follow-up was 48.3 ± 15.3 months. Seventy-seven patients (91%) returned to sports, and 84% returned to the same sport. The mean Marx activity score at the time of the latest follow-up was 13.7 ± 3.5 points. Patients were involved in fewer sports after ACL reconstruction, 1.48 ± 0.92 compared with 1.83 ± 1.01 sports before reconstruction (p = 0.002). Sixteen patients (19%) sustained an ACL graft rupture, 11 patients (13%) sustained a contralateral ACL tear, and 1 of these patients (1%) sustained both. The overall prevalence of a second ACL injury was 32%. Time to return to sport was the only significant predictor of a second ACL injury, with a slower return being protective (hazard ratio per month, 0.87 [95% confidence interval, 0.73 to 0.99]; p = 0.04). Pediatric athletes return to sports at a high rate (91%) after ACL reconstruction. Unfortunately, the prevalence of a second ACL injury is high at 32%. Within this population, an earlier return to sport is predictive of a second ACL injury. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  13. Absence of sensory function in the reconstructed anterior cruciate ligament

    DEFF Research Database (Denmark)

    Krogsgaard, Michael R; Fischer-Rasmussen, Torsten; Dyhre-Poulsen, Poul

    2011-01-01

    Cruciate ligaments provide sensory information that cause excitatory as well as inhibitory effects to the activity of the muscles around the knee. The aim of the study was to determine whether these muscular reflexes are reestablished after anterior cruciate ligament (ACL) re-construction. Wire...... electrodes were inserted during arthroscopy into the normal posterior cruciate ligament (PCL) and the reconstructed ACL in 11 patients who had a successful ACL re-construction 8 months to 12 years earlier. After the anesthesia had subsided, the PCL was stimulated electrically through the electrodes...

  14. Anterior cruciate ligament reconstruction with double bundle versus single bundle: experimental study

    National Research Council Canada - National Science Library

    Roberto F. Mota e Albuquerque; Sandra Umeda Sasaki; Marco Martins Amatuzzi; Fabio Janson Angelini

    2007-01-01

    OBJECTIVE: To test an intra-articular reconstruction of the anterior cruciate ligament of the knee in 10 human cadavers by replacing 2 anterior cruciate ligament bundles, with the purpose of producing...

  15. Incidence rate of anterior cruciate ligament reconstructions.

    Science.gov (United States)

    Csintalan, Rick P; Inacio, Maria C S; Funahashi, Tadashi T

    2008-01-01

    Anterior cruciate ligament (ACL) reconstructions are among the most common sports medicine procedures performed in the US each year. Differences have been reported in the incidence rates (IRs) of ACL tears among male and female national elite athletes. However, there is little information in the published literature that assesses IRs for ACL reconstructions done in the Health Maintenance Organization (HMO) setting specifically. Different populations may show variation in ACL reconstruction IRs. This study reports on the IR of ACL reconstructions in a predefined population and compares the differences in age and sex over time. A retrospective analysis of 4485 ACL reconstructions performed within Kaiser Permanente Southern California between 2001 and 2005 was completed by a query of an administrative database. Trends in IRs per 100,000 members were calculated and compared across age, sex, and the five-year study period. Linear regression was used to test trends in IR. Sex distribution was compared using the χ(2) test. Analysis of variance was used to compare the mean age from year to year in males and females. The independent sample t-test was used to compare mean age between males and females for each independent year. The IR of ACL reconstructions in females rose significantly (p = 0.010) from 14.4 in 2001 (95% confidence interval [CI], 12.6-16.3) to 19.3 in 2005 (95% CI, 17.2-21.5). Within specific age groups, IR increased significantly for females age 14 to 17 (p = 0.013), 18 to 21 (p = 0.017), and 45 to 49 years (p = 0.014). The most dramatic change was seen in the female age category of 14 to 17 years, which increased at a rate of 8.14 cases/100,000 members per year. Identifying the sex and age groups with most rapidly increasing rates of ACL reconstructions is important in implementing ACL injury-prevention programs.

  16. A study of isokinetic strength and laxity with and without anterior cruciate ligament injury

    OpenAIRE

    Kim, Kewwan; Jeon, Kyoungkyu; Mullineaux, David R.; Cho, Eunok

    2016-01-01

    [Purpose] The purpose of this study was to provide useful information for future treatments and to organize rehabilitation programs for anterior cruciate ligament injury by assessing isokinetic muscle strength and laxity of knee joints in athletes with anterior cruciate ligament injuries. [Subjects and Methods] Thirty-one high school athletes with anterior cruciate ligament injuries participated in this study. Isokinetic muscle strength at 60?/sec and anterior cruciate ligament laxity for non...

  17. Emerging Trends in Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Budny, Jacob; Fox, Joseph; Rauh, Michael; Fineberg, Marc

    2017-01-01

    Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed and researched orthopedic procedures. As technology and comparative research have advanced, surgical practices have changed to achieve a superior outcome. Our group performed a survey of orthopedic surgeons to evaluate current practice trends and techniques as a follow-up to similar surveys performed in 1999 and 2006. In a survey between 2013 and 2014 consisting of 35 questions regarding the surgical technique, graft choice, fixation method, and perioperative care in ACL reconstruction was sent electronically to the members of the American Orthopaedic Society of Sports Medicine and the Arthroscopy Association of North America. Responses were recorded and compared with previous results. Survey responses were received from 824 active surgeons. Of the respondents, 89.4% are subspecialty trained, 98% of which in sports medicine. Preoperatively, full-knee extension was the only "very significant" factor in surgical timing. Approach preference via an arthroscopic-assisted single-incision approach predominated (89%)-similar to earlier results. Bone-patellar-tendon-bone use decreased relative to hamstring allograft at 45 and 41%, respectively. Tibial tunnel placement shifted anteriorly and femoral tunnel placement shifted posterosuperiorly as compared with the results obtained 5 years ago. Femoral drilling through a low medial portal was preferred in 47% of responses, increased from 15%. Preferred fixation on both the tibial and femoral sides was either metal or bioabsorbable interference screws. The use of transfixation pins and other devices decreased. Postoperative rehab protocols did not significantly change, 68.7% preferred full-weight bearing, 55% using a range of motion knee brace locked in extension, 66.4% starting physical therapy 1 week postoperatively, with unrestricted activity at 6 to 9 months. Overall, an increasing trend toward using hamstring autograft and drilling the

  18. Reducing time to surgery after anterior cruciate ligament injury.

    Science.gov (United States)

    Sapsford, H; Sutherland, A G

    2016-05-01

    Recent work suggests that reconstruction of the ruptured anterior cruciate ligament within 12 months of injury results in better outcomes. We present a complete audit cycle examining the effect of establishment of an Acute Knee Clinic on time to surgery. Records of 20 anterior cruciate ligament reconstructions undertaken by the senior author between June 2003 and May 2004 were examined to identify the time to surgery. The Acute Knee Clinic was established in December 2004. Prospectively collected data on patients attending the Acute Knee Clinic between May 2005 and July 2007 and patients undergoing anterior cruciate ligament reconstruction from September 2006 to 2007 were reviewed with respect to referral route, time from injury to specialist review and time to surgery. Mean time from injury to surgery of the initial cohort was 14 months (range 3-56). After establishment of the Acute Knee Clinic, 90% of referrals from Accident and Emergency (A&E) were seen by a specialist within four weeks. Between September 2006 and September 2007, 49 patients underwent anterior cruciate ligament reconstruction: 21 came via the Acute Knee Clinic, with a mean time from injury to surgery of 6 months; 28 patients from the elective clinic had a mean time to surgery of 25 months. 95% of Acute Knee Clinic patients and 53 % of elective clinic patients had surgery within 12 months of injury. The Acute Knee Clinic has been shown to reduce the time from injury to anterior cruciate ligament reconstruction. The Acute Knee Clinic only accounts for the referral of 40% of anterior cruciate ligament reconstructions in this series: Further education work is required with A&E staff and GPs regarding the referral of knee injuries. Access to the Acute Knee Clinic could be extended to GPs, although this could create service overload. © The Author(s) 2016.

  19. A comparison of joint stability between anterior cruciate intact and deficient knees: a new canine model of anterior cruciate ligament disruption.

    Science.gov (United States)

    Lopez, Mandi J; Kunz, David; Vanderby, Ray; Heisey, Dennis; Bogdanske, John; Markel, Mark D

    2003-03-01

    Transection of the canine anterior cruciate ligament (ACL) is a well-established osteoarthritis (OA) model. This study evaluated a new method of canine ACL disruption as well as canine knee joint laxity and joint capsule (JC) contribution to joint stability at two time points (16 and 26 weeks) after ACL disruption (n=5/time interval). Ten crossbreed hounds were evaluated with force plate gait analysis and radiographs at intervals up to 34 weeks after monopolar radiofrequency energy (MRFE) treatment of one randomly selected ACL. Each contralateral ACL was sham treated. The MRFE treated ACLs ruptured approximately eight weeks (mean 52.5 days, SEM+/-1.0, range 48-56 days) after treatment. Gait analysis and radiographic changes were consistent with established canine ACL transection models of OA. Anterior-posterior (AP) translation and medial-lateral (ML) rotation were measured in each knee at 30 degrees, 60 degrees, and 90 degrees of flexion with and then without JC with loads of 40 N in AP translation and 4 Nm in ML rotation. A statistically significant interaction in AP translation included JC by cruciate (P=0.02), and there was a trend for a cruciate by time (P=0.07) interaction. Significant interactions in ML rotational testing included the presence of joint capsule (P=0.0001) and angle by cruciate (P=0.0012). This study describes a model in which canine ACLs predictably rupture approximately eight weeks after arthroscopic surgery and details the contribution of JC to canine knee stability in both ACL intact and deficient knees. The model presented here avoids the introduction of potential surgical variables at the time of ACL rupture and may contribute to studies of OA pathogenesis and inhibition. This model may also be useful for insight into the pathologic changes that occur in the knee as the ACL undergoes degeneration prior to rupture.

  20. 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

  1. Anterior cruciate ligament reconstruction complicated by pyoderma gangrenosum

    OpenAIRE

    Bagouri, E; Smith, Jon; Geutjens, G

    2012-01-01

    We report a case of pyoderma gangrenosum as a complication of an anterior cruciate ligament reconstruction in a patient with inflammatory bowel disease, which was misdiagnosed initially as a post-operative wound infection. An early dermatology opinion and skin biopsy should be considered in cases of suspected infection where thorough surgical debridement and antimicrobial therapy has failed to improve the clinical picture.

  2. Nocardia Septic Arthritis Complicating an Anterior Cruciate Ligament Repair

    OpenAIRE

    Yong, Elaine X. L.; Cheong, Elaine Y.L.; Boutlis, Craig S.; Chen, Darren B.; Liu, Eunice Y.-T.; McKew, Genevieve L.

    2015-01-01

    Nocardia infection following anterior cruciate ligament (ACL) allograft reconstruction is a rare occurrence. We report a case of Nocardia infection of an allograft ACL reconstruction and septic arthritis of the knee joint due to an organism most similar to the novel Nocardia species Nocardia aobensis.

  3. Semitendinosus Tendon for Solitary Use in Anterior Cruciate ...

    African Journals Online (AJOL)

    for reconstruction of the anterior cruciate ligament requires adequate tendon length (>28 cm) and four strand construct diameter (>8 mm). This study sought to determine the dimensions of the semitendinosus tendon graft among Kenyans. Methods: Forty pairs of ST tendons were harvested from formalin fixed cadavers by ...

  4. Mucoid degeneration of the anterior cruciate Ligament: a case report ...

    African Journals Online (AJOL)

    We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Mucoid degeneration of the ACL is a very rare cause of knee pain. There have been only some reported cases of mucoid degeneration of the ACL in the English literature. We reviewed previous reports and summarized clinical features and ...

  5. Return to work in miners following anterior cruciate ligament ...

    African Journals Online (AJOL)

    Introduction: The aim of the study is retrospectively investigated durations for returning to work following anatomic ACL reconstruction by hamstring autograft in miners and the reasons in patients who were delayed to return to work. Methods: Miners with symptomatic anterior cruciate ligament rupture underwent arthroscopic ...

  6. Semitendinosus Tendon for Solitary Use in Anterior Cruciate ...

    African Journals Online (AJOL)

    Background: The use of a combined graft of both semitendinosus (ST) and gracilis (G) tendons in anterior cruciate ligament (ACL) reconstruction may cause weakness in knee flexion. It has since been proposed that ST be used alone since sparing G leads to near complete preservation of flexion strength. The use of the ...

  7. 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...

  8. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

    NARCIS (Netherlands)

    Hofbauer, Marcus; Muller, Bart; Wolf, Megan; Forsythe, Brian; Fu, Freddie H.

    2013-01-01

    Over the past decade, intense research of the function of the 2 distinct bundles, the anteromedial and posterolateral, of the anterior cruciate ligament (ACL) has led to pronounced changes in the technical concepts of ACL reconstruction. Recently, the renewed focus of ACL reconstruction has been to

  9. Anterior cruciate ligament reconstruction in patients with generalized joint laxity.

    Science.gov (United States)

    Kim, Sung-Jae; Kumar, Praveen; Kim, Sung-Hwan

    2010-09-01

    Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation.

  10. 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

  11. Nocardia Septic Arthritis Complicating an Anterior Cruciate Ligament Repair.

    Science.gov (United States)

    Yong, Elaine X L; Cheong, Elaine Y L; Boutlis, Craig S; Chen, Darren B; Liu, Eunice Y-T; McKew, Genevieve L

    2015-08-01

    Nocardia infection following anterior cruciate ligament (ACL) allograft reconstruction is a rare occurrence. We report a case of Nocardia infection of an allograft ACL reconstruction and septic arthritis of the knee joint due to an organism most similar to the novel Nocardia species Nocardia aobensis. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  12. Proprioception in anterior cruciate ligament deficient knees and its relevance in anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Mandeep S Dhillon

    2011-01-01

    Full Text Available Injury to the anterior cruciate ligament (ACL not only causes mechanical instability but also leads to a functional deficit in the form of diminished proprioception of the knee joint. "Functional" recovery is often incomplete even after "anatomic" arthroscopic ACL reconstruction, as some patients with a clinically satisfactory repair and good ligament tension continue to complain of a feeling of instability and giving way, although the knee does not sublux on clinical testing. Factors that may play a role could be proprioceptive elements, as the intact ACL has been shown to have significant receptors. Significant data have come to light demonstrating proprioceptive differences between normal and injured knees, and often between injured and reconstructed knees. ACL remnants have been shown to have proprioceptive fibers that could enhance functional recovery if they adhere to or grow into the reconstructed ligament. Conventionally the torn remnants are shaved off from the knee before graft insertion; modern surgical techniques, with remnant sparing methods have shown better outcomes and functional recovery, and this could be an avenue for future research and development. This article analyzes and reviews our understanding of the sensory element of ACL deficiency, with specific reference to proprioception as an important component of functional knee stability. The types of mechanoreceptors, their distribution and presence in ACL remnants is reviewed, and suggestions are made to minimize soft tissue shaving during ACL reconstruction to ensure a better functional outcome in the reconstructed knee.

  13. Absence of sensory function in the reconstructed anterior cruciate ligament

    DEFF Research Database (Denmark)

    Krogsgaard, Michael R; Fischer-Rasmussen, Torsten; Dyhre-Poulsen, Poul

    2011-01-01

    Cruciate ligaments provide sensory information that cause excitatory as well as inhibitory effects to the activity of the muscles around the knee. The aim of the study was to determine whether these muscular reflexes are reestablished after anterior cruciate ligament (ACL) re-construction. Wire...... electrodes were inserted during arthroscopy into the normal posterior cruciate ligament (PCL) and the reconstructed ACL in 11 patients who had a successful ACL re-construction 8 months to 12 years earlier. After the anesthesia had subsided, the PCL was stimulated electrically through the electrodes...... and the sensory threshold was determined. Stimulus amplitudes were increased to 1.5-2.0 times the sensory threshold, and inhibitory reflexes could be elicited from PCL in the quadriceps during active extension and in the hamstrings muscles during active flexion in all patients. Subsequently the ACL re-constructions...

  14. STUDY OF ANTERIOR CRUCIATE LIGAMENT INJURY AND ITS MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Tummala Venkata

    2016-03-01

    Full Text Available BACKGROUND The anterior cruciate ligament is the weaker of the two cruciate ligaments stabilizing the knee joint, and therefore gets torn easier than the posterior cruciate ligament. OBJECTIVE To determine pattern of anterior cruciate ligament injury and its management in a tertiary care center. MATERIALS AND METHODS A prospective study was carried out for two years, 28 patients with ACL injury were included. A detailed history regarding the pattern of injury was noted and ACL reconstruction was done using BT Bautograft with mini-arthrotomy and arthroscopic assisted ACL reconstruction. RESULTS The mean age of the study subjects was 30.6±7.3 years & majority were males. Majority of the ACL injury was sports related & was on the right knee. 64% underwent arthroscopic assisted ACL reconstruction & majority of them had normal range of motion of the knee. CONCLUSION Our present study concludes that most common age group involved was 20-30 years & ACL injury was more common among males. Patients with an early ACL reconstruction were more satisfied with the end result. Also, ACL reconstruction techniques using BTB auto graft leads to good ligamentous stability and function of the knee.

  15. Anterior Cruciate Ligament Injury, Reconstruction, and the Optimization of Outcome

    Science.gov (United States)

    Bliss, James Philip

    2017-01-01

    Anterior cruciate ligament reconstruction (ACLR) provides an established surgical intervention to control pathological tibiofemoral translational and rotational movement. ACLR is a safe and reproducible intervention, but there remains an underlying rate of failure to return to preinjury sporting activity levels. Postoperative pathological laxity and graft reinjury remain concerns. Previously, unrecognized meniscal lesions, disruption of the lateral capsule, and extracapsular structures offer potential avenues to treat and to therefore improve kinematic outcome and functional results, following reconstruction. Addressing laterally based injuries may also improve the durability of intraarticular ACLR. Improving the anterior cruciate ligament (ACL) graft replication of the normal ACL attachment points on the femur and the tibia, using either double bundle or anatomical single bundle techniques, improves kinematics, which may benefit outcome and functionality, following reconstruction. PMID:28966384

  16. Controversies in knee rehabilitation: anterior cruciate ligament injury.

    Science.gov (United States)

    Failla, Mathew J; Arundale, Amelia J H; Logerstedt, David S; Snyder-Mackler, Lynn

    2015-04-01

    Controversy in management of athletes exists after anterior cruciate ligament (ACL) injury and reconstruction. Consensus criteria for evaluating successful outcomes following ACL injury include no reinjury or recurrent giving way, no joint effusion, quadriceps strength symmetry, restored activity level and function, and returning to preinjury sports. Using these criteria, the success rates of current management strategies after ACL injury are reviewed and recommendations are provided for the counseling of athletes after ACL injury. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Prevention and rehabilitation of paediatric anterior cruciate ligament injuries

    OpenAIRE

    Grindem, Hege; MOKSNES, HÅVARD

    2015-01-01

    Purpose: To review the current knowledge on anterior cruciate ligament (ACL) injury prevention and ACL rehabilitation in individuals who have not yet reached musculoskeletal maturity. Methods: This is a narrative review based on a targeted and systematic literature search for paediatric ACL injury risk factors, injury prevention and rehabilitation. Results: The search strategies resulted in 119 hits on risk factor studies, 57 hits on prevention and 37 hits on rehabilitat...

  18. Complications following anterior cruciate ligament reconstruction in the English NHS.

    OpenAIRE

    Jameson, Simon S.; Dowen, Daniel; James, Philip; Serrano Pedraza, Ignacio; Reed, Mike R; Deehan, David

    2012-01-01

    Unlike the English National Joint Registry (NJR) for arthroplasty, no surgeon driven national database currently exists for ligament surgery in England. Therefore information on outcome and adverse events following anterior cruciate ligament (ACL) surgery is limited to case series. This restricts the ability to make formal recommendations upon surgical care. Prospectively collected data, which is routinely collected on every NHS patient admitted to hospital in England, was analysed to determi...

  19. Anatomic anterior cruciate ligament reconstruction using an individualized approach

    Directory of Open Access Journals (Sweden)

    Carola F. van Eck

    2014-01-01

    Full Text Available Anterior cruciate ligament (ACL reconstruction is one of the most commonly performed orthopaedic procedures. Recently, there has been a shift in interest towards reconstruction techniques that more closely restore the native anatomy of the ACL. This review paper discusses our approach to individualized anatomic ACL reconstruction, including the anatomy of the ACL, the physical exam, imaging modalities, the surgical technique for anatomic reconstruction including pre- and intraoperative considerations and our postoperative rehabilitation protocol.

  20. Anterior Cruciate Ligament Injury Prevention Training in Female Athletes

    OpenAIRE

    Noyes, Frank R.; Barber Westin, Sue D.

    2012-01-01

    Context: Many anterior cruciate ligament (ACL) injury prevention training programs have been published, but few have assessed the effects of training on both ACL injury rates and athletic performance tests. Objective: To determine if ACL injury prevention programs have a positive influence on both injury rates and athletic performance tests in female athletes. Data sources: In August 2011, a search was conducted (1995?August 2011) of the PubMed, Science Direct, and CINAHL databases. Study sel...

  1. Bone tunnel enlargement on anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Leonardi, Adriano Barros de Aguiar; Duarte Junior, Aires; Severino, Nilson Roberto

    2014-01-01

    To assess the presence of tibial bone tunnel enlargement after surgical reconstruction of the anterior cruciate ligament using quadruple graft of the flexor tendons and correlate the functional results in their presence. The studied lasted six months and included 25 patients, with ages ranging from 18 to 43 years old. Assessment was based on radiographs taken immediately postoperatively and at the third and sixth month of follow up in the anterior cruciate ligament reconstruction. Reconstruction of ligaments was performed with tendon grafts of the semitendinosus and gracilis muscle fixated in the femur with transverse metal screw and in the tibia with interference screws. Patients were evaluated objectively by tests ligament, graded from zero to four crosses and subjectively by the Lysholm method preoperative and after sixth month follow up. Significant increase in the tunnels diameters were observed, 20.56% for radiographs in the anteroposterior view, 26.48% in profile view and 23.22% in computed tomography. Descriptive statistics showed significant improvement in subjective and objective clinical parameters. The bone tunnel enlargement is a phenomenon found in the first months after surgical reconstruction of the anterior cruciate ligament and it has no implications on clinical outcomes in the short term. Level of Evidence II, Prospective Study.

  2. Biomechanical changes elicited by an anterior cruciate ligament deficiency during steady rate cycling.

    Science.gov (United States)

    Hunt, Michael A; Sanderson, David J; Moffet, Hélène; Inglis, J Timothy

    2003-06-01

    To identify any changes to lower limb biomechanics during steady rate cycling as a result of an anterior cruciate ligament deficiency. Comparative study in which healthy and anterior cruciate ligament injured individuals underwent biomechanical analysis during stationary cycling. Individuals with an anterior cruciate ligament deficiency often exhibit reductions in the magnitude of quadriceps muscle activity and subsequent knee joint extensor moments during walking. It is not known whether these compensations are present during cycling, an exercise frequently used to retrain anterior cruciate ligament injured individuals. Ten healthy and 10 unilateral anterior cruciate ligament deficient individuals participated. All participants were required to cycle for approximately 30 s at each of six different cycling intensities while lower limb EMG, kinetics, and kinematics were collected bilaterally. Before riding, participants performed submaximal isometric contractions to generate normalizing data. In addition to reduced quadriceps activation and net knee joint extensor moments, the anterior cruciate ligament deficient limbs exhibited decreases in linear impulse of the resultant pedal force, knee joint flexor moments, hip and ankle extensor moments, and muscle activity from gluteus maximus. These decreases were counteracted by an increase in output from the anterior cruciate ligament intact limb. Anterior cruciate ligament injured individuals exhibited a limb attenuation strategy during cycling activities. This study reports lower limb kinetic and electromyographic data from anterior cruciate ligament deficient individuals during stationary cycling, and shows that these individuals exhibit a limb attenuation strategy on the very leg that is undergoing rehabilitation.

  3. The effect of anterior cruciate ligament resection and immediate or delayed implantation of a meniscus prosthesis on knee joint biomechanics and cartilage. An experimental study in rabbits.

    Science.gov (United States)

    Sommerlath, K G; Gillquist, J

    1993-04-01

    In a rabbit experiment with anterior cruciate ligament (ACL) resection, immediate substitution of the medial meniscus with a prosthesis was compared with delayed prosthetic implantation after a postmeniscectomy period of three weeks. The knees with a prosthetic implant were compared with their contralateral joints as well as to joints with an intact ACL and menisci. Anterior cruciate ligament resection alone led to disturbed biomechanics and cartilage degeneration. Anterior cruciate ligament resection in combination with meniscus resection increased cartilage degeneration and led to more inferior biomechanics. Ingrowth and stable fixation was less frequent when the prosthesis was inserted three weeks after meniscus resection than when inserted immediately. Furthermore, in knees with delayed prosthetic implantation, only minor improvement in terms of cartilage protection was shown when compared with knees with resection only. In contrast, knees with immediate meniscus replacement demonstrated similar joint stiffness and stress relaxation characteristics and similar cartilage protection effects as knees with a nonresected medial meniscus.

  4. Kinematic analysis of anterior cruciate ligament reconstruction in total knee arthroplasty.

    Science.gov (United States)

    Liu, Hua-Wei; Ni, Ming; Zhang, Guo-Qiang; Li, Xiang; Chen, Hui; Zhang, Qiang; Chai, Wei; Zhou, Yong-Gang; Chen, Ji-Ying; Liu, Yu-Liang; Cheng, Cheng-Kung; Wang, Yan

    2016-01-01

    This study aims to retain normal knee kinematics after knee replacement surgeries by reconstructing anterior cruciate ligament during total knee arthroplasty. We use computational simulation tools to establish four dynamic knee models, including normal knee model, posterior cruciate ligament retaining knee model, posterior cruciate ligament substituting knee model, and anterior cruciate ligament reconstructing knee model. Our proposed method utilizes magnetic resonance images to reconstruct solid bones and attachments of ligaments, and assemble femoral and tibial components according representative literatures and operational specifications. Dynamic data of axial tibial rotation and femoral translation from full-extension to 135 were measured for analyzing the motion of knee models. The computational simulation results show that comparing with the posterior cruciate ligament retained knee model and the posterior cruciate ligament substituted knee model, reconstructing anterior cruciate ligament improves the posterior movement of the lateral condyle, medial condyle and tibial internal rotation through a full range of flexion. The maximum posterior translations of the lateral condyle, medial condyle and tibial internal rotation of the anterior cruciate ligament reconstructed knee are 15.3 mm, 4.6 mm and 20.6 at 135 of flexion. Reconstructing anterior cruciate ligament in total knee arthroplasty has been approved to be an more efficient way of maintaining normal knee kinematics comparing to posterior cruciate ligament retained and posterior cruciate ligament substituted total knee arthroplasty.

  5. The Effect of Skeletal Maturity on Functional Healing of the Anterior Cruciate Ligament

    Science.gov (United States)

    Murray, Martha M.; Magarian, Elise M.; Harrison, Sophia L.; Mastrangelo, Ashley N.; Zurakowski, David; Fleming, Braden C.

    2010-01-01

    Background: The effects of skeletal maturity on functional ligament healing are unknown. Prior studies have suggested that ligament injuries in skeletally mature animals heal with improved mechanical properties. In this study, we hypothesized that skeletally immature animals have improved functional healing compared with skeletally mature animals. Methods: Twenty-one Yucatan minipigs (eight juvenile, eight adolescent, and five adult animals) underwent bilateral anterior cruciate ligament transection. On one side, the ligament injury was left untreated to determine the intrinsic healing response as a function of age. On the contralateral side, an enhanced suture repair incorporating a collagen-platelet composite was performed. Biomechanical properties of the repairs were measured after fifteen weeks of healing, and histologic analysis was performed. Results: Anterior cruciate ligaments from skeletally immature animals had significantly improved structural properties over those of adult animals at three months after transection in both the untreated and repair groups. Use of the enhanced suture technique provided the most improvement in the adolescent group, in which an increase of 85% in maximum load was noted with repair. The repair tissue in the adult tissue had the highest degree of hypercellularity at the fifteen-week time point. Conclusions: Functional ligament healing depends on the level of skeletal maturity of the animal, with immature animals having a more productive healing response than mature animals. Clinical Relevance: As future investigations assess new techniques of ligament healing in animal models, skeletal maturity should be considered in the design and the interpretation of those experiments. PMID:20810854

  6. Anterior Cruciate Ligament Injury: Return to Play, Function and Long-Term Considerations.

    Science.gov (United States)

    Sepúlveda, Fernando; Sánchez, Luis; Amy, Eduardo; Micheo, William

    Anterior cruciate ligament tears are common and affect young individuals who participate in jumping and pivoting sports. After injury many individuals undergo ligament reconstruction (ACLR) but do not return to play, suffer recurrent injury and osteoarthritis. Outcome studies show that after ACLR, 81% of individuals return to sports, 65% return to their preinjury level and 55% return to competitive sports. Systematic reviews place the risk of ipsilateral retears at 5.8% and contralateral injuries at 11.8%, with recent reports of over 20% failure rate. Approximately 20% to 50% of patients will have evidence of OA within 10 to 20 yr. Factors important in reducing complications include timing of surgery, individualized return to play protocols, and prevention programs for injury. Further understanding of the factors that increase return to play percentages, reduce the risk of recurrent injury and improve long-term outcomes after ACL injury is needed to reduce the burden of these injuries on society.

  7. Reduced step length reduces knee joint contact forces during running following anterior cruciate ligament reconstruction but does not alter inter-limb asymmetry.

    Science.gov (United States)

    Bowersock, Collin D; Willy, Richard W; DeVita, Paul; Willson, John D

    2017-03-01

    Anterior cruciate ligament reconstruction is associated with early onset knee osteoarthritis. Running is a typical activity following this surgery, but elevated knee joint contact forces are thought to contribute to osteoarthritis degenerative processes. It is therefore clinically relevant to identify interventions to reduce contact forces during running among individuals after anterior cruciate ligament reconstruction. The primary purpose of this study was to evaluate the effect of reducing step length during running on patellofemoral and tibiofemoral joint contact forces among people with a history of anterior cruciate ligament reconstruction. Inter limb knee joint contact force differences during running were also examined. 18 individuals at an average of 54.8months after unilateral anterior cruciate ligament reconstruction ran in 3 step length conditions (preferred, -5%, -10%). Bilateral patellofemoral, tibiofemoral, and medial tibiofemoral compartment peak force, loading rate, impulse, and impulse per kilometer were evaluated between step length conditions and limbs using separate 2 factor analyses of variance. Reducing step length 5% decreased patellofemoral, tibiofemoral, and medial tibiofemoral compartment peak force, impulse, and impulse per kilometer bilaterally. A 10% step length reduction further decreased peak forces and force impulses, but did not further reduce force impulses per kilometer. Tibiofemoral joint impulse, impulse per kilometer, and patellofemoral joint loading rate were lower in the previously injured limb compared to the contralateral limb. Running with a shorter step length is a feasible clinical intervention to reduce knee joint contact forces during running among people with a history of anterior cruciate ligament reconstruction. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. MR imaging of anterior cruciate ligament injury: associated findings

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    Han, Gi Seok; Kang, Heung Sik; Goo, Jin Mo; Kim, Chu Wan; Cho, Kyu Hyung; Seong, Sang Cheol [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1995-04-15

    Authors investigated the associated findings and their value in the diagnosis of anterior cruciate ligament (ACL) injury in MR image. The knee MR images of 47 patients with ACL injury (complete;24, partial;23) and 61 patients with normal ACL confirmed by the knee arthroscopy or operation were reviewed retrospectively. The degree of anterior translocation of tibia and the degree of posterior cruciate ligament (PCL) buckling were evaluated. The prevalence and pattern of associated adjacent bone, ligament and meniscus injuries were studied. The means({+-} 2 standard errors) of anterior translocation were different significantly in statistical analysis ({rho} < 0.001, student t-test) between injury group (7.51 {+-} 1.16 mm) and normal group (-0.56 {+-} 0.92mm). In the level of 5mm of anterior translocation for the criteria of ACL injury, the sensitivity, specificity, accuracy were 78.7%, 89.5%, 84.3% for each. The means of PCL buckling ratio were also different statistically between injury group(0.23 {+-} 0.02) and normal group(0.17 {+-} 0.01)({rho} < 0.001). In the level of 0.20 for diagnostic criteria of ACL injury, the sensitivity, specificity, accuracy were 71.4%, 83.6%, 78.4% for each. Thirty one medial meniscus tear (66%), thirteen lateral meniscus tear (28%), ten medial collateral ligament injury (28%), one PCL injury(2%) were associated with ACL injury. The twenty nine bone marrow changes were found in twenty patients (43%) which included acutely injured seven patients. In acute cases, the bone marrow changes were depicted as diffuse or focal high signal intensity lesions in lateral femoral or tibial condyles in contrast to the changes in chronic cases depicted as focal low signal intensity lesions in variable location. Lateral femoral condylar notch depression were found in nine patients (19%) and avulsion fractures of anterior tibial spine in four patients(9%). The associated findings with ACL injury (anterior translocation, buckling of PCL, associated bone

  9. Arthroscopy Up to Date: Anterior Cruciate Ligament Anatomy.

    Science.gov (United States)

    Schillhammer, Carl K; Reid, John B; Rister, Jamie; Jani, Sunil S; Marvil, Sean C; Chen, Austin W; Anderson, Chris G; D'Agostino, Sophia; Lubowitz, James H

    2016-01-01

    To categorize and summarize up-to-date anterior cruciate ligament (ACL) research published in Arthroscopy and The American Journal of Sports Medicine and systematically review each subcategory, beginning with ACL anatomy. After searching for "anterior cruciate ligament" OR "ACL" in Arthroscopy and The American Journal of Sports Medicine from January 2012 through December 2014, we excluded articles more pertinent to ACL augmentation; open growth plates; and meniscal, chondral, or multiligamentous pathology. Studies were subcategorized for data extraction. We included 212 studies that were classified into 8 categories: anatomy; basic science and biomechanics; tunnel position; graft selection; graft fixation; injury risk and rehabilitation; practice patterns and outcomes; and complications. Anatomic risk factors for ACL injury and post-reconstruction graft failure include a narrow intercondylar notch, low native ACL volume, and increased posterior slope. Regarding anatomic footprints, the femoral attachment is 43% of the proximal-to-distal lateral femoral condylar length whereas the posterior border of the tendon is 2.5 mm from the articular margin. The tibial attachment of the ACL is two-fifths of the medial-to-lateral interspinous distance and 15 mm anterior to the posterior cruciate ligament. Anatomic research using radiology and computed tomography to evaluate ACL graft placement shows poor interobserver and intraobserver reliability. With a mind to improving outcomes, surgeons should be aware of anatomic risk factors (stenotic femoral notch, low ligament volume, and increased posterior slope) for ACL graft failure, have a precise understanding of arthroscopic landmarks identifying femoral and tibial footprint locations, and understand that imaging to evaluate graft placement is unreliable. Level III, systematic review of Level III evidence. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  10. The remains of anterior cruciate ligament graft tension after cyclic knee motion

    NARCIS (Netherlands)

    Arnold, MR; Lie, DTT; Verdonschot, N; de Graaf, R; Amis, AA; van Kampen, A

    Background: There is sometimes a return of excess knee laxity after anterior cruciate ligament reconstruction. One of the contributing factors might be a loss in graft tension. It is unknown whether the tension imposed on an anterior cruciate ligament graft degrades with time and, if so, the effect

  11. The remains of anterior cruciate ligament graft tension after cyclic knee motion.

    NARCIS (Netherlands)

    Arnold, M.P.; Lie, D.T.; Verdonschot, N.J.J.; Graaf, R. de; Amis, A.A.; Kampen, A. van

    2005-01-01

    BACKGROUND: There is sometimes a return of excess knee laxity after anterior cruciate ligament reconstruction. One of the contributing factors might be a loss in graft tension. It is unknown whether the tension imposed on an anterior cruciate ligament graft degrades with time and, if so, the effect

  12. Editorial Commentary: A Positive "Half Dial Test" Is Seen in Anterior Cruciate Ligament Injury, so Get Out Your Goniometer.

    Science.gov (United States)

    Rossi, Michael J

    2017-07-01

    Isolated anterior cruciate ligament (ACL)-deficient knees have roughly 7° of increased external rotation at both 30° and 90° of flexion compared with both the contralateral knee and the ACL reconstructed knee. This positive "Half Dial test" may be a new approach to confirming ACL injury but requires confirmation that the posterolateral corner itself is not injured. In the ACL-deficient knee, it is suggested that a greater cutoff (>15°) for the true Dial test be used to confirm posterolateral corner injuries. Goniometer measurements are reproducible and necessary for confirmation. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  13. In vivo posterior cruciate ligament elongation in running activity after anatomic and non-anatomic anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Tang, Jing; Thorhauer, Eric; Bowman, Karl; Fu, Freddie H; Tashman, Scott

    2017-04-01

    The goals of this study were to (1) investigate the in vivo elongation behaviour of the posterior cruciate ligament (PCL) during running in the uninjured knee and (2) evaluate changes in PCL elongation during running after anatomic or non-anatomic anterior cruciate ligament (ACL) reconstruction. Seventeen unilateral ACL-injured subjects were recruited after undergoing anatomic (n = 9) or non-anatomic (n = 8) ACL reconstruction. Bilateral high-resolution CT scans were obtained to produce 3D models. Anterolateral (AL) and posteromedial (PM) bundles insertion sites of the PCL were identified on the 3D CT scan reconstructions. Dynamic knee function was assessed during running using a dynamic stereo X-ray (DSX) system. The lengths of the AL and PM bundles were estimated from late swing through mid-stance. The contralateral knees served as normal controls. Control knees demonstrated a slight decrease in AL bundle and a significant decrease in PM bundle length following foot strike. Length and elongation patterns of the both bundles of the PCL in the anatomic ACL reconstruction group were similar to the controls. However, the change in dynamic PCL length was significantly greater in the non-anatomic group than in the anatomic reconstruction group after foot strike (p < 0.05). The AL bundle length decreased slightly, and the PM bundle length significantly decreased after foot strike during running in uninjured knees. Anatomic ACL reconstruction maintained normal PCL elongation patterns more effectively than non-anatomic ACL reconstruction during high-demand, functional loading. These results support the use of anatomic ACL reconstruction to achieve normal knee function in high-demand activities. Case-control study, Level III.

  14. Anterior Cruciate Ligament Reconstruction in Ehlers-Danlos Syndrome

    Directory of Open Access Journals (Sweden)

    John Williams

    2015-01-01

    Full Text Available This report details the reconstruction of the anterior cruciate ligament in an 18-year-old man with Ehlers-Danlos syndrome (EDS. The reduced mechanical properties of the tissue in EDS can pose a challenge to the orthopaedic surgeon. In this case, we describe the use of a hamstring autograft combined with a Ligament Advanced Reinforcement System (LARS. There was a good radiographical, clinical, and functional outcome after two years. This technique gave a successful outcome in the reconstruction of the ACL in a patient with EDS and therefore may help surgeons faced with the same clinical scenario.

  15. A perioperative rehabilitation program for anterior cruciate ligament surgery.

    Science.gov (United States)

    Arnold, T; Shelbourne, K D

    2000-01-01

    Rehabilitation programs have progressed alongside surgical advances in anterior cruciate ligament reconstruction. A perioperative program has been successfully used at our clinic for more than 10 years to reduce postoperative complications and return patients to activity safely and quickly. The four-phase program starts at the time of injury and preoperatively includes aggressive swelling reduction, hyperextension exercises, gait training, and mental preparation. Goals after surgery are to control swelling while regaining full knee range of motion. After quadriceps strengthening goals are reached, patients can shift to sport-specific exercises.

  16. Anatomical reconstruction of the anterior cruciate ligament: a logical approach

    Directory of Open Access Journals (Sweden)

    Julio Cesar Gali

    2015-08-01

    Full Text Available ABSTRACT We describe the surgical approach that we have used over the last years for anterior cruciate ligament (ACL reconstruction, highlighting the importance of arthroscopic viewing through the anteromedial portal (AMP and femoral tunnel drilling through an accessory anteromedial portal (AMP. The AMP allows direct view of the ACL femoral insertion site on the medial aspect of the lateral femoral condyle, does not require guides for anatomic femoral tunnel reaming, prevents an additional lateral incision in the distal third of the thigh (as would be unavoidable when the outside-intechnique is used and also can be used for double-bundle ACL reconstruction.

  17. Osseous femoral avulsion of the anterior cruciate ligament origin in an adult

    Directory of Open Access Journals (Sweden)

    Samir H. Shah, MD

    2015-01-01

    Full Text Available Injuries of the anterior cruciate ligament are commonly encountered in clinical practice, and occur in a wide variety of settings, from sports-related injuries to polytrauma. Tears of the anterior cruciate ligament supersede osseous avulsion in the adult demographic; however, in the pediatric population, osseous avulsion reflects the most frequent injury. When osseous avulsion of the anterior cruciate ligament occurs in children or adults, the injury typically occurs at the level of the tibial eminence. Conversely, osseous avulsion injuries from the femur are rare, with all cases reported in the literature occurring in the skeletally immature. We report a case of a 47-year-old woman who suffered an osseous avulsion of her anterior cruciate ligament from her lateral femoral condyle. To our knowledge, this reflects the first reported case of femoral osseous avulsion of the anterior cruciate ligament origin in an adult.

  18. Fracture of the patella after the anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Milankov, Miroslav; Rasović, Predrag; Kovacev, Nemanja; Milović, Milan; Bojat, Veselin

    2012-01-01

    Fracture of the patella, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, is a rare complication. We made 1714 reconstructions of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and 7 patients had fracture of the patella (0.42%). The fracture was immediately recognized in the patients with vertical non-displaced patellar fracture and the broken screw osteosynthesis was carried out without changes in the rehabilitation period. One patient was treated non-operatively and patellar fracture in four patients was treated with operative reduction and osteosynthesis. The patients were invited for the check-up 5 years (2-8 years) after surgery on average. The mean Lysholm score was 92 (85-100). All of them continued to engage in sporting activities at the same or greater level after 9 months on average (6-12 months). In all patients the Lachman test was with the firm stop compared to the other leg. X-ray changes in the patella were found in 2 patients who had multifragmentary fractures. The fracture of patella can be prevented by avoiding to take too much bone graft, by using the most precise tools for cutting, while rehabilitation must be carefully planned. The optimal treatment of the fracture of the patella after the reconstruction of the anterior cruciate ligament is a firm osteosynthesis, which allows healing of the bone and continuation of the rehabilitation program.

  19. Magnetic resonance imaging of anterior cruciate ligament rupture

    Directory of Open Access Journals (Sweden)

    Chiang Hongsen

    2004-07-01

    Full Text Available Abstract Background Magnetic resonance (MR imaging is a useful diagnostic tool for the assessment of knee joint injury. Anterior cruciate ligament repair is a commonly performed orthopaedic procedure. This paper examines the concordance between MR imaging and arthroscopic findings. Methods Between February, 1996 and February, 1998, 48 patients who underwent magnetic resonance (MR imaging of the knee were reported to have complete tears of the anterior cruciate ligament (ACL. Of the 48 patients, 36 were male, and 12 female. The average age was 27 years (range: 15 to 45. Operative reconstruction using a patellar bone-tendon-bone autograft was arranged for each patient, and an arthroscopic examination was performed to confirm the diagnosis immediately prior to reconstructive surgery. Results In 16 of the 48 patients, reconstructive surgery was cancelled when incomplete lesions were noted during arthroscopy, making reconstructive surgery unnecessary. The remaining 32 patients were found to have complete tears of the ACL, and therefore underwent reconstructive surgery. Using arthroscopy as an independent, reliable reference standard for ACL tear diagnosis, the reliability of MR imaging was evaluated. The true positive rate for complete ACL tear diagnosis with MR imaging was 67%, making the possibility of a false-positive report of "complete ACL tear" inevitable with MR imaging. Conclusions Since conservative treatment is sufficient for incomplete ACL tears, the decision to undertake ACL reconstruction should not be based on MR findings alone.

  20. Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS): Longitudinal MRI-based whole joint assessment of anterior cruciate ligament injury.

    Science.gov (United States)

    Roemer, Frank W; Frobell, Richard; Lohmander, L Stefan; Niu, Jingbo; Guermazi, Ali

    2014-05-01

    To develop a whole joint scoring system, the Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS), for magnetic resonance imaging (MRI)-based assessment of acute anterior cruciate ligament (ACL) injury and follow-up of structural sequelae, and to assess its reliability. Baseline and follow-up 1.5 T MRI examinations from 20 patients of the KANON study, a randomized controlled study comparing a surgical and non-surgical treatment strategy, were assessed for up to six longitudinal visits using a novel MRI scoring system incorporating acute structural tissue damage and longitudinal changes including osteoarthritis (OA) features. Joint features assessed were acute osteochondral injury, traumatic and degenerative bone marrow lesions (BMLs), meniscus morphology and extrusion, osteophytes, collateral and cruciate ligaments including ACL graft, Hoffa-synovitis and effusion-synovitis. Cross-sectional (baseline) and longitudinal (all time points and change) intra- and inter-observer reliability was calculated using weighted (w) kappa statistics and overall percent agreement on a compartmental basis (medial tibio-femoral, lateral tibio-femoral, patello-femoral). Altogether 87 time points were evaluated. Intra-observer reliability ranged between 0.52 (baseline, Hoffa-synovitis) and 1.00 (several features), percent agreement between 52% (all time points, Hoffa-synovitis) and 100% (several features). Inter-observer reliability ranged between 0.00 and 1.00, which is explained by low frequency of some of the features. Altogether, 73% of all assessed 142 parameters showed w-kappa values between 0.80 and 1.00 and 92% showed agreement above 80%. ACLOAS allows reliable scoring of acute ACL injury and longitudinal changes. This novel scoring system incorporates features that may be relevant for structural outcome not covered by established OA scoring instruments. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  1. Histological analysis of the tibial anterior cruciate ligament insertion.

    Science.gov (United States)

    Oka, Shinya; Schuhmacher, Peter; Brehmer, Axel; Traut, Ulrike; Kirsch, Joachim; Siebold, Rainer

    2016-03-01

    This study was performed to investigate the morphology of the tibial anterior cruciate ligament (ACL) by histological assessment. The native (undissected) tibial ACL insertion of six fresh-frozen cadaveric knees was cut into four sagittal sections parallel to the long axis of the medial tibial spine. For histological evaluation, the slices were stained with haematoxylin and eosin, Safranin O and Russell-Movat pentachrome. All slices were digitalized and analysed at a magnification of 20×. The anterior tibial ACL insertion was bordered by a bony anterior ridge. The most medial ACL fibres inserted from the medial tibial spine and were adjacent to the articular cartilage of the medial tibial plateau. Parts of the bony insertions of the anterior and posterior horns of the lateral meniscus were in close contact with the lateral part of the tibial ACL insertion. A small fat pad was located just posterior to the functional ACL fibres. The anterior-posterior length of the medial ACL insertion was an average of 10.8 ± 1.1 mm compared with the lateral, which was only 6.2 ± 1.1 mm (p foot-like'. In contrast to previous findings, the functional mid-substance fibres arose from the most posterior part of the 'duck-foot' in a flat and 'c-shaped' way. The most anterior part of the tibial ACL insertion was bordered by a bony anterior ridge and the most medial by the medial tibial spine. No posterolateral fibres nor ACL bundles have been found histologically. This histological investigation may improve our understanding of the tibial ACL insertion and may provide important information for anatomical ACL reconstruction.

  2. Proprioceptive deficit in patients with complete tearing of the anterior cruciate ligament

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    Pedro Godinho

    2014-12-01

    Full Text Available Objective:To investigate the existence of proprioceptive deficits between the injured limb and the uninjured (i.e. contralateral normal limb, in individuals who suffered complete tearing of the anterior cruciate ligament (ACL, using a strength reproduction test.Methods:Sixteen patients with complete tearing of the ACL participated in the study. A voluntary maximum isometric strength test was performed, with reproduction of the muscle strength in the limb with complete tearing of the ACL and the healthy contralateral limb, with the knee flexed at 60°. The meta-intensity was used for the procedure of 20% of the voluntary maximum isometric strength. The proprioceptive performance was determined by means of absolute error, variable error and constant error values.Results:Significant differences were found between the control group and ACL group for the variables of absolute error (p = 0.05 and constant error (p = 0.01. No difference was found in relation to variable error (p = 0.83.Conclusion:Our data corroborate the hypothesis that there is a proprioceptive deficit in subjects with complete tearing of the ACL in an injured limb, in comparison with the uninjured limb, during evaluation of the sense of strength. This deficit can be explained in terms of partial or total loss of the mechanoreceptors of the ACL.

  3. Effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction

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    Shim, Jae-Kwang; Choi, Ho-Suk; Shin, Jun-Ho

    2015-01-01

    [Purpose] This study examined the effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction. [Subjects and Methods] The subjects were 16 adults who underwent arthroscopic anterior cruciate reconstruction and neuromuscular training. The Lysholm scale was used to assess functional disorders on the affected knee joint. A KT-2000 arthrometer was used to measure anterior displacement of the tibia against the femur. Surface electromyography was used t...

  4. VARIATION IN THE FEMORAL ATTACHMENT AND ANATOMY OF ANTERIOR CRUCIATE LIGAMENT OF KNEE : A CASE REPORT

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    Sesi

    2015-03-01

    Full Text Available Anterior cruciate ligament is the main restraint of anterior tibial movement over femoral condyles in the knee joint. It is functionally a double bundle structure with a twisted single bundle anatomy . A natomical variation in the anatomy of acl are rare and usually confer with the biomechanical double bundle model. We present an anatomical variation in the femoral attachment and anatomy of anterior cruciate ligament of knee

  5. Biomechanics of the porcine triple bundle anterior cruciate ligament.

    Science.gov (United States)

    Kato, Yuki; Ingham, Sheila J M; Linde-Rosen, Monica; Smolinski, Patrick; Horaguchi, Takashi; Fu, Freddie H

    2010-01-01

    Several species of animals are used as a model to study human anterior cruciate ligament (ACL) reconstruction. In many animals, three bundles were clearly discernible during dissection in the ACL. However, there are few reports about the biomechanical role of each bundle in the porcine knee. The purpose of this study is to investigate the role of each of the three bundles in the porcine knee, especially the intermediate bundle. Ten porcine knees were tested using a robotic/universal forcemoment sensor system. This system applied anterior loading of 89 N at 30 degrees, 60 degrees and 90 degrees of flexion, and a combined 7 Nm valgus and 4 Nm internal tibial torque at 30 degrees and 60 degrees of flexion before and after each bundle was selectively cut. The in situ force (N) for each bundle of the ACL was measured. Both intermediate (IM) bundle and postero-lateral (PL) bundle had significantly lower in situ force than the antero-medial (AM) bundle in anterior loading. The IM and PL bundles carried a larger proportion of the force under the torsional loads than the anterior loads. But IM bundle had a significant lower in situ force during the combined torque at 60 degrees of knee flexion, when compared intact ACL. In summary, IM bundle has a subordinate role to the AM and PL bundles. AM bundle is more dominant than IM and PL bundles. The porcine knee is a suitable model for ACL studies, especially for AP stability.

  6. Single bundle anterior cruciate reconstruction does not restore normal knee kinematics at six months: an upright MRI study.

    Science.gov (United States)

    Nicholson, J A; Sutherland, A G; Smith, F W

    2011-10-01

    Abnormal knee kinematics following reconstruction of the anterior cruciate ligament may exist despite an apparent resolution of tibial laxity and functional benefit. We performed upright, weight-bearing MR scans of both knees in the sagittal plane at different angles of flexion to determine the kinematics of the knee following unilateral reconstruction (n = 12). The uninjured knee acted as a control. Scans were performed pre-operatively and at three and six months post-operatively. Anteroposterior tibial laxity was determined using an arthrometer and patient function by validated questionnaires before and after reconstruction. In all the knees with deficient anterior cruciate ligaments, the tibial plateau was displaced anteriorly and internally rotated relative to the femur when compared with the control contralateral knee, particularly in extension and early flexion (mean lateral compartment displacement: extension 7.9 mm (sd 4.8), p = 0.002 and 30° flexion 5.1 mm (sd 3.6), p = 0.004). In all ten patients underwent post-operative scans. Reconstruction reduced the subluxation of the lateral tibial plateau at three months, with resolution of anterior displacement in early flexion, but not in extension (p = 0.015). At six months, the reconstructed knee again showed anterior subluxation in both the lateral (mean: extension 4.2 mm (sd 4.2), p = 0.021 and 30° flexion 3.2 mm (sd 3.3), p = 0.024) and medial compartments (extension, p = 0.049). Our results show that despite improvement in laxity and functional benefit, abnormal knee kinematics remain at six months and actually deteriorate from three to six months following reconstruction of the anterior cruciate ligament.

  7. Non-traumatic Thickening of the Anterior Cruciate Ligament

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    Oh, Hyun Jun; Park, Jin Gyoon; Song, Sang Gook [Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2009-08-15

    To describe the magnetic resonance (MR) imaging findings of non-traumatic thickening of the anterior cruciate ligament (ACL) and to evaluate the associated lesions. Between January 2003 and August 2005, 44 knees of 44 patients who had thickened ACLs on MR images and had no history of knee trauma were analyzed retrospectively. The normal thickness of the ACL was measured on axial T2-weighted images of 40 healthy adult knees. The MR imaging findings of the thickened ACLs and associated lesions were analyzed. In 40 cases of healthy knees, the thickness of the proximal ACL was 3-6 mm. In 44 cases of non-traumatic thickening of the ACL, the thickness of the proximal ACL was 8-14 mm. There was an increased signal intensity and ill-defined border in all cases of thickened ACLs, linear low-signal intensity fibers parallel to the long axis of the thickened ACL (celery stalk appearance) in 24 cases, and entrapment in 10 cases. With respect to associated lesions, there was osteoarthritis in 40 cases, meniscal tears in 42 cases, and degeneration of the posterior cruciate ligament in 7 cases. Non-traumatic thickening of the ACL was associated with osteoarthritis and meniscal tears in almost all cases and showed increased signal intensity and ill-defined borders simulating acute ligamentous tears

  8. Healing Potential of the Anterior Cruciate Ligament Remnant Stump.

    Science.gov (United States)

    Trocan, Ilie; Ceausu, Raluca A; Jitariu, Andreea A; Haragus, Horia; Damian, Gratian; Raica, Marius

    2016-01-01

    The aim of this study was to analyze the microstructural architecture and cellular differentiation of the anterior cruciate ligament (ACL) stumps in different stages after injury, as this could augment graft biointegration. The histological appearance and immunoreaction for cluster of differentiation 34 antigen (CD34) of 54 biopsies from 27 remnants were compared to 10 biopsies from 5 normal cruciate ligaments. CD34 reaction in endothelial cells, fibroblasts and fibrocytes was consistently positive in small synovial vessels. Remnants also exhibited CD34(+) cells among collagen fibers. Blood vessel density varied between specimens. The mean vascular microdensity was 43 per ×200 field in remnants compared to 15.2 in controls. A total of 94.44% of remnant ACL samples had significant hyperplasia of stellate and fusiform stromal cells, CD34(+); 22.4% had developed capillary vessels inside the ligament; 33% exhibited ongoing angiogenesis. Significant differences exist between torn and intact ACL regarding microvascularization. The remnants contain stellate stromal cells and CD34(+) fibrocytes, and display angiogenesis both at synovia as well as in the ligament itself. These findings underline the potential contribution to neoligament healing when remnants are preserved. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  9. Physical properties of rabbit articular cartilage after transection of the anterior cruciate ligament.

    Science.gov (United States)

    Sah, R L; Yang, A S; Chen, A C; Hant, J J; Halili, R B; Yoshioka, M; Amiel, D; Coutts, R D

    1997-03-01

    The effect of unilateral transection of the anterior cruciate ligament on the confined compression and swelling properties of the distal femoral articular cartilage of skeletally mature rabbits at 9 weeks after surgery was determined. Gross morphological grading of the transected and contralateral control distal femora stained with India ink confirmed that cartilage degeneration had been induced by ligament transection. Osteochondral cores, 1.8 mm in diameter, were harvested from the medial femoral condyles. The modulus, permeability, and electrokinetic (streaming potential) coefficient of the articular cartilage of the osteochondral cores were assessed by confined compression creep experiments. The properties (mean +/- SD) of control cartilage were: confined compression modulus, 0.75 +/- 0.28 MPa; hydraulic permeability, 0.63 +/- 0.28 x 10(-15) m2/Pa*sec; and electrokinetic coefficient, 0.16 +/- 0.31 x 10(-9) V/Pa. In transected knees, the modulus was reduced by 18% (p = 0.04), while the permeability and electrokinetic coefficient were not detectably altered. The change in modulus was accompanied by a trend (p = 0.07) toward a decrease (-11%) in the glycosaminoglycan density within the tissue, a significant increase (p < 0.001) in the water content of the cartilage after equilibration in 1 x phosphate buffered saline from 70.3 +/- 4.1% in control knees to 75.2 +/- 4.0% in transected knees, and little further swelling after tissue equilibration in hypotonic saline. The compressive modulus of the cartilage from both control and transected knees was positively correlated with the density of tissue glycosaminoglycan. The alterations in the physical properties of the articular cartilage after transection of the anterior cruciate ligament in the rabbit show trends similar to those observed in human and other animal models of osteoarthritis and provide further support for the use of this model in the study of cartilage degeneration.

  10. Transient superficial peroneal nerve palsy after anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Majed Alrowaili

    2016-06-01

    Full Text Available A 19-year-old male subject was diagnosed with medial meniscal, lateral meniscal and anterior cruciate ligament (ACL tear. The symptoms did not subside after 4 months of physical therapy, and he underwent arthroscopic partial medial and lateral meniscectomy and ACL reconstruction. Immediately after the patient woke up from general anesthesia, he started experience loss of sensation in the area of superficial peroneal nerve with inverted dorsiflexion of foot and ankle. Instantly, the bandage and knee brace was removed and a diagnosis of compartment syndrome was ruled out. After eight hours, post-operatively, the patient started receiving physiotherapy. He complained of numbness and tingling in the same area. After 24 h, post-operatively, the patient started to regain dorsiflexion and eversion gradually. Two days after the surgery, the patient exhibited complete recovery of neurological status.

  11. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies.

    Science.gov (United States)

    Griffin, L Y; Agel, J; Albohm, M J; Arendt, E A; Dick, R W; Garrett, W E; Garrick, J G; Hewett, T E; Huston, L; Ireland, M L; Johnson, R J; Kibler, W B; Lephart, S; Lewis, J L; Lindenfeld, T N; Mandelbaum, B R; Marchak, P; Teitz, C C; Wojtys, E M

    2000-01-01

    An estimated 80,000 anterior cruciate ligament (ACL) tears occur annually in the United States. The highest incidence is in individuals 15 to 25 years old who participate in pivoting sports. With an estimated cost for these injuries of almost a billion dollars per year, the ability to identify risk factors and develop prevention strategies has widespread health and fiscal importance. Seventy percent of ACL injuries occur in noncontact situations. The risk factors for non-contact ACL injuries fall into four distinct categories: environmental, anatomic, hormonal, and biomechanical. Early data on existing neuromuscular training programs suggest that enhancing body control may decrease ACL injuries in women. Further investigation is needed prior to instituting prevention programs related to the other risk factors.

  12. Anterior cruciate ligament injuries in the female athlete.

    Science.gov (United States)

    Toth, A P; Cordasco, F A

    2001-01-01

    With the participation of women in athletics growing rapidly over the last two decades, a disturbing gender-specific pre-disposition has emerged regarding anterior cruciate ligament (ACL) injuries of the knee. Female athletes have a two- to eightfold higher incidence of ACL injury than their male counterparts. It is estimated that 38,000 women sustain ACL tears per year. The majority of ACL injuries in female athletes occur through noncontact mechanisms, most often during deceleration activities, such as landing from a jump or cutting. The risk factors for noncontact ACL injuries can be categorized as intrinsic (anatomic and hormonal) and extrinsic (environmental and biomechanical). This article will discuss these risk factors that are thought to contribute to the higher incidence of ACL injuries in women, the development of prevention strategies, and the outcomes of ACL reconstruction in women.

  13. Anterior cruciate ligament injury/reinjury in alpine ski racing

    DEFF Research Database (Denmark)

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

    2017-01-01

    The purpose of the present review was to: 1) provide an overview of the current understanding on the epidemiology, etiology, risk factors, and prevention methods for anterior cruciate ligament (ACL) injury in alpine ski racing; and 2) provide an overview of what is known pertaining to ACL reinjury...... and return to sport after ACL injury in alpine ski racing. Given that most of the scientific studies on ACL injuries in alpine ski racing have been descriptive, and that very few studies contributed higher level scientific evidence, a nonsystematic narrative review was employed. Three scholarly databases...... were searched for articles on ACL injury or knee injury in alpine ski racing. Studies were classified according to their relevance in relation to epidemiology, etiology, risk factors, and return to sport/reinjury prevention. Alpine ski racers (skiers) were found to be at high risk for knee injuries...

  14. Anterior cruciate ligament tear prevention in the female athlete.

    Science.gov (United States)

    Silvers, Holly J; Giza, Eric R; Mandelbaum, Bert R

    2005-12-01

    This paper examines the effectiveness of implementing neuromuscular and proprioceptive training programs in female athletes and their ability to decrease the incidence of anterior cruciate ligament (ACL) injury. The relationship of sex, age, and training on the incidence of ACL injury is pivotal in developing a comprehensive neuromuscular and proprioceptive training program to decrease ACL injuries occurring in female athletes. Based on the 2-year results, ACL incidence has remained consistently lower in the intervention group versus the control group. A prophylactic neuromuscular and proprioceptive training program may have a direct benefit in decreasing the number of ACL injuries incurred by female athletes. This research foundation endorses further epidemiologic and biomechanic studies to determine the exact mechanism of ACL injury and the most effective intervention that will effectively decrease ACL injuries in this high-risk population.

  15. Primary Anterior Cruciate Ligament Reconstruction. How Do We Do It?

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    Todor Adrian

    2016-11-01

    Full Text Available Anterior cruciate ligament (ACL tears are frequently seen in current practice mostly affecting the young, active subjects, and usually require ligament reconstruction in order to restore normal knee kinematics. As worldwide interest in anatomic reconstruction grew over the last decade, we have also refined our technique in order to restore the anatomical function as near to the normal as possible. This anatomical restoration concept is believed to prevent the onset of osteoarthritis, which the non-anatomic reconstructions fail to attain. The knowledge gained from the ACL anatomy, function and kinematics has helped in developing the current anatomic methods of reconstruction, which take into account patient anatomy, the rupture pattern, as well as the comorbidities. We present our approach to anatomical single- and double-bundle ACL reconstruction.

  16. A Brief History of Anterior Cruciate Ligament Reconstruction

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    Nikolaos Davarinos

    2014-01-01

    Full Text Available Reconstructions of the anterior cruciate ligament (ACL are among the most frequently performed procedures in knee surgery nowadays. The history of ACL surgery can be traced as far back as the Egyptian times. The early years reflect the efforts to establish a viable, consistently successful reconstruction technique while, during the early 20th century, we witness an increasing awareness of, and interest in, the ligament and its lesions. Finally, we highlight the most important steps in the evolution of the ACL reconstruction surgery by discussing the various techniques spanning the years using not only autologous grafts (fascia lata, meniscal, hamstring, patella tendon, bone-patella tendon-bone, and double bundle grafts but also synthetic ones and allografts.

  17. Anterior cruciate ligament assessment using arthrometry and stress imaging.

    Science.gov (United States)

    Rohman, Eric M; Macalena, Jeffrey A

    2016-06-01

    Arthrometry and stress imaging are useful clinical tools for the objective assessment of anterior cruciate ligament (ACL) integrity. They are most frequently used for the diagnosis of a complete ACL tear when other workup is equivocal, in conjunction with history and clinical exam findings. Other applications include the diagnosis of partial ACL tears, injury prognosis, and post-operative monitoring. However, further studies are needed to validate these uses. Many different devices and techniques exist for objective examination, which have been compared in recent literature. Reliability and validity measures of these methods vary, and often depend upon examiner familiarity and skill. The KT series of devices is the current gold standard for arthrometry, although the newer robotic GNRB device shows promising early results. Newer methods of data interpretation have been developed for stress imaging, and portable technology may impact this field further.

  18. LOWER EXTREMITY MALALIGNMENTS AND ANTERIOR CRUCIATE LIGAMENT INJURY HISTORY

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    Rebecca A. Braham

    2004-12-01

    Full Text Available To identify if lower extremity malalignments were associated with increased propensity of a history of anterior cruciate ligament (ACL ruptures in males and females using a case control design. Twenty subjects (10 males, 10 females had a history of ACL injury and twenty (10 males, 10 females had no history of ACL injury. Subjects were assessed for navicular drop, quadriceps angle, pelvic tilt, hip internal and external rotation range of motion, and true and apparent leg length discrepancies. Statistical analysis was performed to identify differences in these measures in regard to injury history and gender, and to identify if any of these measures were predictive of ACL injury history. Increased navicular drop and anterior pelvic tilt were found to be statistically significant predictors of ACL injury history regardless of gender. Limbs that had previously suffered ACL ruptures were found to have increased navicular drop and anterior pelvic tilt compared to uninjured limbs. Based on the results of this retrospective study, the lower extremity malalignments examined do not appear to predispose females to tearing their ACLs more than males.

  19. Anterior Cruciate Ligament Strain In Vivo: A Systematic Review.

    Science.gov (United States)

    Luque-Seron, Juan Antonio; Medina-Porqueres, Ivan

    2016-09-01

    Distinct exercises have been proposed for knee rehabilitation after anterior cruciate ligament (ACL) reconstruction. There is a need to understand ACL strain behavior during different rehabilitation exercises to protect the graft from excessive strain that could interfere with its healing process. To critically review studies that directly measured normal ACL strain in vivo during different movements, conditions, or exercises to gain insight into which of them may produce more strain on the ligament or the ligament graft in the case of reconstructed knees. A literature search of PubMed, CINAHL, SPORTDiscus, and PEDro databases was conducted. Keywords included anterior cruciate ligament, strain, stress, deformation, transducer, rehabilitation, rehabilitation exercise, physical therapy, and physiotherapy. Inclusion criteria were (1) peer-reviewed studies published in English or Spanish, (2) research conducted on adult human subjects with normal ACLs and healthy knees, and (3) ACL strain directly measured during different movements, conditions, or exercises by using a transducer. Systematic review. Level 4. Specific data were abstracted from the selected studies, including isometric quadriceps and hamstrings activity, active and passive flexion-extension of the knee, closed kinetic chain exercises, and application of joint compressive load. A total of 10 studies met all criteria and were included in the final analysis. The strain values produced by closed kinetic chain and open kinetic chain exercises were similar. However, closed kinetic chain exercises appear to attenuate the strain increase that occurs in open kinetic chain exercises when increasing resistance. These data may be relevant to develop rehabilitation exercises or programs that do not endanger the healing ACL graft and to provide a basis for future clinical trials. © 2016 The Author(s).

  20. Effectiveness of anterior cruciate ligament injury prevention training programs.

    Science.gov (United States)

    Sadoghi, Patrick; von Keudell, Arvind; Vavken, Patrick

    2012-05-02

    The objective of this study was to systematically review the literature on anterior cruciate ligament (ACL) injury prevention programs and to perform a meta-analysis to address three questions: First, what is the effectiveness of ACL injury prevention programs? Second, is there evidence for a "best" program? Third, what is the quality of the current literature on ACL injury prevention? We conducted a systematic review with use of the online PubMed, MEDLINE, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health), and Cochrane Central Register of Controlled Trials databases. Search terms were anterior cruciate ligament, knee, injury, prevention, and control. Data on study design and clinical outcomes were extracted independently in triplicate. After assessment of between-study heterogeneity, DerSimonian-Laird random-effect models were used to calculate pooled risk ratios and risk differences. The risk difference was used to estimate the number needed to treat (the number of individuals who would need to be treated to avoid one ACL tear). The pooled risk ratio was 0.38 (95% confidence interval [CI], 0.20 to 0.72), reflecting a significant reduction in the risk of ACL rupture in the prevention group (p = 0.003). The number needed to treat ranged from five to 187 in the individual studies. Stratified by sex, the pooled risk ratio was 0.48 (95% CI, 0.26 to 0.89) for female athletes and 0.15 (95% CI, 0.08 to 0.28) for male athletes. Our study indicated strong evidence in support of a significant effect of ACL injury prevention programs. Our pooled estimates suggest a substantial beneficial effect of ACL injury prevention programs, with a risk reduction of 52% in the female athletes and 85% in the male athletes.

  1. Anterior cruciate ligament injury and reconstruction among university students.

    Science.gov (United States)

    Freedman, K B; Glasgow, M T; Glasgow, S G; Bernstein, J

    1998-11-01

    The consequences of athletic injuries extend beyond the musculoskeletal system. Depression, anger, and tension have been observed in athletes with athletic injuries. It was hypothesized that among student athletes, the psychologic impact of injury may be seen as a drop in academic performance. Thirty-eight students who had an anterior cruciate ligament injury and subsequent reconstruction were evaluated retrospectively by academic transcript and questionnaire to measure their academic performance before their injury, in the semester of their injury, and in the semester after their surgery. The patients were compared with randomly selected undergraduate control subjects. To evaluate any effect of the timing of the surgery on academic performance, the patients were separated into two groups, according to the timing of their reconstruction: those who had surgery during the academic semester, and those who elected to wait for a school break. There was a significant drop in grade point average of 0.3 grade points during the semester of injury among all injured students. Compared with those who had surgery during a break, the students who had surgery during the semester received more frequently the grade of failure (6% versus 0%) or incomplete (33% versus 9%). These students also missed more school days (10.5 days versus 1.5 days) and examinations (2.2 examinations versus 0.1 examinations). Only 47% of students who had surgery during the semester were satisfied with their decision for surgical timing, compared with 96% satisfied with the timing during an academic break. Acute anterior cruciate ligament rupture, and surgical reconstruction during an academic semester, have a significant academic effect in university students.

  2. Clinical diagnosis of an anterior cruciate ligament rupture: A meta-analysis

    NARCIS (Netherlands)

    Benjammse, A.; Gokeler, A.; Van der Schans, C.P.

    2006-01-01

    Study Design: Meta-analysis. Objectives: To define the accuracy of clinical tests for assessing anterior cruciate ligament (ACL) ruptures. Background: The cruciate ligaments, and especially the ACL, are among the most commonly injured structures of the knee. Given the increasing injury prevalence,

  3. Clinical diagnosis of an anterior cruciate ligament rupture : A meta-analysis

    NARCIS (Netherlands)

    Benjammse, A; Gokeler, A; van der Schans, CP

    Study Design: Meta-analysis. Objectives: To define the accuracy of clinical tests for assessing anterior cruciate ligament (ACL) ruptures. Background: The cruciate ligaments, and especially the ACL, are among the most commonly injured structures of the knee. Given the increasing injury prevalence,

  4. A study of isokinetic strength and laxity with and without anterior cruciate ligament injury.

    Science.gov (United States)

    Kim, Kewwan; Jeon, Kyoungkyu; Mullineaux, David R; Cho, Eunok

    2016-12-01

    [Purpose] The purpose of this study was to provide useful information for future treatments and to organize rehabilitation programs for anterior cruciate ligament injury by assessing isokinetic muscle strength and laxity of knee joints in athletes with anterior cruciate ligament injuries. [Subjects and Methods] Thirty-one high school athletes with anterior cruciate ligament injuries participated in this study. Isokinetic muscle strength at 60°/sec and anterior cruciate ligament laxity for non-involved and involved sides, classified on the basis of the severity of anterior cruciate ligament injury, were assessed. [Results] A comparison of isokinetic muscle strength measured from the non-involved and involved sides showed a significant difference in the maximum strength and knee flexor muscle strength. For laxity, a significant difference was observed in the anterior drawer test results obtained with a force of 88 N. [Conclusion] In conclusion, this study has shown that the assessment of isokinetic muscle strength and ligament laxity from athletes with anterior cruciate ligament injury should be utilized to provide baseline data for prevention and prediction of injury.

  5. Meniscus Injuries Alter the Kinematics of Knees With Anterior Cruciate Ligament Deficiency.

    Science.gov (United States)

    Hosseini, Ali; Li, Jing-Sheng; Gill, Thomas J; Li, Guoan

    2014-08-01

    Most knee joint biomechanics studies have involved knees with an isolated anterior cruciate ligament (ACL) injury. However, a large portion of patients with injured ACLs have accompanied meniscus tearing. In this study, the in vivo alteration of knee biomechanics after tearing the ACL with or without combined medial or lateral meniscus tear was investigated during stair-ascending activity. The kinematic behavior of ACL-deficient knees changes with a combined medial or lateral meniscus tear. Controlled laboratory study. Twenty-one patients with injured ACLs (contralateral side intact) were recruited before undergoing ACL reconstruction. Among these patients, 5 had isolated ACL injuries (group I), 8 had combined ACL and medial meniscus injuries (group II), and 8 had combined ACL and lateral meniscus injuries (group III). Bilateral magnetic resonance scans were obtained on each patient to construct 3-dimensional anatomic knee models. Both knees were then scanned during stair-climbing activity using a dual fluoroscopic imaging system. The knee kinematics during stair climbing were reproduced using a bone model image matching method. Anteroposterior and mediolateral translations and axial tibial rotation of the knee during stair ascent were then compared between the injured and intact contralateral knees of the patients. On average, injured knees in groups I and III showed more than 2 mm increased anterior tibial translation close to full knee extension. In group II, no statistically significant difference was observed between the injured and contralateral side in anteroposterior translation. Near full extension, in groups I and III, injured knees had less than 1 mm of increased medial tibial translation compared with the contralateral side, whereas in group II, a 1.0-mm increase in lateral tibial shift was observed in the injured knees. With regard to axial tibial rotation, group I showed an increased external tibial rotation (approximately 5°), group II had little

  6. Arthroscopic anatomical double bundle anterior cruciate ligament reconstruction: A prospective longitudinal study

    Directory of Open Access Journals (Sweden)

    Ashish Devgan

    2015-01-01

    Full Text Available Background: Single bundle anterior cruciate ligament (ACL reconstruction has been the current standard of treatment for ACL deficiency. However, a significant subset of patients continue to report residual symptoms of instability with a poor pivot control. Cadaveric biomechanical studies have shown double bundle (DB ACL reconstructions to restore the knee kinematics better. This study evaluates the outcome of DB ACL reconstruction. Materials and Methods: 30 consecutive patients who underwent anatomic DB ACL reconstruction were included in this prospective longitudinal study. There were all males with a mean age of 25 ± 7.45 years. All patients were prospectively evaluated using GeNouRoB (GNRB arthrometer, functional knee scores (International Knee Documentation Committee [IKDC] and Lysholm and postoperative magnetic resonance imaging (MRI for comparing the graft orientation and footprint of the reconstructed ACL with that of the normal knee. Results: The average followup was 36.2 months. At the time of final followup the mean Lysholm score was 93.13 ± 3.31. As per the objective IKDC score, 26 patients (86.6% were in Group A while 4 patients (13.3% were in Group B. The mean differential anterior tibial translation by GNRB, arthrometer was 1.07 ± 0.8 mm (range 0.1-2.3 mm. All cases had a negative pivot shift test. MRI scans of operated and the contralateral normal knee showed the mean sagittal ACL tibial angle coronal ACL tibial angle and tibial ACL footprint to be in accordance with the values of the contralateral, normal knee. Conclusion: The study demonstrates that DB ACL reconstruction restores the ACL anatomically in terms of size and angle of orientation. However, long term studies are needed to further substantiate its role in decreasing the incidence of early osteoarthritic changes compared to the conventional single bundle reconstructions.

  7. Proprioception in patients with posterior cruciate ligament tears: A meta-analysis comparison of reconstructed and contralateral normal knees.

    Science.gov (United States)

    Yoon, Jung-Ro; Lee, Dae-Hee; Ko, Seung-Nam; Shin, Young-Soo

    2017-01-01

    Posterior cruciate ligament (PCL) reconstruction for patients with PCL insufficiency has been associated with postoperative improvements in proprioceptive function due to mechanoreceptor regeneration. However, it is unclear whether reconstructed PCL or contralateral normal knees have better proprioceptive function outcomes. This meta-analysis was designed to compare the proprioceptive function of reconstructed PCL or contralateral normal knees in patients with PCL insufficiency. All studies that compared proprioceptive function, as assessed with threshold to detect passive movement (TTDPM) or joint position sense (JPS) in PCL reconstructed or contralateral normal knees were included. JPS was calculated by reproducing passive positioning (RPP). Five studies met the inclusion/exclusion criteria for the meta-analysis. The proprioceptive function, defined as TTDPM (95% CI: 0.25 to 0.51°; Pproprioceptive function of PCL reconstructed knees was decreased, compared with contralateral normal knees, as determined by both TTDPM and RPP. In addition, the amount of loss of proprioception was greater in TTDPM than in RPP, even with minute differences. Results from subgroup analysis, that evaluated the mean angles of error in moving directions through RPP, suggested that the moving direction of flexion has a significantly greater mean for angles of error than the moving direction of extension. Although the level of differences between various parameters were statistically significant, further studies are needed to determine whether the small differences (>1°) of the loss of proprioception are clinically relevant.

  8. Rehabilitation in Patients with Anterior Cruciate Ligament Reconstruction Using Auxiliary Platelet-Rich Plasma Therapy

    Directory of Open Access Journals (Sweden)

    Albu Daniel – Emil

    2016-06-01

    Full Text Available Background: The main target after successful AnteriorCruciate Ligament (ACL reconstruction is early rehabilitation. New options such as PRP (platelet rich plasma may improve clinical outcomes.

  9. The anatomic approach to primary, revision and augmentation anterior cruciate ligament reconstruction

    NARCIS (Netherlands)

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

    2010-01-01

    The anatomic approach is gaining popularity in anterior cruciate ligament (ACL) reconstruction. It is predominantly applied during primary ACL reconstruction. However, following the same principles as during primary surgery, the anatomic approach can also be applied during revision and augmentation

  10. Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle

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    Melloni, Pietro [Servei de Diagnostic per Imatge, Unitat de Diagnostic d' Alta Tecnologia (UDIAT), Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain); UDIAT, c/ Parc Tauli, s/n, 08208 Sabadell (Barcelona) (Spain); Valls, Rafael [Servei de Diagnostic per Imatge, Unitat de Diagnostic d' Alta Tecnologia (UDIAT), Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain); Yuguero, Mariano [Servei de Traumatologia i Ortopedia, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain); Saez, Amparo [Servei de Anatomia Patologica, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)

    2004-06-01

    We report a case of a mucoid degeneration of the anterior cruciate ligament (ACL) that produced osseous erosion of the medial aspect of the lateral femoral condyle. The MRI findings and differential diagnosis are discussed. (orig.)

  11. Arthroscopic prevalence of ramp lesion in 868 patients with anterior cruciate ligament injury.

    Science.gov (United States)

    Liu, Xin; Feng, Hua; Zhang, Hui; Hong, Lei; Wang, Xue Song; Zhang, Jin

    2011-04-01

    A special type of repairable meniscal lesion involving the peripheral attachment of the posterior horn of the medial meniscus is commonly associated with anterior cruciate ligament deficiency and is termed a "ramp lesion." However, there are no previously published articles reporting the epidemiologic characteristics of ramp lesions. The ramp lesion is a special type of medial meniscal tear with high prevalence associated with anterior cruciate ligament rupture; the prevalence increases with time from anterior cruciate ligament injury. Age and gender are risk factors affecting the prevalence of the ramp lesion. Cross-sectional study; Level of evidence, 3. From April 2002 to October 2007, 868 consecutive knees were diagnosed as having an anterior cruciate ligament injury and received arthroscopic surgery for anterior cruciate ligament reconstruction. All the patients had verified tears of the ramp area under arthroscopy. The prevalence of the ramp lesion was evaluated retrospectively. Then, all cases were divided into different groups depending on the time interval from anterior cruciate ligament injury to anterior cruciate ligament reconstruction and other relevant risk factors such as age and gender. The effects of age, gender, and time from injury on the prevalence of ramp lesions were analyzed. Among 868 knees that underwent surgery for anterior cruciate ligament reconstruction, 144 knees were diagnosed as having a ramp lesion. The mean age was 24.7 years; there were 113 male and 31 female patients. The mean time from injury to anterior cruciate ligament reconstruction was 27.2 months. The prevalence of ramp lesions was 16.6%, which was analyzed as a logarithmic correlation with time from injury. Patients younger than 30 years of age and male patients had a significantly higher prevalence of ramp lesions. The ramp lesion is a common meniscal injury that can occur at the time of anterior cruciate ligament rupture or as a result of knee laxity associated with

  12. Casuistry of physiotherapy care of patient after anterior cruciate ligament reconstruction surgery of knee

    OpenAIRE

    Škráčková, Barbora

    2017-01-01

    Title: Casuistry of physiotherapy care of patient after anterior cruciate ligament reconstruction surgery of knee Objectives: The purpose of the theoretical part of the thesis is to introduce the issue of soft tissue injury of the knee joint, especially anterior cruciate ligament. Acquaintance with conservative and surgical treatment, physical therapy and physiotherapeutical care after ligament reconstruction surgery. The special part of the thesis presents casuistry of physiotherapy care of ...

  13. Visual biofeedback exercises for improving body balance control after anterior cruciate ligament reconstruction

    OpenAIRE

    Molka, Alicja Zyta; Lisi?ski, Przemys?aw; Huber, Juliusz

    2015-01-01

    [Purpose] To evaluate the effects of balance training after arthroscopic anterior cruciate ligament reconstruction. [Subjects and Methods] Sixteen patients (mean 33 ? 8?years old) who underwent anterior cruciate ligament reconstruction three months prior to participating in a one-month rehabilitation program. The control group included 15 people aged 34 ? 4?years. Patients? functional level was evaluated according to the Lysholm knee score, and balance quality was ascertained by static and dy...

  14. Combined rupture of the patellar tendon, anterior cruciate ligament and lateral

    OpenAIRE

    Tsarouhas, A; Iosifidis, M; Kotzamitelos, D; Traios, S

    2011-01-01

    Simultaneous rupture of both the patellar tendon and the anterior cruciate ligament is a relatively rare injury. Its diagnosis can easily be missed during the initial examination. Treatment options include immediate repair of the patellar tendon with either simultaneous or delayed reconstruction of the ACL. We present the case of a combined rupture of the patellar tendon, the anterior cruciate ligament and the lateral meniscus in a 38-year old recreational martial arts athlete after a direct ...

  15. [Simultaneous rupture of the anterior cruciate ligament and the patellar tendon: a case report].

    Science.gov (United States)

    Achkoun, Abdessalam; Houjairi, Khalid; Quahtan, Omar; Hassoun, Jalal; Arssi, Mohamed; Rahmi, Mohamed; Garch, Abdelhak

    2016-01-01

    Simultaneous rupture of both the patellar tendon and the anterior cruciate ligament is a relatively rare injury. Its diagnosis can easily be missed during the initial examination. Treatment options include immediate repair of the patellar tendon with either simultaneous or delayed reconstruction of the ACL. We present the case of a combined rupture of the patellar tendon, the anterior cruciate ligament in a 22-year old footballer. A two-stage treatment approach was performed with an excellent functional outcome.

  16. Results of the surgical reconstruction of the anterior cruciate ligament.

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    Zelić, Zoran; Jovanović, Savo; Wertheimer, Vjekoslav; Sarić, Gordan; Biuk, Egon; Gulan, Gordan

    2012-03-01

    Results of the surgical reconstruction of the anterior cruciate ligament (ACL), using as a graft fourfold hamstring tendons (gracilis and semitendinosus) and middle third of the patellar ligament, were compared. In all patients that were participating in this study clinical examination and magnetic resonance showed ACL rupture, and apart from the choice of the graft, surgical technique was identical. We evaluated 112 patients with implemented patellar ligament graft and fourfold hamstring tendons graft six months after the procedure. Both groups were similar according to age, sex, activity level, knee instability level and rehabilitation program. The results showed that there was no significant difference between groups regarding Lysholm Knee score, IKDC 2000 score, activity level, musculature hypotrophy, and knee joint stability 6 months after the surgery. Anterior knee pain incidence is significantly higher in the group with patellar ligament graft (44% vs. 21%). Both groups had a significant musculature hypotrophy of the upper leg of the knee joint that was surgically treated, six months after the procedure. Both grafts showed good subjective and objective results.

  17. IN VIVO KINEMATICS OF THE ANTERIOR CRUCIATE LIGAMENT DEFICIENT KNEE DURING WIDE-BASED SQUAT USING A 2D/3D REGISTRATION TECHNIQUE

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    Takeshi Miyaji

    2012-12-01

    Full Text Available Anterior cruciate ligament (ACL deficiency increases the risk of early osteoarthritis (OA. Studies of ACL deficient knee kinematics would be important to reveal the disease process and therefore to find mechanisms which would potentially slow OA progression. The purpose of this study was to determine if in vivo kinematics of the anterior cruciate ligament deficient (ACLD knee during a wide-based squat activity differ from kinematics of the contralateral intact knee. Thirty-three patients with a unilateral ACLD knee consented to participate in this institutional review board approved study with the contralateral intact knee serving as the control. In vivo knee kinematics during the wide-based squat were analyzed using a 2D/3D registration technique utilizing CT-based bone models and lateral fluoroscopy. Comparisons were performed using values between 0 and 100° flexion both in flexion and extension phases of the squat activity. Both the ACLD and intact knees demonstrated increasing tibial internal rotation with knee flexion, and no difference was observed in tibial rotation between the groups. The tibia in the ACLD knee was more anterior than that of the contralateral knees at 0 and 5° flexion in both phases (p < 0.05. Tibiofemoral medial contact points of the ACLD knees were more posterior than that of the contralateral knees at 5, 10 and 15° of knee flexion in the extension phase of the squat activity (p < 0.05. Tibiofemoral lateral contact points of the ACLD knees were more posterior than that of the contralateral knees at 0° flexion in the both phases (p < 0.05. The kinematics of the ACLD and contralateral intact knees were similar during the wide-based squat except at the low flexion angles. Therefore, we conclude the wide-based squat may be recommended for the ACLD knee by avoiding terminal extension

  18. The fifty highest cited papers in anterior cruciate ligament injury.

    Science.gov (United States)

    Vielgut, Ines; Dauwe, Jan; Leithner, Andreas; Holzer, Lukas A

    2017-07-01

    The anterior cruciate ligament (ACL) is one of the most common injured knee ligaments and at the same time, one of the most frequent injuries seen in the sport orthopaedic practice. Due to the clinical relevance of ACL injuries, numerous papers focussing on this topic including biomechanical-, basic science-, clinical- or animal studies, were published. The purpose of this study was to determine the most frequently cited scientific articles which address this subject, establish a ranking of the 50 highest cited papers and analyse them according to their characteristics. The 50 highest cited articles related to Anterior Cruciate Ligament Injury were searched in Thomson ISI Web of Science® by the use of defined search terms. All types of scientific papers with reference to our topic were ranked according to the absolute number of citations and analyzed for the following characteristics: journal title, year of publication, number of citations, citation density, geographic origin, article type and level of evidence. The 50 highest cited articles had up to 1624 citations. The top ten papers on this topic were cited 600 times at least. Most papers were published in the American Journal of Sports Medicine. The publication years spanned from 1941 to 2007, with the 1990s and 2000s accounting for half of the articles (n = 25). Seven countries contributed to the top 50 list, with the USA having by far the most contribution (n = 40). The majority of articles could be attributed to the category "Clinical Science & Outcome". Most of them represent a high level of evidence. Scientific articles in the field of ACL injury are highly cited. The majority of these articles are clinical studies that have a high level of evidence. Although most of the articles were published between 1990 and 2007, the highest cited articles in absolute and relative numbers were published in the early 1980s. These articles contain well established scoring- or classification systems. The

  19. Case study of physiotherapy treatment of a patient with the diagnosis: the anterior cruciate ligament of the knee joint reconstruction

    OpenAIRE

    Hájek, Tomáš

    2011-01-01

    Title: Case study of physiotherapy treatment of a patient with the diagnosis: the anterior cruciate ligament of the knee joint reconstruction. Objective: Summary of theoretical knowledge and processing of study reports of a patient with the diagnosis: the anterior cruciate ligament of the knee joint reconstruction. Abstract: This thesis consists of two parts. The general section includes anatomical and biomechanical aspects of anterior cruciate ligament, as well as epidemiology, diagnosis, th...

  20. Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Wiggins, Amelia J.; Grandhi, Ravi K.; Schneider, Daniel K.; Stanfield, Denver; Webster, Kate E.; Myer, Gregory D.

    2017-01-01

    Background Injury to the ipsilateral graft used for reconstruction of the anterior cruciate ligament (ACL) or a new injury to the contralateral ACL are disastrous outcomes after successful ACL reconstruction (ACLR), rehabilitation, and return to activity. Studies reporting ACL reinjury rates in younger active populations are emerging in the literature, but these data have not yet been comprehensively synthesized. Purpose To provide a current review of the literature to evaluate age and activity level as the primary risk factors in reinjury after ACLR. Study Design Systematic review and meta-analysis. Methods A systematic review of the literature was conducted via searches in PubMed (1966 to July 2015) and EBSCO host (CINAHL, Medline, SPORTDiscus [1987 to July 2015]). After the search and consultation with experts and rating of study quality, 19 articles met inclusion for review and aggregation. Population demographic data and total reinjury (ipsilateral and contralateral) rate data were recorded from each individual study and combined using random-effects meta-analyses. Separate meta-analyses were conducted for the total population data as well as the following subsets: young age, return to sport, and young age + return to sport. Results Overall, the total second ACL reinjury rate was 15%, with an ipsilateral reinjury rate of 7% and contralateral injury rate of 8%. The secondary ACL injury rate (ipsilateral + contralateral) for patients younger than 25 years was 21%. The secondary ACL injury rate for athletes who return to a sport was also 20%. Combining these risk factors, athletes younger than 25 years who return to sport have a secondary ACL injury rate of 23%. Conclusion This systematic review and meta-analysis demonstrates that younger age and a return to high level of activity are salient factors associated with secondary ACL injury. These combined data indicate that nearly 1 in 4 young athletic patients who sustain an ACL injury and return to high-risk sport

  1. Tourniquet-induced cardiovascular responses in anterior cruciate ligament reconstruction surgery under general anesthesia: Effect of preoperative oral amantadine

    Directory of Open Access Journals (Sweden)

    Ashraf Abd Elmawgood

    2015-01-01

    Conclusion: Preoperative oral amantadine reduced tourniquet induced hypertension and postoperative analgesic requirements in anterior cruciate ligament reconstruction surgery under general anesthesia.

  2. Prevention, treatment, and rehabilitation of anterior cruciate ligament injuries in children.

    Science.gov (United States)

    Lang, Pamela J; Sugimoto, Dai; Micheli, Lyle J

    2017-01-01

    As more children and adolescents participate in competitive organized sports, there has been an increase in the reported incidence of anterior cruciate ligament (ACL) injuries in these age groups. ACL injuries in skeletally immature athletes present a challenge, as reconstruction must preserve the physis of the distal femur and of the proximal tibia to avoid growth disturbances. Historically, a skeletally immature athlete with an ACL injury was treated with a brace and activity modification until skeletal maturity, with ACL reconstruction being performed at that time in the "non-copers" who experienced instability. More recently, evidence has shown that delayed reconstruction may lead to increased damage to the meniscus and articular cartilage. As a result, early reconstruction is favored to protect the meniscus and allow continued physical activity. While adolescents at or those near skeletal maturity may be treated with standard reconstruction techniques, they may result in growth disturbances in younger athletes with significant growth remaining. In response to the growing need for ACL reconstruction techniques in skeletally immature individuals, physeal-sparing and physeal-respecting reconstruction techniques have been developed. In addition to the advancements in surgical technique, ACL injury prevention has also gained attention. This growing interest in ACL prevention is in part related to the high risk of ACL re-tear, either of the ACL graft or of the contralateral ACL, in children and adolescents. Recent reports indicate that well-designed neuromuscular training programs may reduce the risk of primary and subsequent ACL injuries.

  3. Kinematic motion of the anterior cruciate ligament deficient knee during functionally high and low demanding tasks.

    Science.gov (United States)

    Takeda, Kentaro; Hasegawa, Takayuki; Kiriyama, Yoshimori; Matsumoto, Hideo; Otani, Toshiro; Toyama, Yoshiaki; Nagura, Takeo

    2014-07-18

    The purpose of this study was to determine whether mechanical adaptations were present in patients with anterior cruciate ligament (ACL)-deficient knees during high-demand activities. Twenty-two subjects with unilateral ACL deficiency (11 males and 11 females, 19.6 months after injury) performed five different activities at a comfortable speed (level walking, ascending and descending steps, jogging, jogging to a 90-degree side cutting toward the opposite direction of the tested side). Three-dimensional knee kinematics for the ACL-deficient knees and uninjured contralateral knees were evaluated using the Point Cluster Technique. There was no significant difference in knee flexion angle, but an offset toward the knee in less valgus and more external tibial rotation was observed in the ACL-deficient knee. The tendency was more obvious in high demand motions, and a significant difference was clearly observed in the side cutting motions. These motion patterns, with the knee in less valgus and more external tibial rotation, are proposed to be an adaptive movement to avoid pivot shift dynamically, and reveal evidence in support of a dynamic adaptive motion occurring in ACL-deficient knees. Copyright © 2014. Published by Elsevier Ltd.

  4. Prevention, treatment, and rehabilitation of anterior cruciate ligament injuries in children

    Science.gov (United States)

    Lang, Pamela J; Sugimoto, Dai; Micheli, Lyle J

    2017-01-01

    As more children and adolescents participate in competitive organized sports, there has been an increase in the reported incidence of anterior cruciate ligament (ACL) injuries in these age groups. ACL injuries in skeletally immature athletes present a challenge, as reconstruction must preserve the physis of the distal femur and of the proximal tibia to avoid growth disturbances. Historically, a skeletally immature athlete with an ACL injury was treated with a brace and activity modification until skeletal maturity, with ACL reconstruction being performed at that time in the “non-copers” who experienced instability. More recently, evidence has shown that delayed reconstruction may lead to increased damage to the meniscus and articular cartilage. As a result, early reconstruction is favored to protect the meniscus and allow continued physical activity. While adolescents at or those near skeletal maturity may be treated with standard reconstruction techniques, they may result in growth disturbances in younger athletes with significant growth remaining. In response to the growing need for ACL reconstruction techniques in skeletally immature individuals, physeal-sparing and physeal-respecting reconstruction techniques have been developed. In addition to the advancements in surgical technique, ACL injury prevention has also gained attention. This growing interest in ACL prevention is in part related to the high risk of ACL re-tear, either of the ACL graft or of the contralateral ACL, in children and adolescents. Recent reports indicate that well-designed neuromuscular training programs may reduce the risk of primary and subsequent ACL injuries. PMID:28652828

  5. Factors informing fear of reinjury after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Ross, Cheryl A; Clifford, Amanda; Louw, Quinette A

    2017-02-01

    Fear of reinjury is associated with cessation of sport after anterior cruciate ligament (ACL) reconstruction despite normal postoperative knee function. The objective of this study is to describe factors informing athletes' experience of fear of reinjury post ACL reconstruction, in athletes who cited fear as the sole reason for not returning to their pre-injury level of sport. Mixed-methods study design of qualitative and a preliminary quantitative component. A conveniently selected private hospital. Ten male and two female athletes, aged between 19 and 45 years, were eligible for the interview from 68 male and 32 female potential participants (age range 17-50) who underwent an ACL reconstruction using any graft type, excluding revision or multi-ligament surgery. To explore factors informing fear of reinjury in participants citing fear of reinjury as the sole reason for not returning to sport, albeit normal knee function. From the participant interview, four themes emerged: undergoing the surgery and recovery again, nature of the pre-injury sport imposing risk of reinjury, personality traits, and social priorities. Clinicians should be aware of factors informing fear of reinjury post ACL reconstruction. Modifiable fears including pain, mode and length of rehabilitation and psychological factors should be considered during rehabilitation to potentially improve the return to sport rate.

  6. Return to work in miners following anterior cruciate ligament reconstruction

    Science.gov (United States)

    Tiftikci, Ugur; Serbest, Sancar; Kilinc, Cem Yalin; Karabicak, Gül Öznur; Vergili, Özge

    2015-01-01

    Introduction The aim of the study is retrospectively investigated durations for returning to work following anatomic ACL reconstruction by hamstring autograft in miners and the reasons in patients who were delayed to return to work. Methods Miners with symptomatic anterior cruciate ligament rupture underwent arthroscopic reconstruction. Patients were evaluated in terms of range of motion (ROM) values; Lysholm, Cincinati and Tegner activity scales; laxity testing and complications. By modifying the method used by Fitzgerald et al. we decided for the criteria returning to work. Results Thirty three patients were evaluated with mean followup of 22.7 ± 8.3 months (range 13-46 months). Mean age at the surgery was 27.8 (18-38) years. Lysholm, Cincinati and Tegner activity scales were signifi cantly higher from preoperative scores (Lysholm scores: preoperative: 60.7 ± 12.5, postoperative: 90.3 ± 4.8 (P postoperative: 6.2 ± 1.5 (P postoperative: 26.9 ± 1.6 (P < 0.001). The average time for returning to work was determined as 15,3 ± 4 weeks. There was no significant difference for knee scores and time for returning to work between patients with meniscal injuries and don't have meniscus lesions. Conclusion The reasons for delays in returning to work was work accident. Hematoma or effusion and pain inside the knee were the most significant reason which affected returning to work. PMID:26918069

  7. Management of anterior cruciate ligament injuries in skeletally immature individuals.

    Science.gov (United States)

    Moksnes, Håvard; Engebretsen, Lars; Risberg, May Arna

    2012-03-01

    Anterior cruciate ligament (ACL) injuries in skeletally immature individuals remain a challenge for the child, the parents, orthopaedic surgeons, and physical therapists. The main challenges are the potential risk of recurrent instability, secondary injuries following nonoperative treatment, and the risks involved with surgical treatment due to the vulnerability of the epiphyseal growth plates. We first present the physiological background for considerations that must be made when advising on treatment alternatives for skeletally immature individuals after ACL injury. The implications of continuous musculoskeletal development for treatment decisions are emphasized. No randomized controlled trials have been performed to investigate outcomes of different treatment algorithms. There is no consensus in the literature on clinical treatment decision criteria for whether a skeletally immature child should undergo transphyseal ACL reconstruction, physeal sparing ACL reconstruction, or nonoperative treatment. Additionally, well-described rehabilitation programs designed for either nonoperative treatment or postoperative rehabilitation have not been published. Based on the currently available evidence, we propose a treatment algorithm for the management of ACL injuries in skeletally immature individuals. Finally, we suggest directions for future prospective studies, which should include development of valid and reliable outcome measures and specific rehabilitation programs.

  8. What's New in Pediatric and Adolescent Anterior Cruciate Ligament Injuries?

    Science.gov (United States)

    Dekker, Travis J; Rush, Jeremy K; Schmitz, Matthew R

    2016-06-02

    Anterior cruciate ligament (ACL) tears in children and adolescent patients are being diagnosed and treated at an ever-increasing rates. We performed a review of recent literature regarding care of children and adolescent athletes with an ACL injury. PubMed database was searched for all papers related to treatment of children and adolescents with ACL injuries from October 1, 2012 to September 30, 2015, yielding 114 publications. A total of 59 papers were found to have contributed important new findings. Papers were selected based on new findings in the following categories: epidemiology, anatomy, risk factors, sex disparity, prevention, surgical outcomes, timing and associated pathologies, and rehabilitation and return to sport. Pediatric ACL injuries continue to rise and there are multiple surgical procedures that restore clinical function with good outcomes. Early surgical treatment is favored to prevent concomitant articular injuries. Early return to play can increase risk of reinjury and should be met with caution in this age group. Prevention strategies should be further studied and implemented in hopes of decreasing the incidence of this injury and the long-term potential damage. Level 4-titerature review.

  9. Anterior cruciate ligament injury: diagnosis, management, and prevention.

    Science.gov (United States)

    Cimino, Francesca; Volk, Bradford Scott; Setter, Don

    2010-10-15

    There are an estimated 80,000 to 100,000 anterior cruciate ligament (ACL) repairs in the United States each year. Most ACL tears occur from noncontact injuries. Women experience ACL tears up to nine times more often than men. Evaluation of the ACL should be performed immediately after an injury if possible, but is often limited by swelling and pain. When performed properly, a complete knee examination is more than 80 percent sensitive for an ACL injury. The Lachman test is the most accurate test for detecting an ACL tear. Magnetic resonance imaging is the primary study used to diagnose ACL injury in the United States. It can also identify concomitant meniscal injury, collateral ligament tear, and bone contusions. Treatment consists of conservative management or surgical intervention, with the latter being the better option for patients who want to return to a high level of activity. Patients who undergo surgery must commit to appropriate rehabilitation for the best outcome. Long-term sequelae of ACL injury include knee osteoarthritis in up to 90 percent of patients. Primary prevention of ACL injury includes specific proprioceptive and neuromuscular training exercises to improve knee stability.

  10. Timing of surgery in anterior cruciate ligament-injured knees.

    Science.gov (United States)

    Shelbourne, K D; Patel, D V

    1995-01-01

    Despite recent advances in the surgical techniques of anterior cruciate ligament (ACL) reconstruction in the past two decades, there is no consensus of opinion as to the ideal timing for ACL surgery. Based on the evolution of management of patients with ACL injuries over the period 1982-1994, we have found that various factors need to be considered in order to provide the best possible long-term result to the patient with minimal or no complications. In this review, we discuss the perioperative factors that one must consider to determine optimum timing for ACL surgery. Factors such as mental preparation of the patient; school, work, family, and social schedules; preoperative condition of the knee [i.e., minimal or no swelling, good strength, good leg control, and full range of motion (ROM) including full hyperextension]; and associated ligamentous and/or meniscal injuries must be considered before undertaking ACL surgery. With careful consideration of the above-mentioned factors and with our preoperative and postoperative rehabilitation program, we have been able to obtain predictable, successful, long-term results following ACL reconstruction in our athletic population. We emphasize that every patient should be treated on his or her own merit, and treatment decisions must be individualized.

  11. Validation of Functional Performance Tests after Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Kong, Doo Hwan; Yang, Sang Jin; Ha, Jeong Ku; Jang, Seok Hwan; Seo, Jung Gook

    2012-01-01

    Purpose To validate the functional performance tests (FPTs) after anterior cruciate ligament (ACL) reconstruction. Materials and Methods Thirty men in their third decade after ACL reconstruction at 6 month follow-up and thirty healthy subjects were selected. Lysholm knee score, International Knee Documentation Committee (IKDC) subjective score, Tegner activity score, KT-2000 arthrometer test, isokinetic strength test, functional performance tests (one leg hop test, co-contraction test, shuttle run test, carioca test) were performed in two groups. We evaluated the test-retest reliability of FPTs in healthy group and the between FPTs and other parameters in ACL reconstruction group. Results The test-retest result showed high correlation in co-contraction test (r=0.511), shuttle run test (r=0.746), carioca test (r=0.742). In the ACL reconstruction group, the IKDC score, Tegner activity score, extensor power at 60°/s, and one leg hop test also showed high correlation between each test. Conclusions The three FPTs showed correlations with the established methods for determining return to sports activities after ACL reconstruction and had high test-retest reliability. Therefore we believe the three FPTs can be useful methods to assess knee function in athletes after ACL reconstruction. PMID:22570851

  12. Complications of anterior cruciate ligament reconstruction: MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Papakonstantinou, Olympia; Chung, Christine B.; Chanchairujira, Kullanuch; Resnick, Donald L. [Department of Radiology, Veterans Affairs Medical Center, University of California, 3350 La Jolla Village Dr., San Diego, CA 92161 (United States)

    2003-05-01

    Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is being performed with increasing frequency, particularly in young athletes. Although the procedure is generally well tolerated, with good success rates, early and late complications have been documented. As clinical manifestations of graft complications are often non-specific and plain radiographs cannot directly visualize the graft and the adjacent soft tissues, MR imaging has a definite role in the diagnosis of complications after ACL reconstruction and may direct subsequent therapeutic management. Our purpose is to review the normal MR imaging of the ACL graft and present the MR imaging findings of a wide spectrum of complications after ACL reconstruction, such as graft impingement, graft rupture, cystic degeneration of the graft, postoperative infection of the knee, diffuse and localized (i.e., cyclops lesion) arthrofibrosis, and associated donor site abnormalities. Awareness of the MR imaging findings of complications as well as the normal appearances of the normal ACL graft is essential for correct interpretation. (orig.)

  13. Mechanisms for anterior cruciate ligament injuries in badminton.

    Science.gov (United States)

    Kimura, Yuka; Ishibashi, Yasuyuki; Tsuda, Eiichi; Yamamoto, Yuji; Tsukada, Harehiko; Toh, Satoshi

    2010-12-01

    A high incidence of anterior cruciate ligament (ACL) injuries related to sports activities has been reported; however, the injury situation of ACL injury in badminton has not been elucidated. This study investigated the mechanism of ACL injury in badminton using a questionnaire. Information on injury mechanism was gathered from interviews with six male and 15 female badminton players who received a non-contact ACL injury playing badminton and underwent ACL reconstruction. The most common injury mechanism (10 of 21 injuries) was single-leg landing after overhead stroke. Nine of 10 players had injured the knee opposite to the racket-hand side. The second most frequent injury mechanism (eight of 21 injuries) was plant-and-cut while side-stepping or backward stepping. All eight players injured the knee of the racket-hand side. Eleven injuries occurred in the rear court, and six of the 11 injuries occurred during single-leg landing after an overhead stroke. The knee opposite to the racket-hand side tended to sustain the ACL injuries during single-leg landing after a backhand overhead stroke, whereas the knee of the racket-hand side tended to be injured by plant-and-cut during side or backward stepping. These injury patterns appear to be due to specific movements during badminton.

  14. Mucoid degeneration of the anterior cruciate ligament: Management and outcome

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    Vivek Pandey

    2014-01-01

    Full Text Available Background: Mucoid degeneration (MD is a rare pathological affection of the anterior cruciate ligament (ACL. Mucinous material within the substance of ACL produces pain and limited motion in the knee. This series describes the clinicoradiological presentation of patients with mucoid ACL, partial arthroscopic debridement of ACL and outcomes. Materials and Methods: During a period of 3 years, 11 patients were included based upon the clinical suspicion, magnetic resonance imaging (MRI findings, arthroscopic features and histopathologic confirmation of MD of ACL. Result: Six patients were male and five were female with median age of 40 years (range 21-59 years. All patients complained of knee pain with median duration of 5 months (range 1-24 months. All patients had painful deep flexion with 63.6% (N = 7 reporting trivial trauma before the onset of symptoms. MRI revealed MD of ACL in all with associated cyst in three patients. Partial debridement of ACL was done in ten and complete in one patient. None of them required notchplasty. Histopathology confirmed the diagnosis in all of them. At the mean followup of 13.81 months (range 6-28 months, all patients regained complete flexion and none complained of instability. Conclusion: Prior knowledge of condition with high index of suspicion and careful interpretation of MRI can establish the diagnosis preoperatively. It responds well to partial debridement of ACL and mucinous material without development of instability.

  15. Basic science of anterior cruciate ligament injury and repair

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    Kiapour, A. M.; Murray, M. M.

    2014-01-01

    Injury to the anterior cruciate ligament (ACL) is one of the most devastating and frequent injuries of the knee. Surgical reconstruction is the current standard of care for treatment of ACL injuries in active patients. The widespread adoption of ACL reconstruction over primary repair was based on early perception of the limited healing capacity of the ACL. Although the majority of ACL reconstruction surgeries successfully restore gross joint stability, post-traumatic osteoarthritis is commonplace following these injuries, even with ACL reconstruction. The development of new techniques to limit the long-term clinical sequelae associated with ACL reconstruction has been the main focus of research over the past decades. The improved knowledge of healing, along with recent advances in tissue engineering and regenerative medicine, has resulted in the discovery of novel biologically augmented ACL-repair techniques that have satisfactory outcomes in preclinical studies. This instructional review provides a summary of the latest advances made in ACL repair. Cite this article: Bone Joint Res 2014;3:20–31. PMID:24497504

  16. Basic principles of aggressive rehabilitation after anterior cruciate ligament reconstruction

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    Dubljanin-Raspopović Emilija

    2005-01-01

    Full Text Available Rehabilitation after ACL (anterior cruciate ligament reconstruction has drastically changed over the last decade, with the adoption of a more aggressive approach, right from the first day after surgery. Progress in the effectiveness of rehabilitation is based on improvements in operative techniques, as well as on the encouraging results of histological studies regarding graft healing. Despite a huge amount of research papers on this topic, a rehabilitation golden standard still has not been established, due to the complexity of this problem. In this review, we point out the basic principles of rehabilitation after arthroscopically assisted ACL reconstruction based on actual practices, as well as the importance of specific procedures for the prevention of complications during the postoperative period. The importance of range-of-motion exercises, early weight bearing, an appropriate gait scheme, patella mobilisation, pain and oedema control, as well as stretching and balance exercises is explained. The functional advantages of closed kinetic chain exercises, as well as their influence on the graft are also described, in comparison to open kinetic chain exercises. The fundamentals of returning to sports are revealed and the specific aspects of rehabilitation regarding graft choice are pointed out. While waiting for new clinical investigations, which are expected to enable the establishment of a rehabilitation golden standard, the outlined principles should be followed. The complexity of this injury requires treatment in highly specialised institutions.

  17. Partial tearing of the anterior cruciate ligament: diagnosis and treatment

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    Eduardo Frois Temponi

    2015-02-01

    Full Text Available Partial tears of the anterior cruciate ligament (ACL are common and represent 10-27% of the total. The main reasons for attending to cases of non-torn bundles are biomechanical, vascular and proprioceptive. Continued presence of the bundle also serves as protection during the healing process. There is controversy regarding the definition of these injuries, which is based on anatomy, clinical examination, translation measurements, imaging examinations and arthroscopy. The way in which it is treated will depend on the existing laxity and instability. Conservative treatment is optional for cases without instability, with a focus on motor rehabilitation. Surgical treatment is a challenge, since it requires correct positioning of the bone tunnels and conservation of the remnants of the torn bundle. The pivot shift test under anesthesia, the magnetic resonance findings, the previous level and type of sports activity and the arthroscopic appearance and mechanical properties of the remnants will aid the orthopedist in the decision-making process between conservative treatment, surgical treatment with strengthening of the native ACL (selective reconstruction and classical (anatomical reconstruction.

  18. Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction.

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    Ventura, Alberto; Legnani, Claudio; Terzaghi, Clara; Iori, Stefano; Borgo, Enrico

    2017-03-01

    The purpose of the present study was to retrospectively evaluate the outcomes of patients who underwent combined medial unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament (ACL) reconstruction. The hypothesis was that this procedure would lead to a high success rate in patients affected by isolated medial unicompartmental osteoarthritis and concomitant ACL deficiency. Fourteen patients with primary ACL lesion and concomitant medial compartment symptomatic osteoarthritis treated from 2006 to 2010 were followed up for an average time of 26.7 months (SD 4.2). Assessment included KOOS score, Oxford Knee score, American Knee Society scores, WOMAC index of osteoarthritis, Tegner activity level and objective examination including instrumented laxity test with KT-1000 arthrometer. Radiological assessment was done with standard simple radiographs in order to get information about any presence of loosening of the components. KOOS score, OKS, WOMAC index and the AKSS improved significantly after surgery (p reconstruction is a valid therapeutic option for the treatment of combined medial unicompartmental knee osteoarthritis and ACL deficiency in young and active patients and confirms subjective and objective clinical improvement 2 years after surgery. The use of a fixed-bearing prosthesis represents a reliable feature as it allows to overcome problems of improper ligament tensioning during the implantation of the components. IV.

  19. Anterior cruciate ligament reconstruction in children with open growth plates

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    Rustam Sh Sadykov

    2016-09-01

    Full Text Available Introduction. Anterior cruciate ligament (ACL tears are observed in 10%–32% of all traumatic lesions of the knee joint in children. Open growth plates are a serious problem in the treatment of ACL tears. Most modern methods of ACL reconstruction use transepiphyseal channels, which go through the growth plates. This may lead to angle deformity of the knee development, limb shortening and early arthritis. Material and methods. We observed 12 patients (11–17 years old; mean age, 13.2 years with ACL tears with opened growth plates, who were operated on between 2006 and 2010. ACL reconstruction was performed arthroscopically using the BTB-technique and synthetic grafts DONA-M. Results. In all cases, we achieved poor results, especially when the operation was done by BTB. We avoided shortening of the leg, but arthritis was common and progressed quickly. When we tried stabilize the joint, we achieved the reverse effect – pain in the knee, with a decreased quality of life. Conclusion. Our results demonstrate that ACL reconstruction in children with opened growth pates is not effective; we suggest performing the procedure after the growth has finished.

  20. Kinesiophobia and Return to Sports After Anterior Cruciate Ligament Reconstruction.

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    Medvecky, Michael J; Nelson, Stephen

    2015-03-01

    Anterior cruciate ligament (ACL) reconstruction is typically recommended for patients who wish to return to aggressive athletic activity. Unfortunately, reconstructive knee surgery is not a guarantee that all patients will return to their preinjury level of function. A recent meta-analysis including 48 studies showed that after a mean follow-up of 41 months, 82% of participants had returned to some kind of athletic activity but only 63% returned to their preinjury level of participation and a disappointing 44% returned to competitive sports. The reasons why some athletes have been unsuccessful in returning to previous levels of activity are vast and our understanding of these factors is limited. The importance of psychological factors has recently been emphasized. One such factor, kinesiophobia, or fear of reinjury, may play a significant role in some patients' inability to successfully return to their previous level of sports participation. In the meta-analysis, kinesiophobia was the most common reason cited for postoperative reduction in, or cessation of, sports participation.

  1. Sport-specific outcomes after anterior cruciate ligament reconstruction.

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    Warner, Stephen J; Smith, Matthew V; Wright, Rick W; Matava, Matthew J; Brophy, Robert H

    2011-08-01

    Although anterior cruciate ligament (ACL) reconstruction has been studied extensively in the literature, sport-specific outcomes have not been well-documented. The purpose of this systematic review was to assess sport-specific outcomes after ACL reconstruction in the literature. We performed a systematic review of the literature to identify studies reporting sport-specific outcomes after primary ACL reconstruction. Included studies were required to have reported standardized outcomes after primary ACL reconstruction for a single sport or comparing between different sports. In total 8 studies conformed to all inclusion criteria: 2 Level II studies, 1 Level III study, and 5 Level IV case series. Only 1 study reported comparisons of standardized outcomes between different sports, whereas 7 studies reported standardized outcomes in a single sport. Return to activity was the most common sport-specific outcome reported and varied from 19% (soccer) to 100% (bicycling and rugby), although the methods of measuring this outcome differed. Whereas return to activity after ACL reconstruction appears more likely for bicycling and jogging than for cutting and pivoting sports such as soccer and football, the literature on sport-specific outcomes from ACL reconstruction is limited with minimal data. Further studies are needed to report sport-specific outcomes and return to play after ACL reconstruction. Level IV, systematic review of Level II, III, and IV studies. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. Surgical management of partial tears of the anterior cruciate ligament.

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    Papalia, Rocco; Franceschi, Francesco; Zampogna, Biagio; Tecame, Andrea; Maffulli, Nicola; Denaro, Vincenzo

    2014-01-01

    Partial anterior cruciate ligament (ACL) tears involving the posterolateral (PL) bundle can lead to rotatory laxity of the knee, while tears involving the anteromedial (AM) bundle result in abnormal anteroposterior laxity of the knee. In this systematic review, we examine the best evidence on the management of partial tears of the ACL. A comprehensive search of several databases was performed from the inception of the database to December 2011, using various combinations of keywords focusing on clinical outcomes of human patients who had partial tears of ACL and who had undergone ACL augmentation. We evaluated the methodological quality of each article using the Coleman Methodology Score. Ten articles published in peer-reviewed journals were identified (392 males and 242 females), with a mean modified Coleman methodology of 66.1 ± 10.2. Only two studies compared standard ACL reconstruction and augmentation techniques. No study has a sample large enough to allow establishing guidelines. Validated and standardized proprioception assessment methods should be used to report outcomes. Imaging outcomes should be compared to functional outcomes, and a control group consisting of traditional complete ACL reconstruction should be present. There is a need to perform appropriately powered randomized controlled trials presenting clinical outcome with homogeneous score systems to allow accurate statistical analysis. ACL augmentation technique, preserving the intact AM or PL bundle of the ACL, is encouraging but currently available evidences are too weak to support his routine use in clinical practice.

  3. Core Stabilization Training After Anterior Cruciate Ligament Reconstruction

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    Medeni, Özge Çınar; Bayramlar, Kezban; Baltacı, Gül; Yanmış, İbrahim

    2014-01-01

    Objectives: The aim of this study was to compare the effects of core stabilization exercises and conventional rehabilitation exercises after anterior cruciate ligament reconstruction in terms of knee joint laxity, knee muscle strength, postural stability and functional tests. Methods: Twenty eight patients reconstructed with hamstring tendon were included. Thirteen patients evaluated after a conventional rehabilitation and fifteen after a core stabilization programme. Single-limb postural stability assessment, isokinetic knee muscle strength test, instrumented ligament laxity test, functional hop tests were done to both groups after 16th week. Single-limb postural stability was assessed with stabilometer in both eyes open and eyes-closed conditions. Healthy legs were evaluated as internal controls. Results: Knee flexor and extensor strength indices were not different between groups (p>.05). H/Q strength ratio was different at 180 °/s (p.05). Conventional training group had deficit in overall stability score in eyes closed condition (p>.05), but core stabilization group did not have any postural stability deficit (p>.05). Conclusion: Better H/Q strength ratio was seen in core stabilization group. Core stabilization exercises improved postural stability more than classic rehabilitation.

  4. Kinesiophobia After Anterior Cruciate Ligament Reconstruction in Physically Active Individuals.

    Science.gov (United States)

    Cozzi, Arika L; Dunn, Kristina L; Harding, Josie L; Valovich McLeod, Tamara C; Welch Bacon, Cailee E

    2015-11-01

    There are approximately 200,000 anterior cruciate ligament (ACL) tears reported annually in the United States. Patients who undergo ACL reconstruction followed by an aggressive rehabilitation protocol can often structurally and functionally progress to a preinjury level. Despite physical improvements with ACL-rehabilitation protocols, however, there are still a substantial number of individuals who do not return to preinjury level, particularly physically active individuals, of whom only 63% return to their full potential preinjury level. This may be due to continued pain, swelling, stiffness, and weakness in the knee. In addition, research concerning the topic of kinesiophobia (ie, fear of reinjury), which may prevent individuals from returning to their activities, has increased over the past several years. Kinesiophobia is defined as the irrational or debilitating movement of physical activity resulting in the feeling of vulnerability to painful injury or reinjury. Kinesiophobia may have a significant impact on physically active individuals, considering the proportion of patients who do not return to their sport. However, it is unknown whether kinesiophobia is associated with patients' perceived physical-impairment levels after ACL reconstruction. Focused Clinical Question: Is kinesiophobia associated with self-perceived levels of knee function after ACL reconstruction?

  5. Anterior cruciate ligament reconstruction and rehabilitation: predictors of functional outcome.

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    Villa, Francesco Della; Ricci, Margherita; Perdisa, Francesco; Filardo, Giuseppe; Gamberini, Jacopo; Caminati, Daniele; Villa, Stefano Della

    2015-01-01

    Surgical reconstruction of an injured anterior cruciate ligament (ACL) leads to full recovery of function and sports activity in a high percentage of cases. The aim of the present study was to analyze variables related to the patient, the surgical technique and the post-surgical rehabilitation methods, seeking to identify predictors of outcome and recovery time after ACL reconstruction. One hundred and four patients (81 M, 23 F) undergoing a step-based rehabilitation protocol after ACL reconstruction were evaluated. 43.2% of them had an isolated ACL lesion, whereas 56.8% had one or more concurrent injuries. Data relating to personal characteristics, surgery and post-operative management were collected and analyzed for correlation. Clinical outcome was evaluated with IKDC subjective score and the Tegner score, and the time to reach full recovery was noted as well. Young patients with a higher pre-injury Tegner activity level or who practice sport at professional level, no concurrent capsular lesions and no postoperative knee bracing had better clinical results and took shorter time to recover. Also, a higher percentage of on-the-field rehabilitation sessions, and absence of significant muscle strength deficits at the first knee isokinetic test emerged as rehabilitation-related factors leading to a better post-surgical outcome. Personal, surgical and rehabilitation factors should be considered in order to optimize patient management and maximize the expected results. Further studies are needed to find the strongest factors in different patients. Level IV, retrospective study.

  6. Physiotherapists' experiences of the management of anterior cruciate ligament injuries.

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    von Aesch, Arlene V; Perry, Meredith; Sole, Gisela

    2016-05-01

    While extensive research has been reported for management of anterior cruciate ligament (ACL) injuries, variation in treatment by physiotherapists is evident. To explore physiotherapists' experiences regarding ACL injury rehabilitation and factors that influenced physiotherapists' decision making for ACL rehabilitation, and to elicit what research physiotherapists perceived would support their management of these patients. Qualitative study. Fifteen physiotherapists from six private clinics in New Zealand participated in semi-structured interviews. The interviews were recorded, transcribed verbatim and the general inductive approach was used to develop key themes. Participant's management strengths were evident by their intent and commitment to provide expert rehabilitation, using a biopsychosocial approach and evidence-informed practice. The lengthy management process (including prolonged rehabilitation and referral processes) and interprofessional disconnect concerned participants. Translational research was needed for clear directions for exercise prescription and milestones for return to sports and occupation following ACL injury. Participants provided a biopsychosocial and evidence-based approach to ACL injury management. Potential areas of improvement include simplifying the referral process and enhancing communication between physiotherapists and other health professionals. Future research should focus on clarifying areas of ACL rehabilitation uncertainty, or collating results in an accessible and usable format for clinical practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Evaluation of static and dynamic balance in athletes with anterior cruciate ligament injury - A controlled study.

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    Fernandes, Tiago Lazzaretti; Felix, Ellen Cristina Rodrigues; Bessa, Felipe; Luna, Natália Ms; Sugimoto, Dai; Greve, Júlia Maria D'Andrea; Hernandez, Arnaldo José

    2016-08-01

    Anterior cruciate ligament injury leads to adaptive responses to maintain postural control. However, there is no consensus regarding whether leg dominance also affects postural control in athletes with anterior cruciate ligament injury. The purpose of this study was to evaluate dynamic and static postural control among athletes with and without anterior cruciate ligament injury to the dominant leg. Twenty-eight athletes, twenty-one males and seven females aged 15-45 years, were allocated to one of two groups: the anterior cruciate ligament injury group (26±3 years) or the control group without anterior cruciate ligament injury (25±6.5 years). All subjects performed one legged stance tests under eyes open and eyes closed conditions and squat and kick movement tests using a postural control protocol (AccuSwayPlus force platform, Massachusetts). The center of pressure displacement and speed were measured by the force platform. In addition, the distance traveled on the single-leg hop test was assessed as an objective measure of function. Significantly greater mediolateral sway was found under the eyes closed condition (p=0.04) and during squat movement (p=0.01) in the anterior cruciate ligament injury group than in the control group. Analysis of the single-leg hop test results showed no difference between the groups (p=0.73). Athletes with anterior cruciate ligament injury had greater mediolateral displacement of the center of pressure toward the dominant leg under the eyes closed condition and during squat movement compared to control athletes.

  8. Early versus delayed reconstruction of the anterior cruciate ligament: a decision analysis approach.

    Science.gov (United States)

    Bernstein, Joseph

    2011-05-04

    A recent randomized controlled trial compared early anterior cruciate ligament reconstruction with a program of initial rehabilitation, with delayed anterior cruciate ligament reconstruction if needed. The authors reported that the improvement in Knee Injury and Osteoarthritis Outcome Scores was nearly identical in both groups and concluded that in young, active adults with acute ACL (anterior cruciate ligament) tears, a strategy of rehabilitation plus early ACL reconstruction was not superior to a strategy of rehabilitation plus optional delayed ACL reconstruction. Yet, in making that assessment, the authors did not account for the fact that there were more meniscal injuries in the group with delayed anterior cruciate ligament surgery. Establishing the true superiority of one strategy requires consideration of meniscal injury, as well as a further determination if the apparent protective effect regarding meniscal tears found in the cohort of patients with early anterior cruciate ligament reconstruction is offset by the costs of additional reconstructive surgery. That analysis of offsetting utility, omitted in the randomized controlled trial noted above, is provided in the present study. A decision analysis model considering the options and probabilities described in the randomized controlled trial was constructed: the functional outcome of all groups was assumed to be equal, the likelihood of a patient eventually needing surgery despite initially choosing a program of rehabilitation was 37%, and the likelihood of needing a meniscectomy was 23% for the early surgery group and 35% for the rehabilitation and deferred anterior cruciate ligament reconstruction group. The early surgery option is the preferable therapeutic approach as long as the costs of a potential meniscal tear are at least 5.25 times the costs of reconstructive surgery. Early surgery for anterior cruciate ligament tears may be the preferred approach for some patients, on the basis of the utility

  9. Risk factors for knee instability after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Ahn, Ji Hyun; Lee, Sung Hyun

    2016-09-01

    The objective of this study was to estimate risk factors that influence postoperative instability after anterior cruciate ligament (ACL) reconstruction using multivariate logistic regression analysis. A total of 152 consecutive patients with symptomatic ACL insufficiency underwent arthroscopic ACL reconstruction between 2005 and 2011. Loss to follow-up and previous ligament reconstruction were exclusion criteria, resulting in 131 patients remaining for this retrospective study. The median follow-up was 55 months (range 25-100 months). Patients were sorted into two groups by anterior translation on stress radiograph and pivot shift test grade and were analysed for the statistical significance of various risk factors including age at surgery, gender, body mass index, preoperative instability, time from injury to surgery, single-bundle reconstruction with preserved abundant remnant versus double-bundle reconstruction with scanty remnant, and concomitant ligament, meniscus, and articular cartilage injury with use of multivariate logistic regression analysis. Time from injury to surgery over 12 weeks was found to be a significant risk factor for postoperative instability [p ligament (MCL) was also a risk factor (p = 0.02, adjusted OR 13.60; 95 % CI 1.24-148.25). The other variables were not found to be a significant risk factor. Among the risk factor variables, concomitant grade 2 MCL injury and surgical delay of more than 12 weeks from injury were significant risk factors for postoperative knee instability after ACL reconstruction. The overall results suggest that surgery <12 weeks from injury and meticulous attention to concomitant MCL injury should be considered. Retrospective case-control study, Level III.

  10. Knee function after anterior cruciate ligament reconstruction with patellar or hamstring tendon: a meta-analysis.

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    Shi, Dong-Liang; Yao, Zhen-Jun

    2011-12-01

    There is currently no consensus regarding the best graft type for anterior cruciate ligament reconstruction. Therefore, the aim of this study was to investigate the effects of patellar and hamstring tendon grafts on long-term knee function after anterior cruciate ligament reconstruction. This meta-analysis was conducted according to the methodological guidelines outlined by the Cochrane Collaboration. An electronic search of the literature was performed and all trials published between January 1966 and August 2011 comparing knee function after anterior cruciate ligament reconstruction using patellar tendon grafts with knee function after reconstruction with hamstring tendon grafts were pooled. Six studies were included in the final meta-analysis. Anterior cruciate ligament reconstruction using hamstring tendon grafts resulted in greater pain upon kneeling than reconstruction using patellar tendon grafts (P = 0.001). However, both grafts resulted in similar levels of anterior tibial translation, and similar results regarding isokinetic extension/flexion tests, Lysholm scores, and the stair-hop test (P > 0.05). Anterior cruciate ligament reconstruction using patellar or hamstring tendon grafts results in similar long-term knee function.

  11. Anterior cruciate ligament reconstruction in a patient with Athetoid cerebral palsy: a case report

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    Tajima Takuya

    2012-10-01

    Full Text Available Abstract Recent years have seen ACL reconstruction performed in a broad range of patients, regardless of age, sex or occupation, thanks to great advances in surgical techniques, instrumentation and the basic research. Favorable results have been reported; however, we have not been able to locate any reports describing ACL reconstruction in patients with athetoid cerebral palsy. We present herein a previously unreported anterior cruciate ligament (ACL reconstruction performed in a patient with athetoid cerebral palsy. The patient was a 25-year-old woman with level II athetoid cerebral palsy according to the Gross Motor Function Classification System. She initially injured her right knee after falling off a bicycle. Two years later, she again experienced right-knee pain and a feeling of instability. A right-knee ACL tear and avulsion fracture was diagnosed upon physical examination and confirmed with magnetic resonance imaging (MRI and X-ray examination at that time. An ACL reconstruction using an autologous hamstring double-bundle graft was performed for recurrent instability nine years after the initial injury. Cast immobilization was provided for 3 weeks following surgery and knee extension was restricted for 3 months with the functional ACL brace to prevent hyperextension due to involuntary movement. Partial weight-bearing was started 1 week postoperatively, with full weight-bearing after 4 weeks. The anterior drawer stress radiography showed a 63% anterior displacement of the involved tibia on the femur six months following the surgery, while the contralateral knee demonstrated a 60% anterior displacement of the tibia. The functional ACL functional brace was then removed. A second-look arthroscopy was performed 13 months after the ACL reconstruction, and both the anteromedial and posterolateral bundles were in excellent position as per Kondo’s criteria. The Lachman and pivot shift test performed under anesthesia were also negative. An

  12. Trunk position modulates anterior cruciate ligament forces and strains during a single-leg squat

    NARCIS (Netherlands)

    Kulas, Anthony S.; Hortobagyi, Tibor; DeVita, Paul

    Background: Although the squat exercise and its variations are commonly prescribed for anterior cruciate ligament rehabilitation, whether trunk position affects these ligament forces and strains during the squat is unclear. Our purpose was to evaluate the effects of trunk position on anterior

  13. Novel anterior cruciate ligament graft fixation device reduces slippage

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    Lopez MJ

    2013-05-01

    Full Text Available Mandi J Lopez,1 Allen Borne,2 W Todd Monroe,3 Prakash Bommala,1 Laura Kelly,1 Nan Zhang11Laboratory for Equine and Comparative Orthopedic Research, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, 2Louisiana State University, New Orleans Health Sciences Center, School of Medicine, New Orleans, 3Department of Biological and Agricultural Engineering, Agricultural Center, Louisiana State University, Baton Rouge, LA, USAAbstract: Clinically significant laxity occurs in 10%–30% of knees after anterior cruciate ligament reconstruction. Graft slippage and tension loss at the hamstring graft tibial fixation site during and after reconstruction surgery contribute to postoperative joint laxity and are detrimental to long-term knee stability and graft properties. Limiting graft slippage will reduce associated complications. We sought to compare the in vitro mechanical properties and in vivo joint stabilization, postoperative limb use, and graft incorporation of the novel GraftGrab™ (GG device designed to reduce hamstring graft tibial fixation slippage with the commercially available bioabsorbable Bio-Post™ and spiked washer (BP. Mechanical testing was performed on canine tibia-hamstring graft constructs to quantify initial fixation properties. In vivo joint stabilization, postoperative limb use and graft incorporation of hamstring graft reconstructions were determined in a canine model. Outcomes included tibial translation and ground reaction forces preoperatively and 4 and 8 weeks postoperatively, three-dimensional graft and bone tunnel dimensions at the latter two time points, and graft-bone microstructure, as well as mechanical properties 8 weeks after implantation. Immediately after fixation, all grafts slipped from the BP constructs versus about 30% of GG constructs. In vivo limb use remained low, and tibial translation increased with time in the BP cohort. These results together

  14. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option.

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    Lintz, F; Pujol, N; Dejour, D; Boisrenoult, P; Beaufils, P

    2010-06-01

    Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. The clinical presentation is one of posterior pain with limited flexion. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. Arthroscopic resection of ACL mucoid degeneration is effective for treating pain and flexion limitation, but at the expense of anterior laxity. This bicentric, retrospective cohort study with an average follow-up of 6years involved 27 patients (29 knees) presenting with symptomatic ACL mucoid degeneration validated by magnetic resonance imaging (MRI). Noninfiltrating synovial cysts of the ACL were excluded. Average patient age was 49 (22 to 68) years. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Anatomopathology samples were collected in 18 cases. Postoperative follow-up included standard radiography and dynamic examination, measuring laxity with a Telos device. Pain was posterior in 23 knees (80%). Fourteen knees (48%) had limited flexion, on average 97 degrees. Twelve partial and 17 total resections were performed. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. Meniscectomy was undertaken in 11 cases (41%). Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. Average improvement in flexion was 21.5 degrees (0 to 60 degrees). Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. Average postoperative differential laxity on the Telos device was 8.3 mm (5 to 13 mm). Average postoperative International Knee Documentation Committee (IKDC) and Knee Injury and

  15. Influence of functional bracing on the kinetics of anterior cruciate ligament-injured knees during level walking.

    Science.gov (United States)

    Lu, Tung-Wu; Lin, Hsiu-Chen; Hsu, Horng-Chaung

    2006-06-01

    Use of functional knee braces has been suggested to provide protection and to improve kinetic performance of the knee in anterior cruciate ligament-injured patients. However, the efficacy of knee bracing in achieving these goals is still controversial. The purpose of this study was to examine the immediate effects of functional bracing on the three-dimensional kinetics of the knee in individuals with anterior cruciate ligament injuries during level walking. Fifteen anterior cruciate ligament-deficient and 15 anterior cruciate ligament-reconstructed subjects were each fitted with a DonJoy Goldpoint brace and walked at a self-selected pace, first without and then with the brace. Kinematic and kinetic data were measured and three-dimensional joint moments and angular impulses at the knee were calculated and compared between bracing conditions and between limbs. Functional knee bracing did not significantly affect the kinetics of the unaffected knees for either group. Bracing significantly increased the peak abductor moments in anterior cruciate ligament-deficient knees and reduced the bilateral kinetic asymmetry in the coronal plane. For the anterior cruciate ligament-reconstructed group, bracing increased peak moments and impulses of the abductors and extensors. It also reduced bilateral kinetic asymmetry in the sagittal and coronal planes. Effects of the knee brace were apparent in the coronal plane for both anterior cruciate ligament-deficient and anterior cruciate ligament-reconstructed patients, and in the sagittal plane for anterior cruciate ligament-reconstructed patients. Functional bracing can be recommended for anterior cruciate ligament-reconstructed patients to assist in achieving better bilateral kinetic symmetry during gait. For anterior cruciate ligament-deficient patients, apart from bracing, additional emphasis on the rehabilitative training for better kinetic knee performance in the sagittal plane is needed.

  16. Graft position in arthroscopic anterior cruciate ligament reconstruction: anteromedial versus transtibial technique.

    Science.gov (United States)

    Guler, Olcay; Mahırogulları, Mahir; Mutlu, Serhat; Cercı, Mehmet H; Seker, Ali; Cakmak, Selami

    2016-11-01

    When treating anterior cruciate ligament (ACL) injuries, the position of the ACL graft plays a key role in regaining postoperative knee function and physiologic kinematics. In this study, we aimed to compare graft angle, graft position in tibial tunnel, and tibial and femoral tunnel positions in patients operated with anteromedial (AM) and transtibial (TT) methods to those of contralateral healthy knees. Forty-eight patients who underwent arthroscopic ACL reconstruction with ipsilateral hamstring tendon autograft were included. Of these, 23 and 25 were treated by AM and TT techniques, respectively. MRI was performed at 18.4 and 19.7 months postoperatively in AM and TT groups. Graft angles, graft positions in the tibial tunnel and alignment of tibial and femoral tunnels were noted and compared in these two groups. The sagittal graft insertion tibia midpoint distance (SGON) has been used for evaluation of graft position in tunnel. Sagittal ACL graft angles in operated and healthy knees of AM patients were 57.78° and 46.80° (p anterior-posterior position of femoral tunnel was better in AM patients. Lysholm scores and range of motion of operated knees in the AM and TT groups showed no significant difference (p > 0.05). Precise reconstruction on sagittal plane cannot be obtained with either AM or TT technique. However, AM technique is superior to TT technique in terms of anatomical graft positioning. Posterior-placed grafts in tibial tunnel prevent ACL reconstruction, although tibial tunnel is drilled on sagittal plane.

  17. Comparison of hamstring tendon autograft and tibialis anterior allograft in arthroscopic transtibial single-bundle posterior cruciate ligament reconstruction.

    Science.gov (United States)

    Li, Bin; Wang, Jia-Shi; He, Ming; Wang, Guang-Bin; Shen, Peng; Bai, Lun-Hao

    2015-10-01

    To compare the outcomes between hamstring tendon autograft and tibialis anterior allograft in arthroscopic transtibial single-bundle posterior cruciate ligament (PCL) reconstruction. Thirty-seven patients undergoing isolated single-bundle PCL reconstruction were enrolled in this study, and their data were retrospectively analyzed. They were divided into group A [4-strand hamstring tendon autograft (4SHG), n = 18] and group B [2-strand tibialis anterior allograft (2STAG), n = 19] and followed up for 2 years at least. Several parameters including the International Knee Documentation Committee score, Lysholm knee score, Tegner activity rating and knee laxity arthrometer were evaluated, and physical examination was performed preoperatively and postoperatively, and postoperative complications were also observed in all patients. Meanwhile, the postoperative posterior instability was compared between the affected knee and the contra-lateral knee. Compared with preoperative knee laxity and function, both groups had significant improvement postoperatively (P reconstruction. Compared with contra-lateral knees, the affected knees have slight residual knee laxity in both groups. Retrospective comparative study, Level III.

  18. Rehabilitation Charges Associated With Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Zhang, Joanne Y; Cohen, Jeremiah R; Yeranosian, Michael G; Lord, Elizabeth L; Wang, Jeffrey C; Petrigliano, Frank A; McAllister, David R

    2015-01-01

    Pre- and postoperative rehabilitation are important to the management of patients with anterior cruciate ligament (ACL) reconstruction, but little attention has been given to the costs. This study evaluated the pre- and postoperative rehabilitation charges in patients with ACL reconstruction in the United States. Patients receive preoperative rehabilitation less commonly than postoperative rehabilitation. Retrospective database study. Level 4. Using the PearlDiver database, we identified patients undergoing ACL reconstruction from 2007 through 2011 using Current Procedural Terminology codes. The associated rehabilitation charges billed to insurance providers for 90 days preoperatively and 6 months postoperatively were categorized as physical therapy or as durable medical equipment (DME). The charges were examined by year and geographic region and represented as per-patient average charges (PPACs). A total of 92,179 patients were identified in the study period. The PPAC for rehabilitation was $241 during the 90-day preoperative period and $1876 for the 6-month postoperative period. Patients averaged 2 preoperative sessions for physical therapy, with 44% of patients receiving preoperative rehabilitation in contrast with an average of 17 postoperative sessions per patient in 93% of patients. Rehabilitation charges were greater postoperatively than preoperatively (P postoperatively. Preoperative rehabilitation PPACs were highest in the Northeast, followed by Midwest, South, and West (P postoperative rehabilitation PPACs for geographic region (P = 0.43). Preoperative rehabilitation charges were lower than postoperative charges. A patient undergoing ACL reconstruction typically received 9 times more sessions of postoperative physical therapy than preoperative. This study found that preoperative supervised rehabilitation for patients with ACL reconstruction was infrequent across the United States. © 2015 The Author(s).

  19. Biologic agents for anterior cruciate ligament healing: A systematic review.

    Science.gov (United States)

    Di Matteo, Berardo; Loibl, Markus; Andriolo, Luca; Filardo, Giuseppe; Zellner, Johannes; Koch, Matthias; Angele, Peter

    2016-09-18

    To systematically review the currently available literature concerning the application of biologic agents such as platelet-rich plasma (PRP) and stem cells to promote anterior cruciate ligament (ACL) healing. A systematic review of the literature was performed on the use of biologic agents (i.e., PRP or stem cells) to favor ACL healing during reconstruction or repair. The following inclusion criteria for relevant articles were used: Clinical reports of any level of evidence, written in English language, on the use of PRP or stem cells during ACL reconstruction/repair. Exclusion criteria were articles written in other languages, reviews, or studies analyzing other applications of PRP/stem cells in knee surgery not related to promoting ACL healing. The database search identified 394 records that were screened. A total of 23 studies were included in the final analysis: In one paper stem cells were applied for ACL healing, in one paper there was a concomitant application of PRP and stem cells, whereas in the remaining 21 papers PRP was used. Based on the ACL injury pattern, two papers investigated biologic agents in ACL partial tears whereas 21 papers in ACL reconstruction. Looking at the quality of the available literature, 17 out of 21 studies dealing with ACL reconstruction were randomized controlled trials. Both studies on ACL repair were case series. There is a paucity of clinical trials investigating the role of stem cells in promoting ACL healing both in case of partial and complete tears. The role of PRP is still controversial and the only advantage emerging from the literature is related to a better graft maturation over time, without documenting beneficial effects in terms of clinical outcome, bone-graft integration and prevention of bony tunnel enlargement.

  20. Clinical characteristics of 4355 patients with anterior cruciate ligament injury.

    Science.gov (United States)

    Mei, Yu; Ao, Ying-fang; Wang, Jian-quan; Ma, Yong; Zhang, Xin; Wang, Jia-ning; Zhu, Jing-xian

    2013-12-01

    Clinical features of anterior cruciate ligament (ACL) injury are important for its prevention, diagnosis and treatment. However, few studies have reported such data, especially in China. The purpose of this study was to describe the clinical characteristics of ACL injury on a large cohort. Between 1993 and 2007, a total of 4355 ACL deficient inpatients (612 athletes and 3743 non-athletes) were registered. Data were collected using a special database system. And the distributions of characteristics in different groups were compared and analyzed statistically. All subjects were confirmed with ACL tear during surgery. Statistical analysis revealed that the percentage of females in Athlete Group was significantly higher than that in Non-athlete Group (56.05% vs. 24.95%, P ACL tears. Soccer, basketball, judo, wrestling and track and field were the five most responsible activities for athletes. The average injury time for athletes was significantly shorter than that for non-athletes (413.3 days vs. 717.5 days, P ACL reconstruction (76.04% single-bundle, 18.30% double-bundle). Three hundred and forty-five patients (7.92%) were combined with other ligaments injuries, 2667 (61.24%) were found with various grades of cartilage lesions, and 3377 (77.54%) were found with meniscal injury. Sports trauma was the main cause of ACL tears in China, and reconstruction had become the principal surgical choice. In order to restore knee joint stability and reduce the incidence of cartilage and meniscal injury, patienttailored ACL reconstruction should be suggested at the right moment.

  1. Functional Bracing After Anterior Cruciate Ligament Reconstruction: A Systematic Review.

    Science.gov (United States)

    Lowe, Walter R; Warth, Ryan J; Davis, Elizabeth P; Bailey, Lane

    2017-03-01

    The purpose of this study was to evaluate the current literature on the use of functional knee braces after anterior cruciate ligament (ACL) reconstruction with respect to clinical and in vivo biomechanical data. A systematic search of both the PubMed and Embase databases was performed to identify all studies that reported clinical and/or in vivo biomechanical results of functional bracing versus nonbracing after ACL reconstruction. Extracted data included study design, surgical reconstruction techniques, postoperative rehabilitation protocols, objective outcomes, and subjective outcomes scores. The in vivo biomechanical data collected included kinematics, strength, function, and proprioception. Subjective clinical outcomes scores were collected when available. Quality appraisal analyses were performed using the Cochrane Collaboration tools for randomized and nonrandomized trials to aid in data interpretation. Fifteen studies met the selection criteria (including 3 randomized trials [level II], 11 nonrandomized trials [level II], and 1 retrospective comparative study [level III]), with follow-up intervals ranging from 3 to 48 months. Most studies were designed to compare the effects of functional bracing versus nonbracing on subjective and objective results in patients who underwent previous primary ACL reconstruction. Functional bracing significantly improved kinematics of the knee joint and improved gait kinetics, although functional bracing may decrease quadriceps activation without affecting functional tests, range of motion, and proprioception. Four studies reported no differences in subjective outcomes scores with brace use; however, one study reported increased patient confidence with brace use, whereas another study reported decreased pain and quicker return to work when the brace was not used. The effectiveness of postoperative functional bracing following ACL reconstruction remains elusive. Some data suggest that functional bracing may have some benefit

  2. Postoperative complications of anterior cruciate ligament reconstruction after ambulatory surgery.

    Science.gov (United States)

    Andrés-Cano, P; Godino, M; Vides, M; Guerado, E

    2015-01-01

    To study postoperative complications of arthroscopic anterior cruciate ligament (ACL) reconstruction performed as an outpatient compared with same surgery performed as a regular admission (inpatient). A study was conducted on a historical cohort of 342 patients (115 outpatients vs 227 inpatients) who underwent arthroscopic ACL primary ligamentoplasty (2004-2012). A review was performed on the demographic, surgical and hospital variables. A study was made of early complications (60 days postoperative) including visits to emergency department and readmissions. A descriptive and bivariate distribution analysis was performed between groups, with the grouping criterion: performing of the surgery with or without admission. The Chi-square test was used for qualitative variables and Mann-Whitney U test for quantitative. Limit significance p<0.05. Overall, there were 13.2% emergency department visits (mean of 1.24 visits) with an average delay of 8.22 days after discharge. pain not controlled with analgesia (6.7%), hemarthrosis that required arthrocentesis (4.4%), fever (3.2%), deep vein thrombosis (0.6%), cellulitis (0.6%), septic arthritis that required arthroscopic debridement (0.3%), and others (1.2%) including problems with immobilization. The hospital readmissions (2.3%) were for surveillance and monitoring of the surgical wound. In the bivariate analysis no statistically significant differences were found between groups as regards the sociodemographic characteristics of the patients or the complications recorded. The most frequent complications recorded were acute pain, hemarthrosis and fever. Serious complications (deep vein thrombosis, septic arthritis or need for hospital readmission) were rare. Outpatient arthroscopic ACL repair is a common technique that can be performed safely by surgery without admission, with an overall low complication rate with no differences between outpatients and inpatients. Copyright © 2014 SECOT. Published by Elsevier Espana. All

  3. Characteristics of inpatient anterior cruciate ligament reconstructions and concomitant injuries.

    Science.gov (United States)

    Bates, Nathaniel A; McPherson, April L; Rao, Marepalli B; Myer, Gregory D; Hewett, Timothy E

    2016-09-01

    The purpose of this epidemiologic study was to quantify the incidence, expense, and concomitant injuries for anterior cruciate ligament reconstruction (ACLR) procedures in the USA from 2003 to 2011 that required an inpatient stay. It was hypothesized that the relative reported rates of concomitant knee injuries would be greater with the MCL and menisci compared to all other concomitant knee injuries. The National Inpatient Sample from 2003 to 2011 was retrospectively sampled using ICD-9-CM codes to identify ACLR patients and to extrapolate national averages. Between the years of 2003-2011, an average of 9,037 ± 1,728 inpatient hospitalization included ACLRs, of which 4,252 ± 1,824 were primarily due to the ACLR. Inpatient visits primarily due to ACLR involved an average hospitalization of 1.7 ± 0.2 days and cost $30,118 ± 9,066 per patient. Knee injuries that were commonly reported along with inpatient ACLRs included medial meniscus damage (18.1 %), lateral meniscus damage (16.8 %), collateral ligament repairs (12.3 %), and medial collateral ligament strains (6.9 %). Prevalence of meniscus injuries was consistent across years, but MCL-related injuries increased over time. ACLR-related inpatient hospitalizations account for approximately 7.1 % of the total ACLRs performed annually in the USA. Inpatient ACLR procedures continue to decrease in frequency; however, the mean cost per patient increased. Meniscus and collateral ligament injuries were the most commonly reported concomitant knee injuries. The clinical relevance of this investigation is that it informs, on a large clinical cohort of patients, the current state of incidence and expense for ACLR surgeries in an inpatient setting. Prognostic, retrospective study, Level II.

  4. Femoral Condyle Fracture during Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Selahattin Ozyurek

    2015-07-01

    Full Text Available Dear Editor,We have greatly enjoyed reading the case report entitled “‘Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature in the issue of Arch Bone Jt Surg. 2015;3(2 with great interest. We would like to commend the authors for their detailed and valuable work. Although various case reports have described postoperative distal femur fracture at a range of time intervals (1,2 intraoperative intra-articular distal femur fracture is a unique entity.However, we believe that some important additional observations seem necessary to be contributed through this study. In this article, the authors stated that, to the best of their knowledge, there is no other case report in the literature introducing a femoral condyle fracture during arthroscopic ACL reconstruction or revision reconstruction. Nevertheless, we would like to call the attention of the readers to the fact that that the literature contains one additional case report re‌porting on intraoperative distal femoral coronal plane (Hoffa fracture during primary ACL reconstruction (2. Werner BC and Miller MD presented of case report of an intraoperative distal femoral coronal plane (Hoffa fracture that occurred during independent femoral tunnel drilling and dilation in a primary ACL reconstruction. As in the their case, this type of fracture can occur with appropriately placed femoral tunnels, but the risk can increase with larger graft diameters in patients with smaller lateral femoral condyles The patient was treated with open reduction and internal fixation, without compromise of graft stability and with good recovery of function. We believe that tailoring graft size to the size of the patient is important to prevent similar adverse events.

  5. Preoperative cryotherapy use in anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Koyonos, Loukas; Owsley, Kevin; Vollmer, Emily; Limpisvasti, Orr; Gambardella, Ralph

    2014-12-01

    Unrelieved postoperative pain may impair rehabilitation, compromise functional outcomes, and lead to patient dissatisfaction. Preemptive multimodal analgesic techniques may improve outcomes after surgery. We hypothesized that patients using preoperative cryotherapy plus a standardized postoperative treatment plan will have lower pain scores and require less pain medication compared with patients receiving a standardized postoperative treatment plan alone after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR). A total of 53 consecutive patients undergoing arthroscopically assisted ACLR performed by one of seven surgeons were randomly assigned to one of two groups. Group 1 received no preoperative cryotherapy and group 2 received 30 to 90 minutes of preoperative cryotherapy to the operative leg using a commercial noncompressive cryotherapy unit. Visual analog scale pain scores and narcotic use were recorded for the first 4 days postoperatively. Total hours of cold therapy and continuous passive motion (CPM) use and highest degree of flexion achieved were recorded as well. Group 1 consisted of 26 patients (15 allograft Achilles tendon and 11 autograft bone patellar tendon bone [BPTB]), and group 2 consisted of 27 patients (16 allograft Achilles tendon and 11 autograft BPTB). Group 2 patients reported less pain (average 1.3 units, p cryotherapy, hours of CPM use, or maximum knee flexion achieved. Complications did not occur in either group. This is the first report we are aware of showing the postoperative effects of preoperative cryotherapy. Our results support the safety and efficacy of preoperative cryotherapy in a multimodal pain regimen for patients undergoing ACL reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Early Results of Anatomic Double Bundle Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Demet Pepele

    2014-03-01

    Full Text Available Aim: The goal in anterior cruciate ligament reconstruction (ACLR is to restore the normal anatomic structure and function of the knee. In the significant proportion of patients after the traditional single-bundle ACLR, complaints of instability still continue. Anatomic double bundle ACLR may provide normal kinematics in knees, much closer to the natural anatomy. The aim of this study is to clinically assess the early outcomes of our anatomical double bundle ACLR. Material and Method: In our clinic between June 2009 and March 2010, performed the anatomic double bundle ACLR with autogenous hamstring grafts 20 patients were evaluated prospectively with Cincinnati, IKDC and Lysholm scores and in clinically for muscle strength and with Cybex II dynamometer. Results: The mean follow-up is 17.8 months (13-21 months. Patients%u2019 scores of Cincinnati, IKDC and Lysholm were respectively, preoperative 18.1, 39.3 and 39.8, while the post-op increased to 27.2, 76.3 and 86.3. In their last check, 17 percent of the patients according to IKDC scores (85% A (excellent and B (good group and 3 patients took place as C (adequate group. The power measurements of quadriceps and hamstring muscle groups of patients who underwent surgery showed no significant difference compared with the intact knees. Discussion: Double-bundle ACL reconstruction is a satisfactory method. There is a need comparative, long-term studies in large numbers in order to determine improving clinical outcome, preventing degeneration and restoring the knee biomechanics better.

  7. Motives for sports participation as predictions of self-reported outcomes after anterior cruciate ligament injury of the knee

    DEFF Research Database (Denmark)

    Roessler, K K; Andersen, Tonny Elmose; Lohmander, S

    2015-01-01

    Aim of the study was to access how individual's motives for participation in sports impact on self-reported outcomes 2 years after an anterior cruciate ligament injury. Based on a longitudinal cohort study, this secondary analysis present data from the Knee Anterior Cruciate Ligament, Nonsurgical...

  8. Measurement of functional recovery after an anterior cruciate ligament reconstruction in competitive athletes; development of a measuring method

    NARCIS (Netherlands)

    Reininga, I.HF; Lemmink, K.A.P.M.; Krijt, D.I.; Waninge, H.; Diercks, Ron; Stevens, M.

    2005-01-01

    Many athletes with an anterior cruciate ligament tear do not return to their original sport level after reconstruction, in spite of good results on clinical tests. After an anterior cruciate ligament tear, knee joint proprioception is shown to be decreased. This leads to the use of compensatory

  9. Neuroplasticity following anterior cruciate ligament injury: a framework for visual-motor training approaches in rehabilitation.

    Science.gov (United States)

    Grooms, Dustin; Appelbaum, Gregory; Onate, James

    2015-05-01

    The neuroplastic effects of anterior cruciate ligament injury have recently become more evident, demonstrating underlying nervous system changes in addition to the expected mechanical alterations associated with injury. Interventions to mitigate these detrimental neuroplastic effects, along with the established biomechanical changes, need to be considered in the rehabilitation process and return-to-play progressions. This commentary establishes a link between dynamic movement mechanics, neurocognition, and visual processing regarding anterior cruciate ligament injury adaptations and injury risk. The proposed framework incorporates evidence from the disciplines of neuroscience, biomechanics, motor control, and psychology to support integrating neurocognitive and visual-motor approaches with traditional neuromuscular interventions during anterior cruciate ligament injury rehabilitation. Physical therapists, athletic trainers, strength coaches, and other health care and performance professionals can capitalize on this integration of sciences to utilize visual-training technologies and techniques to improve on already-established neuromuscular training methods. Therapy, level 5.

  10. BONE TUNNEL WIDENING AFTER ANTERIOR CRUCIATE LIGAMENT AUTOPLASTY WITH HAMSTRINGS (LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    V. V. Slastinin

    2017-01-01

    Full Text Available ABSTRACT Such a phenomenon as bone tunnel widening after anterior cruciate ligament autoplasty with hamstrings has been known for 30 years. Despite the long history of this issue, the etiology is still not fully understood. The process of expansion of the bone tunnels is influenced by many factors such as graft fixation technique, surgical technique and rehabilitation protocol, as well as various biological factors. It is believed that this phenomenon has no influence on a functional result, but may create serious problems in revision anterior cruciate ligament surgery. Given the growing interest in the use of hamstring tendon grafts for anterior cruciate ligament reconstruction, increasing number of these operations and as a result, of revision procedures, the search for methods of bone tunnel widening prevention is becoming more urgent.

  11. Perception of symmetry and asymmetry in individuals with anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Roper, Jaimie A; Terza, Matthew J; Hass, Chris J

    2016-12-01

    Changes in the quantity, quality and integration of sensory information are thought to persist long after anterior cruciate ligament reconstruction and completion of physical therapy. Our purpose was to investigate the ability of individuals with anterior cruciate ligament reconstruction to perceive imposed asymmetry and symmetry while walking. Twenty participants with anterior cruciate ligament reconstruction and 20 controls walked on a split-belt treadmill while we assessed the ability to detect symmetry and asymmetry at fast and slow speeds. Detection scores and spatiotemporal data during asymmetric and symmetric tasks in which the belts were coupled or decoupled over time were recorded. The ability to detect symmetry and asymmetry was not altered in individuals with anterior cruciate ligament reconstruction compared to healthy young adults. The belt-speed ratio at detection also correlated to asymmetry for step length, stride length, double support time, and stance time. However, the anterior cruciate ligament reconstruction group appeared to utilize unique information to determine detection. When asked to detect symmetry at a fast speed, no asymmetry scores significantly correlated with belt-speed ratio in the anterior cruciate ligament reconstruction group. Conversely, asymmetry in stride length, step length, and stance time all significantly correlated with belt-speed ratio at detection in the control group. Specific sensory cues arising from the speed of the leg may also augment perception of symmetry. This strategy may be necessary in order to successfully execute the motor task, and could develop due to altered sensory information from the reconstructed knee at faster walking speeds. Published by Elsevier Ltd.

  12. Different roles of the medial and lateral hamstrings in unloading the anterior cruciate ligament.

    Science.gov (United States)

    Guelich, David R; Xu, Dali; Koh, Jason L; Nuber, Gordon W; Zhang, Li-Qun

    2016-01-01

    Anterior cruciate ligament injuries are closely associated with excessive loading and motion about the off axes of the knee, i.e. tibial rotation and knee varus/valgus. However, it is not clear about the 3-D mechanical actions of the lateral and medial hamstring muscles and their differences in loading the ACL. The purpose of this study was to investigate the change in anterior cruciate ligament strain induced by loading the lateral and medial hamstrings individually. Seven cadaveric knees were investigated using a custom testing apparatus allowing for six degree-of-freedom tibiofemoral motion induced by individual muscle loading. With major muscles crossing the knee loaded moderately, the medial and lateral hamstrings were loaded independently to 200N along their lines of actions at 0°, 30°, 60° and 90° of knee flexion. The induced strain of the anterior cruciate ligament was measured using a differential variable reluctance transducer. Tibiofemoral kinematics was monitored using a six degrees-of-freedom knee goniometer. Loading the lateral hamstrings induced significantly more anterior cruciate ligament strain reduction (mean 0.764 [SD 0.63] %) than loading the medial hamstrings (mean 0.007 [0.2] %), (P=0.001 and effect size=0.837) across the knee flexion angles. The lateral and medial hamstrings have significantly different effects on anterior cruciate ligament loadings. More effective rehabilitation and training strategies may be developed to strengthen the lateral and medial hamstrings selectively and differentially to reduce anterior cruciate ligament injury and improve post-injury rehabilitation. The lateral and medial hamstrings can potentially be strengthened selectively and differentially as a more focused rehabilitation approach to reduce ACL injury and improve post-injury rehabilitation. Different ACL reconstruction procedures with some of them involving the medial hamstrings can be compared to each other for their effect on ACL loading. Copyright

  13. Alterations in patellofemoral kinematics following vastus medialis transection in the anterior cruciate ligament deficient rabbit knee.

    Science.gov (United States)

    Egloff, Christian; Sawatsky, Andrew; Leonard, Tim; Fung, Tak; Valderrabano, Victor; Herzog, Walter

    2014-05-01

    Anterior cruciate ligament deficiency and quadriceps muscle weakness are considered to be important risk factors for aberrant patellar tracking and subsequent patellofemoral osteoarthritis. However, data from in vivo experiments looking at dynamic patellar joint kinematics and muscle force are scarce. Therefore, the purpose of this study was to evaluate the effects of anterior cruciate ligament transection and loss of vastus medialis force on patellar tracking in the rabbit knee in vivo. Eight skeletally mature New Zealand White Rabbits, weighing 6.0kg (0.6kg standard deviation) were used. The experimental trials consisted of active, concentric and eccentric movements of the knee joint. Measurements were performed with the intact, the anterior cruciate ligament deficient, and the vastus medialis transected knee. Patellofemoral kinematics (shift, rotation) were quantified from high speed video. Following anterior cruciate ligament transection, patellar tracking occurred more laterally, and caused a significant lateral rotation of the patella. The addition of vastus medialis transection did not alter patellar tracking or rotation significantly for any of the force-matched experimental conditions. The loss of the anterior cruciate ligament results in lateral patellar shift and rotation while the loss of vastus medialis muscle force does not affect patellar tracking or rotation in the anterior cruciate ligament deficient knee. We suggest that the current results should be considered carefully in future interpretations of knee extensor imbalance. More research is needed to describe the contribution of vastus medialis muscle strength to medial patellofemoral stability and confirm these results in the human knee. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Combined rupture of the patellar tendon, anterior cruciate ligament and lateral.

    Science.gov (United States)

    Tsarouhas, A; Iosifidis, M; Kotzamitelos, D; Traios, S

    2011-04-01

    Simultaneous rupture of both the patellar tendon and the anterior cruciate ligament is a relatively rare injury. Its diagnosis can easily be missed during the initial examination. Treatment options include immediate repair of the patellar tendon with either simultaneous or delayed reconstruction of the ACL. We present the case of a combined rupture of the patellar tendon, the anterior cruciate ligament and the lateral meniscus in a 38-year old recreational martial arts athlete after a direct kick on his left knee. A two-stage treatment approach was performed with an excellent functional outcome.

  15. Experimental and Numerical Analysis of Screw Fixation in Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Chizari, Mahmoud; Wang, Bin; Snow, Martyn; Barrett, Mel

    2008-09-01

    This paper reports the results of an experimental and finite element analysis of tibial screw fixation in anterior cruciate ligament (ACL) reconstruction. The mechanical properties of the bone and tendon graft are obtained from experiments using porcine bone and bovine tendon. The results of the numerical study are compared with those from mechanical testing. Analysis shows that the model may be used to establish the optimum placement of the tunnel in anterior cruciate ligament reconstruction by predicting mechanical parameters such as stress, strain and displacement at regions in the tunnel wall.

  16. Surgical Treatment of a Rare Isolated Bilateral Agenesis of Anterior and Posterior Cruciate Ligaments

    Science.gov (United States)

    2014-01-01

    The isolated bilateral agenesis of both cruciate ligaments is a rare congenital disorder. A 17-year-old male came to our attention due to an alteration in gait pattern, pain, and tendency to walk on the forefoot with his knee flexed. The patient did not recall previous injuries. Upon physical examination anterior and posterior chronic instability were observed. Radiographic examination of both knees showed hypoplasia of the tibial eminence, a hypoplastic lateral femoral condyle, and a narrow intercondylar notch. MRI brought to light a bilateral agenesis of both posterior cruciate ligaments. Arthroscopic evaluation confirmed bilateral isolated agenesis of both cruciate ligaments. We recommended a rehabilitation program to prepare the patient for the arthroscopic construction of both cruciate ligaments. PMID:25197599

  17. Simultaneous bicompartmental bucket-handle meniscal tears with intact anterior cruciate ligament: a case report

    Directory of Open Access Journals (Sweden)

    Beris Alexandros E

    2010-02-01

    Full Text Available Abstract Introduction Bucket handle tear of the menisci is a common type of lesion resulting from injury to the knee joint. Bucket handle injury of both menisci in almost all cases is associated with a lesion to either the anterior or the posterior cruciate ligament of the knee joint. We describe a case of acute bucket-handle tear of the medial and lateral menisci with intact anterior and posterior cruciate ligaments in a dancer. To the best of our knowledge, there are no previous reports of this type of injury in the literature. Case presentation A 28-year-old Caucasian Greek woman presented to the emergency department after sustaining an injury to her right knee during dancing. An MRI evaluation demonstrated tears in both menisci of the right knee, while the anterior and posterior cruciate ligaments were found to be intact. A partial medial and lateral meniscectomy was then performed. At a follow-up examination six months after her injury, clinical tests demonstrated that our patient's right knee was stable, had a full range of motion and had no tenderness. She was satisfied with the outcome of the operation and returned to her pre-injury activities. Conclusion We present the first case in the literature that describes a combined bucket-handle injury of both the medial and lateral menisci with an intact anterior cruciate ligament. The clinical examination of the anterior cruciate ligament was unremarkable, with no signs of deficiency or rupture. The posterior cruciate ligament was also intact. On magnetic resonance imaging, the ligaments were visualised as intact in all their length. These findings were confirmed by arthroscopic evaluation.

  18. Trends in Anterior Cruciate Ligament Reconstruction in the United States.

    Science.gov (United States)

    Buller, Leonard T; Best, Matthew J; Baraga, Michael G; Kaplan, Lee D

    2015-01-01

    The anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee for which surgery is performed. United States national estimates of ACL reconstruction vary widely. This study sought to use the most recently available Centers for Disease Control and Prevention data to investigate changes in the utilization of inpatient and ambulatory surgery for ACL tears in the United States. Descriptive epidemiology study. The National Survey of Ambulatory Surgery, conducted in 1994, 1995, 1996, and 2006 (data from 1994, 1996, and 2006 were used in the study), and the National Hospital Discharge Survey, conducted between 1990 and 2007, were used to identify cases of ACL reconstruction. The data were analyzed for trends in demographics, treatment, and utilization. Between 1994 and 2006, the population-adjusted estimate of the rate of ACL reconstructions increased by 37% (33.0/100,000 capita or 86,837 total procedures to 45.1/100,000 capita or 134,421 total procedures). There was an increase in the proportion of females undergoing reconstruction in both the ambulatory (30% to 40%) and inpatient (29% to 47%) settings over the study period, with a 304% increase in the sex-adjusted estimate of the rate of female ambulatory procedures between 1994 and 2006. Age-adjusted estimates of the rates of ambulatory ACL reconstruction increased among all age groups, with a 924% increase in patients less than 15 years of age. Concurrent meniscectomy remained relatively constant in the ambulatory (37% to 40%) and inpatient (37% to 33%) settings between 1994 and 2007. Private insurance was the largest compensator, representing 77% of cases in 2006. Between 1994 and 2006, the use of peripheral nerve blocks during ambulatory surgery increased from 0.7% to 30.8%. The rate of ACL reconstruction increased dramatically between 1990 and 2007 based on the National Survey of Ambulatory Surgery and National Hospital Discharge Survey databases, which represents the most up

  19. Societal and economic impact of anterior cruciate ligament tears.

    Science.gov (United States)

    Mather, Richard C; Koenig, Lane; Kocher, Mininder S; Dall, Timothy M; Gallo, Paul; Scott, Daniel J; Bach, Bernard R; Spindler, Kurt P

    2013-10-02

    An anterior cruciate ligament (ACL) tear is a common knee injury, particularly among young and active individuals. Little is known, however, about the societal impacts of ACL tears, which could be large given the typical patient age and increased lifetime risk of knee osteoarthritis. This study evaluates the cost-effectiveness of ACL reconstruction compared with structured rehabilitation only. A cost-utility analysis of ACL reconstruction compared with structured rehabilitation only was conducted with use of a Markov decision model over two time horizons: the short to intermediate term (six years), on the basis of Level-I evidence derived from the KANON Study and the Multicenter Orthopaedic Outcomes Network (MOON) database; and the lifetime, on the basis of a comprehensive literature review. Utilities were assessed with use of the SF-6D. Costs (in 2012 U.S. dollars) were estimated from the societal perspective and included the effects of the ACL tear on work status, earnings, and disability. Effectiveness was expressed as quality-adjusted life years (QALYs) gained. In the short to intermediate term, ACL reconstruction was both less costly (a cost reduction of $4503) and more effective (a QALY gain of 0.18) compared with rehabilitation. In the long term, the mean lifetime cost to society for a typical patient undergoing ACL reconstruction was $38,121 compared with $88,538 for rehabilitation. ACL reconstruction resulted in a mean incremental cost savings of $50,417 while providing an incremental QALY gain of 0.72 compared with rehabilitation. Effectiveness gains were driven by the higher probability of an unstable knee and associated lower utility in the rehabilitation group. Results were most sensitive to the rate of knee instability after initial rehabilitation. ACL reconstruction is the preferred cost-effective treatment strategy for ACL tears and yields reduced societal costs relative to rehabilitation once indirect cost factors, such as work status and earnings

  20. Meniscal tears associated with anterior cruciate ligament injury.

    Science.gov (United States)

    Hagino, Tetsuo; Ochiai, Satoshi; Senga, Shinya; Yamashita, Takashi; Wako, Masanori; Ando, Takashi; Haro, Hirotaka

    2015-12-01

    To investigate the frequency of meniscal tear and the location of tear associated with anterior cruciate ligament (ACL) injury. We studied 549 patients (552 knees) who were diagnosed with ACL injury by arthroscopy at our center between January 2006 and March 2014 (8 years and 3 months). The subjects comprised 289 males and 263 females ranging in age from 13 to 66 (mean 26.1) years. The cause of injury was sports-related in 89.1 %, and the mean interval from injury to initial arthroscopy was 23 months. The patients were divided into two groups: arthroscopy performed within 8 weeks after injury (acute group; 256 knees) and more than 8 weeks after injury (chronic group; 296 knees). Frequency of meniscal tear and location of tear were compared between two groups. The incidence of meniscal tear diagnosed by arthroscopic examination was 79.2 % (437 of 552 knees) in all subjects; 72.7 % (186 of 256 knees) in acute group and 84.8 % (251 of 296 knees) in chronic group, and was significantly higher in chronic group. Regarding the locations of meniscal tears, in acute group (186 knees), medial meniscal tear only was found in 20 knees (10.8 %), lateral meniscal tear only in 129 knees (69.4 %), and bilateral (including medial and lateral) meniscal tears in 37 knees (19.9 %). In chronic group (251 knees), medial meniscal tear only was found in 62 knees (24.7 %), lateral meniscal tear only in 85 knees (33.9 %), and bilateral meniscal tears in 104 knees (41.4 %). Lateral meniscal tear was commonly associated with acute ACL injury, while medial meniscal tear with chronic ACL injury. Bucket handle tear was observed in 25 knees (medial: 17 knees, lateral: 8 knees) in acute group, and 81 knees (medial: 69 knees, lateral: 12 knees) in chronic group, and was more common in the chronic group. The incidence of meniscal tear associated with ACL injury is higher in chronic cases; the number of medial meniscal tears is particularly high, many of which require meniscectomy. Early ACL

  1. Psychological Factors Associated With Anterior Cruciate Ligament Reconstruction Recovery.

    Science.gov (United States)

    Christino, Melissa A; Fleming, Braden C; Machan, Jason T; Shalvoy, Robert M

    2016-03-01

    Psychological factors may have underappreciated effects on surgical outcomes after anterior cruciate ligament (ACL) reconstruction; however, few studies have investigated the relationship between specific psychological factors, objective clinical data, and patient-oriented outcomes. Psychological factors are significantly associated with patient perceptions and functional outcomes after ACL reconstruction. The purpose of this study was to demonstrate relationships between self-esteem, health locus of control, and psychological distress with objective clinical outcomes, patient-oriented outcomes, and return to sport. Cross-sectional study; Level of evidence, 3. Twenty-seven patients who were 6 to 24 months post-computer-assisted ACL reconstruction by a single surgeon consented to participate in the study (52% response rate). Participants had a 1-time visit with a physician consisting of: a physical examination, a single-leg hop test, KT-1000 arthrometer measurements, and survey completion. Psychological measures included the Multidimensional Health Locus of Control Scale, Rosenberg Self-Esteem Scale, and Brief Profile of Mood States. Outcome measures included the Tegner activity scale, International Knee Documentation Committee (IKDC) Subjective Knee Score, Knee injury and Osteoarthritis Outcome Score-Quality of Life subscale (KOOS-QOL), and Short Form-36 (SF-36). Patient charts were also reviewed for pertinent operative details. The mean age of patients (±SD) was 25.7 ± 8.4 years, and the mean duration of time since surgery was 16.5 ± 5.9 months. The majority (89%) of the patients identified themselves as athletes, and of these, 65% reported returning to sports at a competitive level. Sport returners were found to have higher levels of self-esteem (P = .002) and higher reported KOOS-QOL scores (P = .02). Self-esteem was significantly associated with IKDC scores (r = 0.46, P physical functioning (r = 0.42, P Self-esteem levels and locus of control had significant

  2. Anterior cruciate ligament injury: A persistently difficult diagnosis.

    Science.gov (United States)

    Parwaiz, Hammad; Teo, Alex Q A; Servant, Christopher

    2016-01-01

    Historically anterior cruciate ligament (ACL) injuries have been diagnosed poorly. A paper published in Injury in 1996 showed that less than 10% of patients with an ACL injury had the diagnosis made by the first physician to see them and that the average delay from first presentation to diagnosis was 21 months. The aim of our study was to investigate whether an improvement has been made over the last two decades in diagnosing ACL injuries. We identified 160 patients who had an ACL reconstruction performed by a single surgeon between October 2004 and December 2011 and for whom a complete data set was available. Data was extracted retrospectively from the hospital notes and a dedicated patient database. We performed a sub-group analysis comparing patients seen prior to the introduction of an acute knee injury clinic in April 2007 and patients seen after the introduction of the clinic. 75.1% (120/160) of patients presented first to an emergency department (ED) or to their general practitioner (GP), but only 14.4% (23/160) were diagnosed on initial presentation. The median number of healthcare professionals a patient saw prior to a diagnosis of ACL injury was 3. The median delay from injury to presentation was 0 weeks (range 0-885), injury to diagnosis 13 weeks (0-926), presentation to diagnosis 10 weeks (0-924), presentation to a specialist knee clinic 24 weeks (0-1006), and specialist knee clinic to surgery 13 weeks (0-102). The median total time from injury to surgery was 42 weeks (0-1047). Following the implementation of an acute knee injury clinic in 2007, the median delay from presentation to surgery dropped from 59 weeks to 36 weeks (p = 0.050) and there was a significant decrease in the median delay from specialist knee clinic to surgery from 23 to 11 weeks (p=0.002). Over the past two decades there appears to have been little improvement in the early diagnosis of ACL injuries, with only 14.4% of patients being diagnosed correctly at initial presentation. We

  3. Anterior cruciate ligament deterioration correlates with patella osteoarthritis.

    Science.gov (United States)

    Iriuchishima, Takanori; Ryu, Keinosuke; Aizawa, Shin; Yorifuji, Hiroshi; Ohyama, Tetsuji; Fu, Freddie H

    2014-04-01

    The correlation between anterior cruciate ligament (ACL) condition and patella osteoarthritic (OA) changes has not been well reported. The aim of this study was to reveal the correlation between ACL deterioration and the morphology of OA changes in the patella. The hypothesis was that significant correlation between ACL deterioration and patella OA morphology would be revealed in this study. Two hundred ninety-one cadaveric knees from 151 cadavers were included in this study with a median age of 83 years (54-98). Knees were opened with a sub-vastus approach and the ACL condition was classified as intact or deteriorated. Patella OA lesions were classified using Han's method: type 1, no or minimal lesion; type 2, medial facet lesion without involvement of the ridge; type 3, lateral facet lesion without involvement of the ridge; type 4, lesion involving the ridge only; type 5, medial facet lesion with involvement of the ridge; type 6, lateral facet lesion with involvement of the ridge; and type 7, global lesion. OA depth evaluation was performed following Outerbridge's classification. Statistical analysis of the collected data was performed using generalized estimating equations (GEE). The ACL was intact in 277 knees and deteriorated in 14 knees. Patella OA lesions were observed as follows: type 1, 29%; type 2, 15%; type 3, 2%; type 4, 12%; type 5, 18%; type 6, 2%; and type 7, 22%. Outerbridge's classification of over grade 2 OA depth was observed in 73.5% of subjects. When patella OA was divided into types 1-4 and types 5-7, ACL deterioration was correlated with the occurrence of type 5-7 patella OA [OR 6.44, 95%CI 2.27-18.25, p = 0.000]. When patella OA was divided into types 1-6 and type 7, ACL deterioration was correlated with the occurrence of type 7 patella OA [OR 6.02, 95%CI 2.57-14.09, p = 0.000]. When patella OA depth was divided into grades 1-3 and grade 4, ACL deterioration was highly correlated with the occurrence of grade 4 patella OA [OR 9.31, 95

  4. Predictors of radiographic knee osteoarthritis after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Li, Ryan T; Lorenz, Stephan; Xu, Yan; Harner, Christopher D; Fu, Freddie H; Irrgang, James J

    2011-12-01

    Evidence suggests that single-bundle anterior cruciate ligament (ACL) reconstruction does not reliably prevent the development of knee osteoarthritis (OA). This study was conducted to determine the overall prevalence of and risk factors for the development of radiographic knee OA after single-bundle ACL reconstruction. Case control study; Level of evidence, 3. There were 249 individuals who had undergone primary single-bundle ACL reconstruction included in this retrospective cohort study. Follow-up radiographs were scored by a single orthopaedic surgery sports medicine fellow using the Kellgren-Lawrence (KL) scale to determine the degree of OA in the medial, lateral, and patellofemoral compartments. Radiographic OA of the involved knee was considered to be present if, compared with the noninvolved knee, there was at least a 2-grade difference in the KL score in at least 1 compartment or a 1-grade difference in at least 2 compartments. Predictors of OA that were explored included patient age, sex, body mass index (BMI), smoking status activity level, meniscectomy before or concurrent with ACL reconstruction, chondral injury present at the time of ACL reconstruction, graft type and source, tibial and femoral tunnel positions, need for revision, and length of follow-up. Univariable and stepwise multivariable logistic regressions were used to identify factors that were associated with radiographic knee OA. Thirty-nine percent of the patients had radiographic OA an average of 7.8 years after surgery. Female sex, BMI, time from injury to surgery, medial and patellofemoral compartment chondrosis, prior medial or lateral meniscectomy, concurrent medial meniscectomy, and length of follow-up were associated with radiographic knee OA after ACL surgery. Stepwise multivariable logistic regression indicated that prior medial meniscectomy (95% confidence interval [CI], 1.39-6.85), grade 2 or greater medial chondrosis (95% CI, 1.27-6.73), length of follow-up (95% CI, 1

  5. Fifty most-cited articles in anterior cruciate ligament research.

    Science.gov (United States)

    Voleti, Pramod B; Tjoumakaris, Fotios P; Rotmil, Gayle; Freedman, Kevin B

    2015-04-01

    The number of times an article has been cited in the peer-reviewed literature is indicative of its impact on its respective medical specialty. No study has used citation analysis to determine the most influential studies pertaining to the anterior cruciate ligament (ACL). The primary aims of this study were to identify the classic works in ACL research using citation analysis and to characterize these articles to determine which types of studies have had the most influence on the field. A systematic query of ISI Web of Science (Thomson Reuters, Philadelphia, Pennsylvania) was performed for articles pertaining to the ACL, and the 50 most-cited articles were selected for evaluation. The following characteristics were determined for each article: number of citations, citation density, journal, publication year, country of origin, language, article type, article subtype, and level of evidence. The number of citations ranged from 219 to 1073 (mean, 326), and the citation densities ranged from 4.9 to 55.6 citations per year (mean, 18.2). All articles were published in 1 of 11 journals, with the most being published in The American Journal of Sports Medicine (46%) and The Journal of Bone and Joint Surgery American (30%). The most common decades of publication were the 1990s (34%), 1980s (28%), and 2000s (26%). The majority (68%) of articles originated from the United States, and all were written in English. By article type, 42% were basic science, and 58% were clinical. Of the clinical articles, 3% were Level I, 17% were Level II, 28% were Level III, and 52% were Level IV. The articles were heterogeneous with regard to article type, article subtype, and level of evidence and tended to have the following characteristics: high-impact journal of publication, recent publication year, US origin, English language, and low level of evidence. These works represent some of the most popular scientific contributions to ACL research. This list may aid residency and fellowship

  6. Combined chronic anterior cruciate ligament and posterior cruciate ligament reconstruction: functional and clinical results.

    Science.gov (United States)

    Denti, Matteo; Tornese, Davide; Melegati, Gianluca; Schonhuber, Herbert; Quaglia, Alessandro; Volpi, Piero

    2015-10-01

    Multiligamentous injury to the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) is an uncommon but debilitating event. Patients with combined ligament injuries typically complain of painful, debilitating knee instability that restricts their sports and daily activities. The purpose of this retrospective study was to evaluate functional and clinical outcomes of patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot. Medical records of 20 consecutive patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot were retrospectively reviewed. All patients had received either an allograft (group A) or a semitendinosus-gracilis graft for ACL repair and a bone-patellar tibial-bone graft for PCL repair (group B). Functional outcomes, after the initial follow-up period at 24-month FU, were assessed with concentric isokinetic knee extensor-flexor testing at 60 and 180°/s. The secondary aim was to compare long-term clinical recovery by the administration of the IKDC (International Knee Document Committee) Knee Ligament Evaluation Form, the Lysholm Knee Scoring Scale and the Cincinnati Knee Rating Scale. The mean per cent quadriceps strength deficit in the operated as compared to the healthy knee was 13.5 % in group A and 15 % in group B (angular velocity 60°/s) and 13.5 % in group A and 9.4 % in group B (angular velocity 180°/s). The mean per cent flexor strength deficit in the operated as compared to the healthy knee was 10.4 % in group A and 12.3 % in group B (angular velocity 60°/s) and 12.2 % in group A and 9 % in group B (angular velocity of 180°/s). The flexor-quadriceps ratio was 49.4 % in group A and 48.8 % in group B in the healthy knee and 53.2 % in group A and 53.8 % in group B in the operated knee (angular velocity 60°/s) and 63.9 % in group A and 60.7 % in group B in

  7. Prevention, treatment, and rehabilitation of anterior cruciate ligament injuries in children

    Directory of Open Access Journals (Sweden)

    Lang PJ

    2017-06-01

    Full Text Available Pamela J Lang,1,2 Dai Sugimoto,1–3 Lyle J Micheli1–3 1Division of Sports Medicine, Department of Orthopedics, Boston Children’s Hospital, 2Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 3The Micheli Center for Sports Injury Prevention, Waltham, MA, USA Abstract: As more children and adolescents participate in competitive organized sports, there has been an increase in the reported incidence of anterior cruciate ligament (ACL injuries in these age groups. ACL injuries in skeletally immature athletes present a challenge, as reconstruction must preserve the physis of the distal femur and of the proximal tibia to avoid growth disturbances. Historically, a skeletally immature athlete with an ACL injury was treated with a brace and activity modification until skeletal maturity, with ACL reconstruction being performed at that time in the “non-copers” who experienced instability. More recently, evidence has shown that delayed reconstruction may lead to increased damage to the meniscus and articular cartilage. As a result, early reconstruction is favored to protect the meniscus and allow continued physical activity. While adolescents at or those near skeletal maturity may be treated with standard reconstruction techniques, they may result in growth disturbances in younger athletes with significant growth remaining. In response to the growing need for ACL reconstruction techniques in skeletally immature individuals, physeal-sparing and physeal-respecting reconstruction techniques have been developed. In addition to the advancements in surgical technique, ACL injury prevention has also gained attention. This growing interest in ACL prevention is in part related to the high risk of ACL re-tear, either of the ACL graft or of the contralateral ACL, in children and adolescents. Recent reports indicate that well-designed neuromuscular training programs may reduce the risk of primary and subsequent ACL injuries. Keywords

  8. Anterior cruciate ligament reconstruction in adolescent patients: limb asymmetry and functional knee bracing.

    Science.gov (United States)

    Dai, Boyi; Butler, Robert J; Garrett, William E; Queen, Robin M

    2012-12-01

    Anterior cruciate ligament (ACL) reinjury rates are high in adolescent patients. Knee braces are commonly used after ACL reconstruction to prevent reinjury during return to sports. Adolescent patients following ACL injury would demonstrate a decreased vertical ground-reaction force, knee extension moment, knee flexion angle, and knee flexion velocity on the surgical limb when compared with the nonsurgical limb during a side-cutting task. A functional knee extension-resistant brace would decrease the limb asymmetries. Controlled laboratory study. Twenty-three adolescent patients 6 months after ACL reconstruction were recruited for this study. Three-dimensional kinematic and kinetic data were collected bilaterally (surgical, nonsurgical) during a 35° side-cutting task while the patient was wearing and not wearing a functional knee extension-resistant brace (nonbraced, braced) on the surgical limb. The surgical limb demonstrated a significant decrease in peak impact vertical ground-reaction force (2.55 body weight [BW] vs 2.8 BW; P knee extension moment (0.13 BW × body height [BH] vs 0.17 BW × BH; P knee flexion angle at peak knee flexion velocity (27.8° vs 30.0°; P = .01), peak knee flexion angle (44.1° vs 48.5°; P knee flexion velocity (571.3 deg/sec vs 640.1 deg/sec; P braced conditions. Bracing increased the initial knee flexion velocity (42.4 deg/sec vs -40.2 deg/sec; P = .01) and decreased the initial knee flexion angle on the surgical limb (13.1° vs 15.7°; P knee brace. There were changes in the surgical knee kinematics with and without bracing, especially near initial ground contact. The limb asymmetries are of concern with regard to injuring the graft or the contralateral limb when the patients return to sport.

  9. The Effect of Kinesiotaping Implementation After Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Ural, İbrahim Halil; Duymaz, Tomris; Özgönenel, Levent

    2017-01-01

    Objective: The main aim of this study was to measure effects of kinesiotaping on pain and range of motion in the conservative treatment of postoperative anterior cruciate ligament(ACL) rupture. Material-Methods: A total of 26 patients(24 women, 2 men) who had unilateral ACL rupture 64.46±9.00 years old(46-81years), 13 had physiotherapy only(mean age 64.46±9.35 years),13 had physiotherapy and kinesiotape(mean age 64.46±9.01 years).The patients in both groups received physiotherapy program (ultrasound with 1 MHz, 1W/cm2 during 5minutes; CPM; strength exercise for quadriceps muscle and cold pack during 15 minute). Kinesiotape was applied to the knee and quadriceps of the patient’s leg using a prescribed application to facilitate muscle performance for the experimental group versus a only physiotherapy group.The patients were treated 20 times for four weeks. Socio-demographic variables (gender, age, body mass index, Kellgren-Lawrence system for classification of knee osteoarthritis, use of analgesic drug, pain during rest and activity (VAS=Visual Analog Scale), range of motion of knee flexion and extansion (universal goniometer), circumference measurements of the knee and the quadriceps muscle (up to 10 cm of patella) were measured at baseline, mid the treatment program and after the treatment program. Statistical analysis was conducted using SPSS 22.0 for Windows.Frequency and percentage (average, standard deviation)were used as descriptive statistics of the study.The Wilcoxon test was used to compare the differences between before and after treatment measurements.The Kruskal Wallis test was used to compare groups.Significance was accepted as pKinesiotape Group Physiotherapy Group p VAS rest Pretreatment 2.07±2.49 2.38±2.72 0.705 Midtreatment 0.46±0.96 1.84±2.03 0.056 Posttreatment 0.07±0.27 2.07±2.36 0.008* p 0.017* 0.046* VAS activity Pretreatment 4.69±3.19 6.00±2.08 0.253 Midtreatment 0.84±0.80 4.30±1.70 0.000** Posttreatment 0.15±0.37 3.61±1.75 0

  10. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction in knees with osteoarthritis and deficient anterior cruciate ligament.

    Science.gov (United States)

    Tian, Shaoqi; Wang, Bin; Wang, Yuanhe; Ha, Chengzhi; Liu, Lun; Sun, Kang

    2016-08-05

    Relative young and more active patients with osteoarthritis (OA) of the isolated medial femorotibial compartment in conjunction with anterior cruciate ligament (ACL) deficiency are difficult to treat. The aim of this study was to explore the early clinical outcomes of combined Oxford unicompartmental knee arthroplasty (UKA) and ACL reconstruction for the patients presenting ACL deficiency and isolated OA of the medial compartment. Twenty-eight patients were included into the study. All patients were treated by combined Oxford UKA and ACL reconstruction. Plain radiographs in the antero-posterior and lateral view and long-leg standing radiographs were routinely performed prior to and after surgery. Stress radiographs in valgus were additionally available in order to verify the well-preserved lateral compartment. The varus deformity of the knee prior to surgery and the valgus degree after surgery, the posterior slope of the tibial component and the range of motion (ROM) of the knee after surgery were measured and recorded. Clinical evaluations include Oxford Knee Score (OKS), Knee Society Score (KSS-clinical score; KSS-function score) and Tegner activity score. All the patients were followed up for 52 ± 8 months. The leg alignment showed 3.1 ± 0.6° of varus deformity prior to surgery and 4.0 ± 0.7° of valgus after surgery. The OKS, KSS and Tegner activity score improved significantly after surgery (P < 0.05). The mean ROM of the operated knee was 123.5 ± 2.8° at the last follow-up. The posterior slope of the tibial component was 3.9 ± 1.2°. A significant correlation was found between them according to the Pearson's correlation (r = 0.39, P = 0.03). There were 2 patients (7 %) with the complication of mobile bearing dislocation, and a second operation of replacing a thicker mobile bearing was performed for them. The early clinical data have shown that combined surgery of UKA and ACL reconstruction has revealed promising

  11. Functional bracing after anterior cruciate ligament reconstruction: a prospective, randomized, multicenter study.

    Science.gov (United States)

    McDevitt, Edward R; Taylor, Dean C; Miller, Mark D; Gerber, John P; Ziemke, Gregg; Hinkin, Daniel; Uhorchak, John M; Arciero, Robert A; Pierre, Patrick St

    2004-12-01

    Bracing after anterior cruciate ligament reconstruction is expensive and is not proven to prevent injuries or influence outcomes. To determine whether postoperative functional knee bracing influences outcomes. Prospective, randomized, multicenter clinical trial. One hundred volunteers from the 3 US service academies with acute anterior cruciate ligament tears were randomized into braced or nonbraced groups. Only those subjects with anterior cruciate ligament tears treated surgically within the first 8 weeks of injury were included. Patients with chondral injuries, significant meniscal tears, or multiple knee ligament injuries were excluded. Surgical procedures and the postoperative physical therapy protocols were identical for both groups. The braced group was instructed to wear an off-the-shelf functional knee brace for all cutting, pivoting, or jumping activities for the first year after surgery. Ninety-five subjects were available with a minimum 2-year follow-up. There were no statistically significant differences between groups in knee stability, functional testing with the single-legged hop test, International Knee Documentation Committee scores, Lysholm scores, knee range of motion, or isokinetic strength testing. Two braced subjects had reinjuries, and 3 nonbraced subjects had reinjuries. In this young, active population, postoperative bracing does not appear to change the clinical outcomes after anterior cruciate ligament reconstruction.

  12. Healing of the goat anterior cruciate ligament after a new suture repair technique and bioscaffold treatment

    NARCIS (Netherlands)

    Nguyen, D. Tan; Geel, Jurre; Schulze, Martin; Raschke, Michael J.; Woo, Savio L.-Y.; van Dijk, C. Niek; Blankevoort, Leendert

    2013-01-01

    Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining

  13. Fracture of the proximal extremity of the tibia after anterior cruciate ligament reconstruction: case report

    Directory of Open Access Journals (Sweden)

    Márcio de Oliveira Carneiro

    2015-06-01

    Full Text Available We report a rare condition that has been little described in the literature: a fracture of the proximal extremity of the tibia after anterior cruciate ligament reconstruction using an autologous patellar bone-tendon graft. In this report, we discuss the factors that predisposed toward this episode, the treatment and the evolution of the case after the surgical treatment.

  14. Psychosocial factors influencing the recovery of athletes with anterior cruciate ligament injury : A systematic review

    NARCIS (Netherlands)

    te Wierike, S. C. M.; van der Sluis, A.; van den Akker-Scheek, I.; Elferink-Gemser, M. T.; Visscher, C.

    2013-01-01

    This review describes the psychosocial factors that affect recovery following anterior cruciate ligament (ACL) injury and reconstructive surgery in athletes. A systematic search in literature with inclusion and exclusion criteria on PubMed, PsycINFO, and Embase was performed. Articles used in this

  15. Augmentation in anterior cruciate ligament reconstruction-a histological and biomechanical study on goats

    NARCIS (Netherlands)

    Buma, P.; Kok, H. J.; Blankevoort, L.; Kuijpers, W.; Huiskes, R.; van Kampen, A.

    2004-01-01

    We studied reconstruction of the anterior cruciate ligament (ACL) in skeletally mature goats. In one group, the autogenous tissue was augmented with polydioxanone (PDS), the other group had no augmentation. Histological complete incorporation and remodeling of the transplant was found in both

  16. Identification of athletes at future risk of anterior cruciate ligament ruptures by neuromuscular screening

    DEFF Research Database (Denmark)

    Zebis, Mette K; Andersen, Lars L; Bencke, Jesper

    2009-01-01

    BACKGROUND: A high percentage of female athletes who sustain an anterior cruciate ligament (ACL) rupture suffer serious long-term consequences such as osteoarthritis and disability. Thus, identification of risk factors has high clinical relevance in the prevention of ACL rupture. Hypothesis...

  17. Muscular reflexes elicited by electrical stimulation of the anterior cruciate ligament in humans

    DEFF Research Database (Denmark)

    Dyhre-Poulsen, P; Krogsgaard, M R

    2000-01-01

    Anterior cruciate ligament (ACL)-deficient knees have impaired proprioception, and, although mechanoreceptors have been found in the ACL, the existence of a reflex elicited from these receptors has not been directly demonstrated in humans. In eight patients that underwent knee arthroscopy and had...

  18. Analgesic efficacy of ultrasound-guided adductor canal blockade after arthroscopic anterior cruciate ligament reconstruction

    DEFF Research Database (Denmark)

    Espelund, Malene; Fomsgaard, Jonna Storm; Haraszuk, Jørgen Peter

    2013-01-01

    Anterior cruciate ligament (ACL) reconstruction surgery is associated with moderate to severe postoperative pain, which may be ameliorated by peripheral nerve blocks. The adductor canal block (ACB) is an almost exclusively sensory nerve block that has been demonstrated to reduce pain and opioid...

  19. 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

    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...

  20. Implementation of Open and Closed Kinetic Chain Quadriceps Strengthening Exercises after Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Ross, Michael D.; Denegar, Craig R.; Winzenried, Jay A.

    2001-01-01

    Reviews the effects of open kinetic chain (OKC) and closed kinetic chain (CKC) exercise on anterior cruciate ligament (ACL) strain and patellofemoral joint stress, suggesting a combination of the two for quadriceps strengthening after ACL reconstruction. Both OKC and CKC exercises may be modified and implemented for quadriceps strengthening after…

  1. Anatomic Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction Flowchart

    NARCIS (Netherlands)

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

    2010-01-01

    Anatomy is the foundation of orthopaedic surgery, and the advancing knowledge of the anterior cruciate ligament (ACL) anatomy has led to the development of improved modern reconstruction techniques that approach the anatomy of the native ACL. Current literature on the anatomy of the ACL and its

  2. 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

  3. Does flexible tunnel drilling affect the femoral tunnel angle measurement after anterior cruciate ligament reconstruction?

    NARCIS (Netherlands)

    Muller, Bart; Hofbauer, Marcus; Atte, Akere; van Dijk, C. Niek; Fu, Freddie H.

    2015-01-01

    To quantify the mean difference in femoral tunnel angle (FTA) as measured on knee radiographs between rigid and flexible tunnel drilling after anatomic anterior cruciate ligament (ACL) reconstruction. Fifty consecutive patients that underwent primary anatomic ACL reconstruction with a single femoral

  4. Reconstruction of the anterior cruciate ligament: dynamic strain evaluation of the graft

    Czech Academy of Sciences Publication Activity Database

    Handl, Milan; Držík, M.; Cerulli, G.; Povýšil, C.; Chlpík, J.; Varga, F.; Amler, Evžen; Trč, T.

    2007-01-01

    Roč. 15, - (2007), s. 233-241 ISSN 0942-2056 R&D Projects: GA AV ČR(CZ) 1ET400110403 Institutional research plan: CEZ:AV0Z50390512 Keywords : Anterior cruciate ligament * Tendon * Material properties Subject RIV: BO - Biophysics Impact factor: 1.626, year: 2007

  5. Atypical hamstrings electromyographic activity as a compensatory mechanism in anterior cruciate ligament deficiency

    NARCIS (Netherlands)

    Boerboom, AL; Hof, AL; Halbertsma, JPK; van Raaij, JJAM; Schenk, W; Diercks, RL; van Horn, [No Value; van Horn, J.R.

    Anterior cruciate ligament (ACL) deficiency may cause functional instability of the knee (noncopers), while other patients compensate and perform at the same level as before injury (copers). This pilot study investigated whether there is a compensatory electromyographic (EMG) activity of the

  6. Increased medial tibial slope in teenage pediatric population with open physes and anterior cruciate ligament injuries

    NARCIS (Netherlands)

    Vyas, Shail; van Eck, Carola F.; Vyas, Nina; Fu, Freddie H.; Otsuka, Norman Y.

    2011-01-01

    Variations in bony morphology have been associated with anterior cruciate ligament (ACL) injury risk. The primary aim of this study was to compare the tibial slope in the teenage pediatric population with open physes, with and without ACL injury. The secondary aims were to compare the notch width

  7. Differential Effects of 2 Rehabilitation Programs Following Anterior Cruciate Ligament Reconstruction

    DEFF Research Database (Denmark)

    Setuain, Igor; Izquierdo, Mikel; Idoate, Fernando

    2017-01-01

    Context- The muscular function restoration related to the type of physical rehabilitation followed after anterior cruciate ligament reconstruction (ACLR) using autologous hamstring tendon graft in terms of strength and cross sectional area (CSA) remain controversial. Objective- To analyze the CSA...... to persist in both rehabilitation groups. However, OCBR after ACLR lead to substantial gains on maximal knee flexor strength and ensured more symmetrical anterior-posterior laxity levels at the knee joint....

  8. A systematic review to evaluate exercise for anterior cruciate ligament injuries: does this approach reduce the incidence of knee osteoarthritis?

    Directory of Open Access Journals (Sweden)

    Duncan KJ

    2016-01-01

    Full Text Available Koji J Duncan, Jaclyn N Chopp-Hurley, Monica R Maly School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada Purpose: Among a variety of conservative and surgical options to treat anterior cruciate ligament (ACL injuries, we do not understand which options could potentially prevent knee osteoarthritis (OA. The aim of this systematic review was to examine the evidence pertaining to exercise treatment of ACL injuries in the context of knee OA. Methods: Medline, Embase, CINAHL, PubMed, and PEDro (Physiotherapy Evidence Database databases were systematically searched using keywords encompassed within four primary key terms: knee, osteoarthritis, anterior cruciate ligament, and exercise. Clinical studies evaluating the effect of an exercise treatment for ACL injuries on the development of knee OA in adult humans were included. The PEDro scale was used to critically assess the studies included in the review. Results: Eighteen studies were included in this review, with a median PEDro score of 6/11 (range, 2/11–9/11. Three studies provided statistical evidence that exercise following ACL injury lowered the risk for knee OA development. Nine studies demonstrated no benefit of exercise in preventing knee OA incidence relative to either operative treatment or the contralateral, unaffected knee. However, exercise resulted in higher knee instability. Nonetheless, there were no significant differences in subjective or objective knee outcomes for early versus late ACL reconstruction. Limitations: This review was not registered through PROSPERO. Conclusion: The relationship between a rehabilitative exercise for ACL injuries and long-term knee OA prevalence is inconclusive. However, research suggests initial conservative treatment with optional late ACL reconstruction because this treatment strategy may reduce the risk of knee OA. More research, ideally randomized controlled trials or comparable designs, is required prior to establishing

  9. Computer aided analysis of gait patterns in patients with acute anterior cruciate ligament injury.

    Science.gov (United States)

    Christian, Josef; Kröll, Josef; Strutzenberger, Gerda; Alexander, Nathalie; Ofner, Michael; Schwameder, Hermann

    2016-03-01

    Gait analysis is a useful tool to evaluate the functional status of patients with anterior cruciate ligament injury. Pattern recognition methods can be used to automatically assess walking patterns and objectively support clinical decisions. This study aimed to test a pattern recognition system for analyzing kinematic gait patterns of recently anterior cruciate ligament injured patients and for evaluating the effects of a therapeutic treatment. Gait kinematics of seven male patients with an acute unilateral anterior cruciate ligament rupture and seven healthy males were recorded. A support vector machine was trained to distinguish the groups. Principal component analysis and recursive feature elimination were used to extract features from 3D marker trajectories. A Classifier Oriented Gait Score was defined as a measure of gait quality. Visualizations were used to allow functional interpretations of characteristic group differences. The injured group was evaluated by the system after a therapeutic treatment. The results were compared against a clinical rating of the patients' gait. Cross validation yielded 100% accuracy. After the treatment the score improved significantly (Panterior cruciate ligament injury can be detected automatically. The results of the automatic analysis are comparable with the clinical rating and support the validity of the system. The visualizations allow interpretations on discriminatory features and can facilitate the integration of the results into the diagnostic process. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Posterior Cruciate Ligament Injury

    Science.gov (United States)

    Posterior cruciate ligament injury Overview Posterior cruciate ligament (PCL) injury happens far less often than does injury to the knee's more vulnerable counterpart, the anterior cruciate ligament (ACL). The posterior cruciate ...

  11. A review of ultrasonographic methods for the assessment of the anterior cruciate ligament in patients with knee instability – diagnostics using a posterior approach

    Directory of Open Access Journals (Sweden)

    Tomasz Poboży

    2016-09-01

    Full Text Available Aim: The purpose of the study was to improve the ultrasonographic assessment of the anterior cruciate ligament by an inclusion of a dynamic element. The proposed functional modification aims to restore normal posterior cruciate ligament tension, which is associated with a visible change in the ligament shape. This method reduces the risk of an error resulting from subjectively assessing the shape of the posterior cruciate ligament. It should be also emphasized that the method combined with other ultrasound anterior cruciate ligament assessment techniques helps increase diagnostic accuracy. Methods: Ultrasonography is used as an adjunctive technique in the diagnosis of anterior cruciate ligament injury. The paper presents a sonographic technique for the assessment of suspected anterior cruciate ligament insufficiency supplemented by the use of a dynamic examination. This technique can be recommended as an additional procedure in routine ultrasound diagnostics of anterior cruciate ligament injuries. Results: Supplementing routine ultrasonography with the dynamic assessment of posterior cruciate ligament shape changes in patients with suspected anterior cruciate ligament injury reduces the risk of subjective errors and increases diagnostic accuracy. This is important especially in cases of minor anterior knee instability and bilateral anterior knee instability. Conclusions: An assessment of changes in posterior cruciate ligament using a dynamic ultrasound examination effectively complements routine sonographic diagnostic techniques for anterior cruciate ligament insufficiency.

  12. Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review

    NARCIS (Netherlands)

    Janssen, R.P.A. (Rob Paulus Augustinus); M. Reijman (Max); Janssen, D.M. (Daan Martijn); van Mourik, J.B.A. (Jan Bernardus Antonius); Janssen, D.M. (Daan Martijn); van Mourik, J.B.A. (Jan Bernardus Antonius)

    2016-01-01

    textabstractAIM To summarize the current knowledge on vascular complications and deep venous thrombosis (DVT) prophylaxis after anterior cruciate ligament (ACL) reconstruction. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and

  13. Relationships between postural orientation and self reported function, hop performance and muscle power in subjects with anterior cruciate ligament injury

    DEFF Research Database (Denmark)

    Trulsson, Anna; Roos, Ewa M; Ageberg, Eva

    2010-01-01

    ABSTRACT: BACKGROUND: Injury to the anterior cruciate ligament (ACL) is associated not only with knee instability and impaired neuromuscular control, but also with altered postural orientation manifested as observable "substitution patterns". However, tests currently used to evaluate knee function...

  14. Compliance with neuromuscular training and anterior cruciate ligament injury risk reduction in female athletes: a meta-analysis

    National Research Council Canada - National Science Library

    Sugimoto, Dai; Myer, Gregory D; Bush, Heather M; Klugman, Maddie F; Medina McKeon, Jennifer M; Hewett, Timothy E

    2012-01-01

    .... We searched PubMed, SPORTDiscus, CINAHL, and MEDLINE for articles published from 1995 to 2010 using the key words anterior cruciate ligament prevention, ACL prevention, knee prevention, prospective...

  15. MRI assessment of tibial tunnel and its relation to complication following arthroscopic reconstruction of anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Nadia F. El Ameen

    2014-09-01

    Conclusion: Anterior cruciate ligament reconstruction is one of the most commonly performed sports medicine procedures. MRI proved as an accurate method for post arthroscopic reconstruction evaluation that can help predict post ACL reconstruction complication.

  16. [Biomechanical correlations of lesions associated with traumatic diseases of the anterior cruciate ligament. Analysis with magnetic resonance].

    Science.gov (United States)

    De Maria, M; Barbiera, F; Lo Casto, A; Iovane, A; Rossello, M; Sparacia, G; Lagalla, R

    1996-06-01

    To investigate the correlations between traumatic injuries of the anterior cruciate ligament and other ligamentous, meniscal and bone traumatic injuries, a series of 193 patients with anterior cruciate ligament injuries studied with MRI between January 1992 and December 1994, was retrospectively reviewed. MR results were compared with arthroscopic and/or surgical findings in most (181) patients; in the remaining 12 patients, clinical follow-up was performed. We used two 0.5 superconductive MR units, with dedicated coils and T1-weighted spin-echo and T2*-weighted gradient-echo sequences on the axial, sagittal and coronal planes. Anterior cruciate ligament injuries were associated with other ligamentous, meniscal and bone injuries in 78% of patients. The patients were classified in 5 groups depending on biomechanics and the association of injuries: -group I: isolated injury of the anterior cruciate ligament (41 patients), most frequently caused by forced extension stress associated with "kissing contusions" of the anterior portion of the lateral femoral condyle and of the lateral tibial plateau; this type of injury is less frequently caused by forced flexion stress associated with avulsion fracture of the tibial eminence; -group II: associated injury of the anterior cruciate ligament and medial compartment (62 patients), caused by forced flexion-external rotation stress (abduction, valgism and external rotation). The classic association of this mechanism was the injury of the anterior cruciate ligament, medial collateral ligament and medial meniscus (O'Donoghue triad) (9 patients). Valgus stress and the pivot-shift phenomenon can impact the tibial and femoral articular surfaces, with consequent osteochondral contusion; -group III: associated injury of the anterior cruciate ligament and lateral compartment (26 patients), caused by forced flexion-internal rotation stress (adduction, varism and internal rotation). This mechanism can cause, as a typical bone lesion

  17. Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

    Science.gov (United States)

    Arno, Sally; Bell, Christopher P; Alaia, Michael J; Singh, Brian C; Jazrawi, Laith M; Walker, Peter S; Bansal, Ankit; Garofolo, Garret; Sherman, Orrin H

    2016-07-01

    Considerable debate remains over which anterior cruciate ligament (ACL) reconstruction technique can best restore knee stability. Traditionally, femoral tunnel drilling has been done through a previously drilled tibial tunnel; however, potential nonanatomic tunnel placement can produce a vertical graft, which although it would restore sagittal stability, it would not control rotational stability. To address this, some suggest that the femoral tunnel be created independently of the tibial tunnel through the use of an anteromedial (AM) portal, but whether this results in a more anatomic footprint or in stability comparable to that of the intact contralateral knee still remains controversial. (1) Does the AM technique achieve footprints closer to anatomic than the transtibial (TT) technique? (2) Does the AM technique result in stability equivalent to that of the intact contralateral knee? (3) Are there differences in patient-reported outcomes between the two techniques? Twenty male patients who underwent a bone-patellar tendon-bone autograft were recruited for this study, 10 in the TT group and 10 in the AM group. Patients in each group were randomly selected from four surgeons at our institution with both groups demonstrating similar demographics. The type of procedure chosen for each patient was based on the preferred technique of the surgeon. Some surgeons exclusively used the TT technique, whereas other surgeons specifically used the AM technique. Surgeons had no input on which patients were chosen to participate in this study. Mean postoperative time was 13 ± 2.8 and 15 ± 3.2 months for the TT and AM groups, respectively. Patients were identified retrospectively as having either the TT or AM Technique from our institutional database. At followup, clinical outcome scores were gathered as well as the footprint placement and knee stability assessed. To assess the footprint placement and knee stability, three-dimensional surface models of the femur, tibia, and ACL

  18. Assessment of Knee Proprioception in the Anterior Cruciate Ligament Injury Risk Position in Healthy Subjects: A Cross-sectional Study

    OpenAIRE

    Mir, Seyed Mohsen; Talebian, Saeed; Naseri, Nasrin; Hadian, Mohammad-Reza

    2014-01-01

    [Purpose] Knee joint proprioception combines sensory input from a variety of afferent receptors that encompasses the sensations of joint position and motion. Poor proprioception is one of the risk factors of anterior cruciate ligament injury. Most studies have favored testing knee joint position sense in the sagittal plane and non-weight-bearing position. One of the most common mechanisms of noncontact anterior cruciate ligament injury is dynamic knee valgus. No study has measured joint posit...

  19. Effect of functional bracing on knee injury in skiers with anterior cruciate ligament reconstruction: a prospective cohort study.

    Science.gov (United States)

    Sterett, William I; Briggs, Karen K; Farley, Timothy; Steadman, J Richard

    2006-10-01

    The role of knee bracing in anterior cruciate ligament reconstructions is controversial. Functional bracing will have an effect on subsequent knee injury in skiers with anterior cruciate ligament reconstruction. Cohort study; Level of evidence, 3. From 1991 to 1997, 11606 skiers at a major destination ski resort underwent preseason knee screening. The anterior cruciate ligament-reconstructed group consisted of 820 skiers who had had an anterior cruciate ligament reconstruction 2 years or more earlier. Of these, 257 skiers selected the use of functional knee brace during skiing. The dependent variable was subsequent knee injury, identified via workers' compensation records. Covariates included age, gender, ski occupation, Lachman grade, pivot-shift grade, KT-1000 arthrometer manual maximum displacement, and use of a functional brace. Univariate and multivariate risk factors for subsequent knee injury were determined. In this study, 257 skier-employees with anterior cruciate ligament reconstruction wore braces and 563 skier-employees with anterior cruciate ligament reconstruction did not. Braced skiers had significantly higher preseason rates of grade II or higher Lachman and pivot-shift tests (braced, 29% and 22%, respectively; nonbraced, 11% and 10%, respectively; P knee injuries were identified, 51 (8.9 injuries/100 knees/ski season) in the nonbraced group and 10 (4.0 injuries/100 knees/ski season) in the braced group (P = .009). Nonbraced skiers were 2.74 times more likely to suffer subsequent injury than were braced skiers (odds ratio, 2.74 [confidence interval, 1.2-4.9]). Logistic regression modeling identified nonbracing as a significant independent multivariate risk factor for subsequent knee injury in the high-demand skiers with anterior cruciate ligament reconstruction. Because of the increased risk of subsequent knee injury in nonbraced skiers, the authors recommend functional bracing for skiers with anterior cruciate ligament reconstruction. Whether the

  20. Reverse Segond Fracture Associated with Anteromedial Tibial Rim and Tibial Attachment of Anterior Cruciate Ligament Avulsion Fractures

    Directory of Open Access Journals (Sweden)

    Yehia H. Bedeir

    2017-01-01

    Full Text Available Reverse Segond fracture is an uncommon avulsion fracture of the tibial attachment of the deep portion of the medial collateral ligament of the knee. We report a reverse Segond fracture associated with anterior cruciate ligament tibial avulsion fracture and anteromedial tibial rim fracture. Unlike previous reports, the combination of reverse Segond fracture, anteromedial tibial rim fracture, and anterior cruciate ligament avulsion fracture was not associated with posterior cruciate ligament injury, posterolateral corner injury, or tibial plateau fracture. This new combination of injuries provides better understanding of the mechanisms of ligamentous injuries of the knee and highlights the importance of meticulous assessment of these injuries for accurate diagnosis and subsequent management.

  1. Patellofemoral Osteoarthritis: Are We Missing an Important Source of Symptoms After Anterior Cruciate Ligament Reconstruction?

    Science.gov (United States)

    Culvenor, Adam G; Crossley, Kay M

    2016-04-01

    Anterior cruciate ligament (ACL) rupture is a well-established risk factor for knee osteoarthritis (OA). Fifty to ninety percent of individuals will develop radiographic tibiofemoral OA within a decade after ACL injury and anterior cruciate ligament reconstruction (ACLR). Although less well recognized, radiographic patellofemoral OA is present in approximately 50% of individuals at more than 10 years after ACLR. This early-onset OA and its associated pain and functional limitations pose a particular challenge to younger adults with OA compared to an older OA population. Targeted interventions need to be developed to reduce the burden of early-onset OA following ACLR. Emerging evidence suggests that such interventions should target both the patellofemoral and tibiofemoral joints.

  2. Anterior cruciate ligament bracing: evidence in providing stability and preventing injury or graft re-rupture.

    Science.gov (United States)

    Bodendorfer, Blake M; Anoushiravani, Afshin A; Feeley, Brian T; Gallo, Robert A

    2013-09-01

    Ligamentous knee injuries are common and costly, both in financial terms and time missed from work and recreational activities. Furthermore, ligamentous injuries appear to predispose patients to future osteoarthritis and other morbidities. Therefore, prevention strategies are important in limiting the potential impact of these injuries. Knee braces are one of the most often prescribed devices in the billion-dollar orthotic industry. Despite widespread use of prophylactic and functional knee braces, the evidence supporting their efficacy in reducing and/or preventing injury remains limited. Knee braces have been shown to be more effective in preventing medial collateral ligament injuries than anterior cruciate ligament injuries in both cadaveric and clinical studies. The use of functional braces after anterior cruciate ligament reconstruction has been supported and refuted in both postoperative and long-term studies.

  3. Magnetic resonance evaluation of anterior cruciate ligament repair using the patellar tendon double bone block technique

    Energy Technology Data Exchange (ETDEWEB)

    Autz, G.; Singson, R.D. (St. Luke' s Roosevelt Hospital Center, New York, NY (United States). Dept. of Radiology); Goodwin, C. (St. Luke' s Roosevelt Hospital Center, New York, NY (United States). Dept. of Orthopedics)

    1991-11-01

    The magnetic resonance (MR) appearance of the anterior cruciate ligament reconstruction was determined in 20 clinically stable and 2 clinically unstable knees for a total of 22 examinations. All patients studied had undergone knee reconstruction using the patellar tendon as graft material. The reconstructed anterior cruciate ligament varies in appearance. It appeared as a thick, well-defined, low signal band on T1- and T2-weighted sagittal and coronal images in 14 of 22 examinations. The remaining 8 knees showed a graft having one or more thin and attenuated, low signal intensity bands in the sagittal and/or coronal plane. Arthroscopy confirmed an intact but lax graft in the clinically unstable knees. (orig.).

  4. ANTERIOR CRUCIATE LIGAMENT INJURY DIAGNOSIS AND MANAGEMENT IN A PEDIATRIC PATIENT: A CASE REPORT

    OpenAIRE

    Hazle, Charles; Duby, Cherie

    2012-01-01

    The management of the skeletally immature athlete sustaining injury to the anterior cruciate ligament and other knee structures provides multiple challenges for both the treating clinicians and parents of the injured child. The diagnostic process and subsequent decision making present additional complexities because of the developmental anatomy and the potential for disturbance of normal growth patterns by some surgical interventions. In the following case report, the course to appropriate ma...

  5. Retear of anterior cruciate ligament grafts in female basketball players: a case series

    OpenAIRE

    Tanaka, Yoshinari; Yonetani, Yasukazu; Shiozaki, Yoshiki; Kitaguchi, Takuya; Sato, Nozomi; Takeshita, Shinya; Horibe, Shuji

    2010-01-01

    Abstract Background Incidence of anterior cruciate ligament (ACL) injuries in young female basketball players is higher than that in male basketball players. Graft retears are more frequent with the increasing number of ACL reconstructions. The present study aimed to examine the incidence of retears in competitive female basketball players. Methods Sixty-four female basketball players (aged 12 to 29 years) who underwent primary anatomic double-bundle ACL reconstruction using hamstring grafts ...

  6. Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis

    OpenAIRE

    Donnell-Fink, Laurel A; Kristina Klara; Collins, Jamie E.; Yang, Heidi Y.; Goczalk, Melissa G.; Katz, Jeffrey N.; Elena Losina

    2015-01-01

    Objective: Individuals frequently involved in jumping, pivoting or cutting are at increased risk of knee injury, including anterior cruciate ligament (ACL) tears. We sought to use meta-analytic techniques to establish whether neuromuscular and proprioceptive training is efficacious in preventing knee and ACL injury and to identify factors related to greater efficacy of such programs. Methods: We performed a systematic literature search of studies published in English between 1996 and 2014. In...

  7. Prevention, treatment, and rehabilitation of anterior cruciate ligament injuries in children

    OpenAIRE

    Lang PJ; Sugimoto D; Micheli LJ

    2017-01-01

    Pamela J Lang,1,2 Dai Sugimoto,1–3 Lyle J Micheli1–3 1Division of Sports Medicine, Department of Orthopedics, Boston Children’s Hospital, 2Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 3The Micheli Center for Sports Injury Prevention, Waltham, MA, USA Abstract: As more children and adolescents participate in competitive organized sports, there has been an increase in the reported incidence of anterior cruciate ligament (ACL) injuries in t...

  8. Risk factors and prevention strategies of non-contact anterior cruciate ligament injuries.

    Science.gov (United States)

    Laible, Catherine; Sherman, Orrin H

    2014-01-01

    In recent years, the number of women playing sports has increased significantly. The passage of Title IX in 1972 had a significant effect in encouraging female participation in sports. This increase in women's sports participation also led to a rise in noncontact anterior cruciate ligament (ACL) injuries. As ACL injuries in young female athletes have be- come a public health issue, much research has been done on risk factors and prevention strategies.

  9. Meniscus Injuries Alter the Kinematics of Knees With Anterior Cruciate Ligament Deficiency

    OpenAIRE

    Hosseini, Ali; Li, Jing-Sheng; Gill, Thomas J.; Li, Guoan

    2014-01-01

    Background: Most knee joint biomechanics studies have involved knees with an isolated anterior cruciate ligament (ACL) injury. However, a large portion of patients with injured ACLs have accompanied meniscus tearing. In this study, the in vivo alteration of knee biomechanics after tearing the ACL with or without combined medial or lateral meniscus tear was investigated during stair-ascending activity. Hypothesis: The kinematic behavior of ACL-deficient knees changes with a combined medial or ...

  10. The Formation of a Pretibial Ganglion Cyst After the Reconstruction of an Anterior Cruciate Ligament

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Seok Jin; Park, Ji Seon; Yoon, Kyung Ho; Park, Yong Goo; Ryu, Kyung Nam [Kyung Hee University Medical Center, Seoul (Korea, Republic of); Park, So Young; Jin, Wook [Kyung Hee University East-West NEO Medical Center, Seoul (Korea, Republic of)

    2010-02-15

    The formation of a pretibial ganglion cyst after the reconstruction of an anterior cruciate ligament is an uncommon complication which may be a result of the degradation of the biodegradable screw or a variety of other reasons. The authors report a case of a significantly large pretibial cyst, which probably occurred as a result of no treatment over a long period, along with a description of the clinical manifestations and radiologic findings

  11. The anatomy of the anterior cruciate ligament and its relevance to the technique of reconstruction.

    Science.gov (United States)

    Śmigielski, R; Zdanowicz, U; Drwięga, M; Ciszek, B; Williams, A

    2016-08-01

    Anterior cruciate ligament (ACL) reconstruction is commonly performed and has been for many years. Despite this, the technical details related to ACL anatomy, such as tunnel placement, are still a topic for debate. In this paper, we introduce the flat ribbon concept of the anatomy of the ACL, and its relevance to clinical practice. Cite this article: Bone Joint J 2016;98-B:1020-6. ©2016 The British Editorial Society of Bone & Joint Surgery.

  12. Comparative study on anterior cruciate ligament reconstruction: determination of isometric points with and without navigation

    Directory of Open Access Journals (Sweden)

    Fabio J. Angelini

    2010-01-01

    Full Text Available OBJECTIVES: To compare the accuracy of tunnel placement and graft isometry for anterior cruciate ligament reconstruction performed using a computer-assisted navigation system (Orthopilot and using traditional instruments. METHODS: The anterior cruciate ligament was removed intact from 36 pairs of human cadaver knees. From each pair, one knee was randomized to Group 1 (conventional and the other to Group 2 (Orthopilot. An inelastic suture was then passed through the central points of the tibial and femoral tunnels. Neither of the tunnels was drilled. All knees were then dissected, and six parameters were obtained: distances from the tibial tunnel center to the 1 posterior cruciate ligament, 2 anterior horn of the lateral meniscus and 3 medial tibial spine; 4 distance from the femoral tunnel center to the posterior femoral cortex; 5 femoral tunnel coronal angle; and 6 variation of the distance from the femoral to the tibial tunnel with the knee extended and at 90 degrees of flexion. RESULTS: The variation of the distance from the femoral to the tibial tunnel during flexion and extension was smaller in the Orthopilot group (better isometry compared to the conventional group. There were no statistical differences in any other parameters between the groups, and all tunnels were considered to be in satisfactory positions. DISCUSSION: The results obtained for anterior cruciate ligament reconstruction depend on precise isometric point positioning, and a navigation system is a precision tool that can assist surgeons in tunnel positioning. CONCLUSION: No differences in tunnel position were observed between the groups. Nonetheless, better isometry was achieved in the Orthopilot group than with conventional instruments.

  13. Anterior Cruciate Ligament Injuries in Pediatric Athletes Presenting to Sports Medicine Clinic

    OpenAIRE

    Stracciolini, Andrea; Stein, Cynthia J.; Zurakowski, David; Meehan, William P.; Myer, Gregory D; Micheli, Lyle J.

    2015-01-01

    Background: Limited data exist regarding the effect of the growth process on anterior cruciate ligament (ACL) injury risk in male versus female children. Hypothesis: The proportion of ACL injuries/sports injuries presenting to clinic will vary by age, sex, and body mass index (BMI). Study Design: Cross-sectional epidemiologic study. Level of Evidence: Level 3. Methods: The study group consisted of a randomly selected 5% probability sample of all children 5 to 17 years of age presenting to a s...

  14. Kissing knees - factors behind the attraction. Knee abduction in individuals with anterior cruciate ligament injury.

    OpenAIRE

    Cronström, Anna

    2017-01-01

    Anterior cruciate ligament (ACL) injury and patellofemoral pain (PFP) are common sports-related knee injuries. Their consequences include compromised health of the effected individual and substantial financial costs for society. Increased knee abduction or a knee medial to foot position (KMFP), so called “kissing knees”, during weight-bearing activities is reported to be more common in patients with ACL injury or PFP than in non-injured individuals and is also reported to be associated with g...

  15. Rehabilitation Following Anterior Cruciate Ligament Tears in Children: A Systematic Review.

    Science.gov (United States)

    Yellin, Joseph L; Fabricant, Peter D; Gornitzky, Alex; Greenberg, Elliot M; Conrad, Sara; Dyke, Julie Ann; Ganley, Theodore J

    2016-01-19

    Anterior cruciate ligament (ACL) tears are increasingly prevalent in the pediatric population. ACL rehabilitation is an essential component of recovery following injury and reconstruction, yet there are few explicit descriptions of pediatric-specific ACL rehabilitation protocols in the literature, especially in the context of varying treatment interventions. Our aim was to systematically review the literature on rehabilitation following ACL tears in children in order to describe common principles among different treatment options and areas of future research. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we performed a systematic review of the PubMed, EMBASE, and Cochrane databases (for the past five years) to identify detailed rehabilitation protocols described in the pediatric population following ACL rupture. When available, the following aspects of rehabilitation were extracted: "prehabilitation" (exercises prior to surgery), bracing, weight-bearing status, range of motion, strength, modalities (ice, heat, electrical stimulation, etc.), plyometrics/proprioceptive exercises, return-to-sport criteria, and suggested ACL injury-prevention programs. Two hundred and two unique articles were identified. Twenty-seven articles meeting inclusion criteria with extractible rehabilitation data were included. A table, categorized by differing orthopaedic intervention, was designed to detail the components and duration of the different aspects of rehabilitation. While there are substantial differences across protocols, several trends emerged, particularly regarding weight-bearing, bracing, range of motion, and strength training. Interestingly, we found that many current protocols are based on time frame alone rather than on functional milestones; of the fourteen unique articles that addressed return-to-sport criteria by specific orthopaedic intervention, seven were based on temporal progression whereas seven also involved

  16. Improving Functional Performance and Muscle Power 4-to-6 Months After Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Souissi, Sabrine; Wong, Del P; Dellal, Alexandre; Croisier, Jean-Louis; Ellouze, Zied; Chamari, Karim

    2011-01-01

    The purpose of this study was to examine the effects of 8-week retraining programs, with either two or three training sessions per week, on measures of functional performance and muscular power in athletes with anterior cruciate ligament reconstruction (ACLR). Sixteen male athletes were randomly assigned to two groups after ACLR: a functional training group (FTG, n = 8) training 2 intense sessions per week (4hrs/week), and a control group (CG, n = 8) training 3 sessions per week with moderate intensity (6hrs/week). The two groups were assessed at four and six months post-ACLR and the effects of retraining were measured using the following assessments: the functional and the muscular power tests, and the agility T-test. After retraining, the FTG had improved more than the CG in the operated leg in the single leg hop test (+34.64% vs. +10.92%; large effect), the five jump test (+8.87% vs. +5.03%; medium effect), and single leg triple jump (+32.15% vs. +16.05%; medium effect). For the agility T-test, the FTG had larger improvements (+17.26% vs. +13.03%, medium effect) as compared to the CG. For the bilateral power tests, no significant training effects were shown for the two groups in the squat jump (SJ), the counter movement jump (CMJ) and the free arms CMJ (Arm CMJ). On the other hand, the unilateral CMJ test with the injured and the uninjured legs showed a significant increase for the FTG with respect to CG (p training modality in rehabilitation after ACLR that results in good recovery of the operated limb along with the contra-lateral leg. This may allow the athletes to reach good functional and strength performance with only two physical training sessions per week, better preparing them for a return to sport activity at 6 months post- ACLR and eventually sparing time for a possible progressive introduction of the sport specific technical training. Key pointsFunctional training (plyometrics, neuromuscular, proprioceptive and agility exercises) in athletes during 4

  17. IMPROVING FUNCTIONAL PERFORMANCE AND MUSCLE POWER 4-TO-6 MONTHS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Sabrine Souissi

    2011-12-01

    Full Text Available The purpose of this study was to examine the effects of 8-week retraining programs, with either two or three training sessions per week, on measures of functional performance and muscular power in athletes with anterior cruciate ligament reconstruction (ACLR. Sixteen male athletes were randomly assigned to two groups after ACLR: a functional training group (FTG, n = 8 training 2 intense sessions per week (4hrs/week, and a control group (CG, n = 8 training 3 sessions per week with moderate intensity (6hrs/week. The two groups were assessed at four and six months post-ACLR and the effects of retraining were measured using the following assessments: the functional and the muscular power tests, and the agility T-test. After retraining, the FTG had improved more than the CG in the operated leg in the single leg hop test (+34.64% vs. +10.92%; large effect, the five jump test (+8.87% vs. +5.03%; medium effect, and single leg triple jump (+32.15% vs. +16.05%; medium effect. For the agility T-test, the FTG had larger improvements (+17.26% vs. +13.03%, medium effect as compared to the CG. For the bilateral power tests, no significant training effects were shown for the two groups in the squat jump (SJ, the counter movement jump (CMJ and the free arms CMJ (Arm CMJ. On the other hand, the unilateral CMJ test with the injured and the uninjured legs showed a significant increase for the FTG with respect to CG (p < 0.05. The present study introduces a new training modality in rehabilitation after ACLR that results in good recovery of the operated limb along with the contra-lateral leg. This may allow the athletes to reach good functional and strength performance with only two physical training sessions per week, better preparing them for a return to sport activity at 6 months post- ACLR and eventually sparing time for a possible progressive introduction of the sport specific technical training

  18. Current Concepts for Injury Prevention in Athletes After Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Hewett, Timothy E.; Di Stasi, Stephanie L.; Myer, Gregory D.

    2013-01-01

    Ligament reconstruction is the current standard of care for active patients with an anterior cruciate ligament (ACL) rupture. Although the majority of ACL reconstruction (ACLR) surgeries successfully restore the mechanical stability of the injured knee, postsurgical outcomes remain widely varied. Less than half of athletes who undergo ACLR return to sport within the first year after surgery, and it is estimated that approximately 1 in 4 to 1 in 5 young, active athletes who undergo ACLR will go on to a second knee injury. The outcomes after a second knee injury and surgery are significantly less favorable than outcomes after primary injuries. As advances in graft reconstruction and fixation techniques have improved to consistently restore passive joint stability to the preinjury level, successful return to sport after ACLR appears to be predicated on numerous postsurgical factors. Importantly, a secondary ACL injury is most strongly related to modifiable postsurgical risk factors. Biomechanical abnormalities and movement asymmetries, which are more prevalent in this cohort than previously hypothesized, can persist despite high levels of functional performance, and also represent biomechanical and neuromuscular control deficits and imbalances that are strongly associated with secondary injury incidence. Decreased neuromuscular control and high-risk movement biomechanics, which appear to be heavily influenced by abnormal trunk and lower extremity movement patterns, not only predict first knee injury risk but also reinjury risk. These seminal findings indicate that abnormal movement biomechanics and neuromuscular control profiles are likely both residual to, and exacerbated by, the initial injury. Evidence-based medicine (EBM) strategies should be used to develop effective, efficacious interventions targeted to these impairments to optimize the safe return to high-risk activity. In this Current Concepts article, the authors present the latest evidence related to risk

  19. Intrinsic factors associated with return to sport after anterior cruciate ligament reconstruction: A systematic review

    Directory of Open Access Journals (Sweden)

    Cheryl A. Ross

    2015-04-01

    Full Text Available Objectives: The anterior cruciate ligament is the most commonly injured ligament in the knee, with an average of only 64% of affected athletes returning to their pre-injury level of sport. Intrinsic factors associated with an increased likelihood of return to sport may be addressed during rehabilitation to improve the outcome of the reconstruction. The objectives of this review were to systematically appraise publications from six electronic databases describing intrinsic factors that may be associated with return to sport after anterior cruciate ligament reconstruction.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA guidelines were followed. Methodological quality appraisal was performed according to the Critical Appraisal Skills Programme for cohort studies. We performed a descriptive synthesis of the findings that associated intrinsic factors with return to sport.Results: Ten studies were included in the review. The findings show that fear of re-injury is a common reason for not returning to participation in sport. Younger patients may be more likely to return to sport, but findings regarding gender were equivocal, with male competitive athletes appearing to be more likely to return to sport than their female counterparts. Good knee function is not always associated with a higher likelihood to return to sport.Conclusion: Fear of re-injury and age should be considered in the management of sports participants after anterior cruciate ligament reconstruction.

  20. Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion–Based Rehabilitation Progression

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    ADAMS, DOUGLAS; LOGERSTEDT, DAVID; HUNTER-GIORDANO, AIRELLE; AXE, MICHAEL J.; SNYDER-MACKLER, LYNN

    2013-01-01

    SYNOPSIS The management of patients after anterior cruciate ligament reconstruction should be evidence based. Since our original published guidelines in 1996, successful outcomes have been consistently achieved with the rehabilitation principles of early weight bearing, using a combination of weight-bearing and non–weight-bearing exercise focused on quadriceps and lower extremity strength, and meeting specific objective requirements for return to activity. As rehabilitative evidence and surgical technology and procedures have progressed, the original guidelines should be revisited to ensure that the most up-to-date evidence is guiding rehabilitative care. Emerging evidence on rehabilitative interventions and advancements in concomitant surgeries, including those addressing chondral and meniscal injuries, continues to grow and greatly affect the rehabilitative care of patients with anterior cruciate ligament reconstruction. The aim of this article is to update previously published rehabilitation guidelines, using the most recent research to reflect the most current evidence for management of patients after anterior cruciate ligament reconstruction. The focus will be on current concepts in rehabilitation interventions and modifications needed for concomitant surgery and pathology. PMID:22402434

  1. Visual biofeedback exercises for improving body balance control after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Molka, Alicja Zyta; Lisiński, Przemysław; Huber, Juliusz

    2015-07-01

    [Purpose] To evaluate the effects of balance training after arthroscopic anterior cruciate ligament reconstruction. [Subjects and Methods] Sixteen patients (mean 33 ± 8 years old) who underwent anterior cruciate ligament reconstruction three months prior to participating in a one-month rehabilitation program. The control group included 15 people aged 34 ± 4 years. Patients' functional level was evaluated according to the Lysholm knee score, and balance quality was ascertained by static and dynamic tests. A balance platform was used to measure the center of foot pressure deflection. Two dynamic balance tests evaluated time of task execution. [Results] Lysholm knee score improved significantly after rehabilitation. Balance in the sagittal plane with eyes closed improved significantly after rehabilitation. The average velocity of center of foot pressure swing in both the frontal and sagittal planes with eyes closed differed significantly from those of controls. Execution time required for the two dynamic tests decreased significantly after rehabilitation and were significantly better than those in the controls. [Conclusion] Maintaining static balance with eyes closed is very challenging after anterior cruciate ligament reconstruction. Maintaining balance in the sagittal plane is particularly difficult. A one-month rehabilitation program partially improves static and dynamic balance.

  2. Impaired voluntary quadriceps force control following anterior cruciate ligament reconstruction: relationship with knee function.

    Science.gov (United States)

    Perraton, Luke; Clark, Ross; Crossley, Kay; Pua, Yong-Hao; Whitehead, Tim; Morris, Hayden; Telianidis, Stacey; Bryant, Adam

    2017-05-01

    Impairments in quadriceps force control and altered quadriceps and hamstring muscle activation strategies have been observed following anterior cruciate ligament reconstruction; however, the functional implications of these impairments are unclear. This study examined the cross-sectional associations between quadriceps force control, quadriceps activation, hamstring coactivation and clinically assessed knee function following anterior cruciate ligament reconstruction with a hamstring graft. Sixty-six patients (18 ± 3 months following surgery) and 41 uninjured individuals participated. Quadriceps force control was assessed using an isometric knee extension task. Participants cyclically increased and decreased quadriceps force at slow speeds between 5 and 30 % maximum voluntary isometric contraction matching a moving target displayed on a screen. Quadriceps activation and hamstring coactivation were assessed concurrently using surface electromyography. Knee function was assessed with the Cincinnati Knee Rating Scale and three single-leg hop tests. The reconstructed group completed the task with 48 % greater root-mean-square error (RMSE), indicating significantly worse quadriceps force control (p anterior cruciate ligament reconstruction and may contribute to irregular knee joint loading and the onset or progression of knee osteoarthritis. Impairments in quadriceps force control and altered muscle activation strategies may be modifiable through neuromuscular training, and this is an area for future research. Case-control study, Level III.

  3. Anterior cruciate ligament allograft surgery: underreporting of graft source, graft processing, and donor age.

    Science.gov (United States)

    Sikka, Robby S; Narvy, Steven J; Vangsness, C Thomas

    2011-03-01

    There has been much controversy regarding the effects of sterilization techniques and graft history on the structural integrity of allograft ligaments used in reconstruction of the anterior cruciate ligament. The purpose of this review was to comprehensively examine anterior cruciate ligament allograft studies published in the last decade to evaluate the extent to which tissue source, tissue processing techniques, and donor age are reported. The authors reviewed 202 articles published from 1999 through November 2009, of which 68 retrospective, prospective, biomechanical, and histology studies evaluating 4689 allografts were included. The majority of studies do not accurately report key elements of graft history including tissue bank, processing or sterilization technique, or donor age. Underreporting was particularly prominent in clinical studies as compared with basic science studies. Limited reporting of allograft processing, allograft source, and donor age raises serious questions regarding the generalizability of published studies of allograft tissue for anterior cruciate ligament reconstruction. Conclusion/ Orthopaedic surgeons who use allograft tissue must understand the tissue treatments being used (ie, preservation methods, chemical and sterilization processes) to best inform their patients regarding the risks, benefits, and long-term outcomes when such tissues are used. A complete understanding of the implanted tissue, as well as surgeon and recipient demographics, is necessary to ensure appropriate and predictable long-term outcomes.

  4. Electromyographic and biomechanic analysis of anterior cruciate ligament deficiency and functional knee bracing.

    Science.gov (United States)

    Ramsey, Dan K; Wretenberg, Per F; Lamontagne, Mario; Németh, Gunnar

    2003-01-01

    Examine the neuromuscular response to functional knee bracing relative to anterior tibial translations in vivo. During randomised brace conditions, electromyographic data with simultaneous skeletal tibiofemoral kinematics were recorded from four anterior cruciate ligament deficient subjects to investigate the effect of the DonJoy Legend functional brace during activity. Knee braces do not increase knee stability but may influence afferent inputs from proprioception and therefore one might expect changes in muscle firing patterns, amplitude and timing. Hoffman bone pins affixed with markers were implanted into the tibia and femur for kinematic measurement. The EMG data from the rectus femoris, semitendinosus, biceps femoris, and lateral head of the gastrocnemius were integrated for each subject in three separate time periods: 250 ms preceding footstrike and two consecutive 125 ms time intervals following footstrike. With brace, semitendinosus activity significantly decreased 17% prior to footstrike whereas bicep femoris significantly decreased 44% during A2, (P<0.05). Rectus femoris activity significantly increased 21% in A2 (P<0.05). No consistent reductions in anterior translations were evident. Our preliminary findings, based on a limited number of subjects, indicate joint stability may result from proprioceptive feedback rather than the mechanical stabilising effect of the brace. Despite a significant increase in rectus femoris activity upon landing, only one subject demonstrated an increase in anterior tibial drawer. Studies have shown functional braces do not mechanically stabilise the anterior cruciate ligament deficient knee. Perhaps bracing alters proprioceptive feedback. It has been shown that bracing the anterior cruciate ligament deficient knee may affect hamstring and quadriceps activity. Our findings stresses the importance of functional knee bracing combined with proprioceptive and muscular coordination training in order to increase joint stability.

  5. Anterior medial meniscal root avulsions due to malposition of the tibial tunnel during anterior cruciate ligament reconstruction: two case reports.

    Science.gov (United States)

    Laprade, Christopher M; James, Evan W; Engebretsen, Lars; Laprade, Robert F

    2014-05-01

    The meniscal roots are essential for preserving the native biomechanical and structural properties of the tibiofemoral joint. Meniscus root avulsions, which disrupt the normal meniscus anchoring points, have been reported to result in deleterious biomechanics and clinical outcomes. In this series, two cases of iatrogenic medial meniscus anterior root avulsions after anterior cruciate ligament (ACL) reconstruction are reported. Iatrogenic medial meniscus anterior root avulsions after malpositioning of the tibial tunnels during ACL reconstruction have not been previously reported in the literature and may account for poor long-term outcomes seen in some patients after ACL reconstruction. Therefore, careful attention must be paid to correct tibial tunnel placement during ACL reconstruction. Case series, Level IV.

  6. [Initial therapeutic evaluation of arthroscopic reconstruction of anterior and posterior cruciate ligament injury with anterior tibialis tendon allograft].

    Science.gov (United States)

    Wang, Hong; Meng, Chunqing; Duan, Deyu; Yang, Shuhua; Ye, Shunan; Shao, Zengwu

    2009-05-01

    To study the operative procedure and effect of arthroscopic reconstruction of both anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) with anterior tibialis tendon allograft. From February 2005 to July 2006, 10 cases of both ACL and PCL rupture were reconstructed with anterior tibialis tendon allograft, including 7 men and 3 women, aging 18-45 years with an average of 30.2 years. The locations were left knee in 6 cases and right knee in 4 cases. All of them had identified trauma history. The disease course was about 1-3 weeks (mean 1.8 weeks). Both ACL and PCL were reconstructed under arthroscope with allograft anterior tibialis tendon of 26-28 cm in length and immobilization with extention position brace was given for 4 weeks after operation. The active flex knee exercise was done from 0-90 degrees at 4 weeks and more than 90 degrees at 6 weeks. All operations were finished successfully, there were no blood vessel and nerve injury. The operative time was 90-110 minutes (mean 100 minutes). The wound healed by first intention and no early complication occurred. Ten cases were followed up for 12 months to 15 months with an average of 13.5 months. Thier gait was normal, knee activity degree was 0-135 degrees. The anterior drawing tests and media and lateral stress tests were negative after operation in 10 cases; and the posterior drawing tests were negative in 8 cases and 2 cases was at grade I. Hydra arthrosis of knee occurred in 2 cases and was cured after remove of fluid and injection of sodium hyaluronate. The Lysholm knee function score was increases from 24.89 +/- 5.39 before operation to 96.00 +/- 4.59 at 12 months after operation, showing significant difference (P anterior tibialis tendon allograft has the advantages of short operation time, less complications and good clinical effects.

  7. Core stability, knee muscle strength, and anterior translation are correlated with postural stability in anterior cruciate ligament-reconstructed patients.

    Science.gov (United States)

    Cinar-Medeni, Ozge; Baltaci, Gul; Bayramlar, Kezban; Yanmis, Ibrahim

    2015-04-01

    The purpose of this study was to investigate the relationship of postural stability and lower extremity performance with core stability, knee laxity, and muscle strength in patients with anterior cruciate ligament reconstruction. Twenty-eight anterior cruciate ligament-reconstructed subjects were included in the study. Anterior knee laxity tests, isokinetic knee muscle strength tests, and core stability tests were performed. Single-limb postural stability was assessed in both eyes-open and eyes-closed positions on a static surface and an eyes-open condition on a foam surface. A single-legged hop test was performed to assess lower extremity performance. To detect differences between the operated and healthy leg, a Mann-Whitney U test was performed, and a correlation analysis was performed using the Spearman correlation coefficient. Knee muscle strength and laxity were different between the operated and healthy legs (P core stability tests (P strength correlated with the mediolateral sway index on a foam surface (P strength correlated with the single-legged hop for both legs (P core stability, decreased knee muscle strength, and increased knee laxity correlated with single-limb postural stability. Better hop performance was demonstrated with better knee flexor and extensor muscle strength and was independent from core stability.

  8. THE TIBIAL APERTURE SURFACE ANALYSIS IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION PROCESS.

    Science.gov (United States)

    Milojević, Zoran; Tabaković, Slobodan; Vićević, Marija; Obradović, Mirko; Vranjes, Miodrag; Milankov, Miroslav Z

    2016-01-01

    The tibial tunnel aperture in the anterior cruciate ligament reconstruction is usually analyzed as an ellipse, generated as an intersection between a tibial plateau and a tibial bone tunnel. The aim of this study is to show that the tibial tunnel aperture, which utilizes 3D tibial surface bone model, differs significantly from common computations which present the tibial tunnel anterior cruciate ligament aperture surface as an ellipse. An interactive program system was developed for the tibial tunnel aperture analysis which included the real tibia 3D surface bone model generated from a series of computed tomography images of ten male patients, their mean age being 25 years. In aperture calculation, the transverse drill angle of 10 degrees was used, whereas sagittal drill angles of 40 degrees, 50 degrees and 60 degrees were used with the drill-bit diameter set to 10 mm. The real 3D and 2D tibial tunnel aperture surface projection was calculated and compared with an ellipse. According to the calculations, generated 3D aperture surfaces were different for every patient even though the same drill parameters were used. For the sagittal drill angles of 40 degrees, 50 degrees and 60 degrees, the mean difference between the projected 3D and 2D area on the tibial plateau was 19.6 +/- 5.4%, 21.1 +/- 8.0% and 21.3 +/- 9.6%, respectively. The difference between the projected 3D area on the tibial plateau and ellipse surface was 54.8 +/- 16.3%, 39.6 +/- 10.4% and 25.0 +/- 8.0% for sagittal drill angles of 40 degrees, 50 degrees and 60 degrees, respectively. The tibial tunnel aperture surface area differs significantly from the ellipse surface area, which is commonly used in the anterior cruciate ligament reconstruction analysis. Inclusion of the 3D shape of the tibial attachment site in the preoperative anterior cruciate ligament reconstruction planning process can lead to a more precise individual anatomic anterior cruciate ligament reconstruction on the tibial bone. Both

  9. Are Female Soccer Players at an Increased Risk of Second Anterior Cruciate Ligament Injury Compared With Their Athletic Peers?

    Science.gov (United States)

    Allen, Melissa M; Pareek, Ayoosh; Krych, Aaron J; Hewett, Timothy E; Levy, Bruce A; Stuart, Michael J; Dahm, Diane L

    2016-10-01

    Female soccer players have a well-known risk for anterior cruciate ligament (ACL) injury, but few studies have reported on second ACL injuries in this population. To (1) report the rates of subsequent ACL injury (ipsilateral graft rupture or contralateral tear) in competitive female soccer players, (2) compare these rates with those of other female athletes of similar competitive level, (3) determine risk factors for second ACL injury, and (4) report clinical outcome scores in this population. Cohort study; Level of evidence, 3. The medical records at a single institution were reviewed for female patients who were injured during a competitive athletic event and treated with primary ACL reconstruction (ACLR) between 1998 and 2013. Patients were followed for a mean of 68.8 months postoperatively (range, 24-115.2 months). Clinical outcome was obtained via Lysholm and International Knee Documentation Committee (IKDC) scores. Soccer players were matched 1:1 to non-soccer athletes for age, activity level, and graft type. A total of 180 female ACLR patients with a mean ± SD age of 19.6 ± 6.9 years met the study inclusion and exclusion criteria (90 soccer players and 90 non-soccer players). Soccer players sustained more second ACL injuries, including both graft failures (11% vs 1%; P follow-up. Twenty-eight percent of all female soccer players and 34% of those players who returned to soccer had a second ACL tear. Soccer players had an increased rate of both graft tear and contralateral ACL injury compared with similar non-soccer athletes. Older age and return to soccer were significant risk factors for graft rupture. © 2016 The Author(s).

  10. Dynamic Intraligamentary Stabilization (DIS) for treatment of acute anterior cruciate ligament ruptures: case series experience of the first three years.

    Science.gov (United States)

    Henle, Philipp; Röder, Christoph; Perler, Gosia; Heitkemper, Sven; Eggli, Stefan

    2015-02-13

    In recent years, the scientific discussion has focused on new strategies to enable a torn anterior cruciate ligament (ACL) to heal into mechanically stable scar tissue. Dynamic intraligamentary stabilization (DIS) was first performed in a pilot study of 10 patients. The purpose of the current study was to evaluate whether DIS would lead to similarly sufficient stability and good clinical function in a larger case series. Acute ACL ruptures were treated by using an internal stabilizer, combined with anatomical repositioning of torn bundles and microfracturing to promote self-healing. Clinical assessment (Tegner, Lysholm, IKDC, and visual analogue scale [VAS] for patient satisfaction scores) and assessment of knee laxity was performed at 3, 6, 12, and 24 months. A one-sample design with a non-inferiority margin was chosen to compare the preoperative and postoperative IKDS and Lysholm scores. 278 patients with a 6:4 male to female ratio were included. Average patient age was 31 years. Preoperative mean IKDC, Lysholm, and Tegner scores were 98.8, 99.3, and 5.1 points, respectively. The mean anteroposterior (AP) translation difference from the healthy contralateral knee was 4.7 mm preoperatively. After DIS treatment, the mean 12-month IKDC, Lysholm, and Tegner scores were 93.6, 96.2, and 4.9 points, respectively, and the mean AP translation difference was 2.3 mm. All these outcomes were significantly non-inferior to the preoperative or healthy contralateral values (p DIS and microfracturing, leads to clinically stable healing of the torn ACL in the large majority of patients. Most patients exhibited almost normal knee function, reported excellent satisfaction, and were able to return to their previous levels of sporting activity. Moreover, this strategy resulted in stable healing of all sutured menisci, which could lower the rate of osteoarthritic changes in future. The present findings support the discussion of a new paradigm in ACL treatment based on preservation and

  11. Smaller Anterior Cruciate Ligament Diameter Is a Predictor of Subjects Prone to Ligament Injuries: An Ultrasound Study

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    Parag Suresh Mahajan

    2015-01-01

    Full Text Available Purpose. To test if diameter of normal anterior cruciate ligament (ACL can be measured by ultrasound (US, to see if there is a relationship between smaller ACL diameter and ACL injury, and to assess agreement between radiologists in measuring ACL diameter in cases and matched controls. Materials and Methods. In this ethics committee-approved study, maximum diameter of ACL near tibial insertion site was measured by static and dynamic US study in 25 normal contralateral knees of subjects who suffered noncontact ACL injury and in 25 matched control subjects. Results. ACL was visualized as a thick linear hypoechoic band inserted approximately 11 mm caudal to the tibial plateau and the intercondylar eminence. Maximum diameter of contralateral ACL near tibial insertion site among injured subjects was significantly smaller than in noninjured subjects (0.62 ± 0.07 cm versus 0.81 ± 0.06 cm; P<0.0001. In the regression analysis, the diameter of ACL near tibial insertion site was found significantly proportional to body weight and not significantly associated to height, gender, and age. Conclusion. Diameter of normal ACL near tibial insertion site can be measured by US and the maximum diameter is significantly smaller among subjects with noncontact ACL injury. US is a promising modality that can be used as an excellent screening test to detect subjects especially aspiring athletes prone to ACL injury. Very strong agreement was observed between radiologists in measuring ACL diameter.

  12. Evaluation of static and dynamic balance in athletes with anterior cruciate ligament injury – A controlled study

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    Tiago Lazzaretti Fernandes

    Full Text Available OBJECTIVES: Anterior cruciate ligament injury leads to adaptive responses to maintain postural control. However, there is no consensus regarding whether leg dominance also affects postural control in athletes with anterior cruciate ligament injury. The purpose of this study was to evaluate dynamic and static postural control among athletes with and without anterior cruciate ligament injury to the dominant leg. METHODS: Twenty-eight athletes, twenty-one males and seven females aged 15-45 years, were allocated to one of two groups: the anterior cruciate ligament injury group (26±3 years or the control group without anterior cruciate ligament injury (25±6.5 years. All subjects performed one legged stance tests under eyes open and eyes closed conditions and squat and kick movement tests using a postural control protocol (AccuSwayPlus force platform, Massachusetts. The center of pressure displacement and speed were measured by the force platform. In addition, the distance traveled on the single-leg hop test was assessed as an objective measure of function. RESULTS: Significantly greater mediolateral sway was found under the eyes closed condition (p=0.04 and during squat movement (p=0.01 in the anterior cruciate ligament injury group than in the control group. Analysis of the single-leg hop test results showed no difference between the groups (p=0.73. CONCLUSION: Athletes with anterior cruciate ligament injury had greater mediolateral displacement of the center of pressure toward the dominant leg under the eyes closed condition and during squat movement compared to control athletes.

  13. An in vitro biomechanical comparison of anterior cruciate ligament reconstruction: single bundle versus anatomical double bundle techniques

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    Sandra Umeda Sasaki

    2008-01-01

    Full Text Available INTRODUCTION: Anterior cruciate ligament ruptures are frequent, especially in sports. Surgical reconstruction with autologous grafts is widely employed in the international literature. Controversies remain with respect to technique variations as continuous research for improvement takes place. One of these variations is the anatomical double bundle technique, which is performed instead of the conventional single bundle technique. More recently, there has been a tendency towards positioning the two bundles through double bone tunnels in the femur and tibia (anatomical reconstruction. OBJECTIVES: To compare, through biomechanical tests, the practice of anatomical double bundle anterior cruciate ligament reconstruction with a patellar graft to conventional single bundle reconstruction with the same amount of patellar graft in a paired experimental cadaver study. METHODS: Nine pairs of male cadaver knees ranging in age from 44 to 63 years were randomized into two groups: group A (single bundle and group B (anatomical reconstruction. Each knee was biomechanically tested under three conditions: intact anterior cruciate ligament, reconstructed anterior cruciate ligament, and injured anterior cruciate ligament. Maximum anterior dislocation, rigidity, and passive internal tibia rotation were recorded with knees submitted to a 100 N horizontal anterior dislocation force applied to the tibia with the knees at 30, 60 and 90 degrees of flexion. RESULTS: There were no differences between the two techniques for any of the measurements by ANOVA tests. CONCLUSION: The technique of anatomical double bundle reconstruction of the anterior cruciate ligament with bone-patellar tendon-bone graft has a similar biomechanical behavior with regard to anterior tibial dislocation, rigidity, and passive internal tibial rotation.

  14. Single-Bundle Versus Double-Bundle Reconstruction for Anterior Cruciate Ligament Rupture: A Meta-Analysis-Does Anatomy Matter?

    NARCIS (Netherlands)

    Eck, Carola F. Van; Kopf, Sebastian; Irrgang, James J.; Blankevoort, Leendert; Bhandari, Mohit; Fu, Freddie H.; Poolman, Rudolf W.

    2012-01-01

    Purpose: To determine whether double-bundle anterior cruciate ligament reconstruction leads to better restoration of anterior and rotational laxity and range of motion than single-bundle reconstruction. Methods: A search was performed in the Medline, Embase, CINAHL, and Cochrane databases. All

  15. Disadvantages and advantages of transtibial technique for creating the anterior cruciate ligament femoral socket.

    Science.gov (United States)

    Robin, Brett N; Lubowitz, James H

    2014-10-01

    Anterior cruciate ligament (ACL) femoral socket techniques have distinct advantages and disadvantages when considering the following techniques: transtibial, anteromedial portal, outside-in, and outside-in retroconstruction. There is no one perfect technique and we have an incomplete understanding of anatomical, biomechanical, isometry, stability, and clinical outcomes. Our primary focus is transtibial technique for creating the ACL femoral socket. Advantages include less invasive, isometric graft placement, stable Lachman exam, and minimal graft impingement with the tunnel and notch. Disadvantages include nonanatomic vertical graft placement that can cause rotational instability and positive pivot shift, interference screw divergence, graft-tunnel length mismatch, femoral socket constraint, posterior cruciate ligament impingement, and a short, oblique tibial tunnel that may undermine the medial plateau in an attempt to achieve anatomic ACL reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  16. Anterior cruciate ligament reconstruction and cartilage contact forces--A 3D computational simulation.

    Science.gov (United States)

    Wang, Lianxin; Lin, Lin; Feng, Yong; Fernandes, Tiago Lazzaretti; Asnis, Peter; Hosseini, Ali; Li, Guoan

    2015-12-01

    Clinical outcome studies showed a high incidence of knee osteoarthritis after anterior cruciate ligament reconstruction. Abnormal joint kinematics and loading conditions were assumed as risking factors. However, little is known on cartilage contact forces after the surgery. A validated computational model was used to simulate anatomic and transtibial single-bundle anterior cruciate ligament reconstructions. Two graft fixation angles (0° and 30°) were simulated for each reconstruction. Biomechanics of the knee was investigated in intact, anterior cruciate ligament deficient and reconstructed conditions when the knee was subjected to 134 N anterior load and 400 N quadriceps load at 0°, 30°, 60° and 90° of flexion. The tibial translation and rotation, graft forces, medial and lateral contact forces were calculated. When the graft was fixed at 0°, the anatomic reconstruction resulted in slightly larger lateral contact force at 0° compared to the intact knee while the transtibial technique led to higher contact force at both 0° and 30° under the muscle load. When graft was fixed at 30°, the anatomic reconstruction overstrained the knee at 0° with larger contact forces, while the transtibial technique resulted in slightly larger contact forces at 30°. This study suggests that neither the anatomic nor the transtibial reconstruction can consistently restore normal knee biomechanics at different flexion angles. The anatomic reconstruction may better restore anteroposterior stability and contact force with the graft fixed at 0°. The transtibial technique may better restore knee anteroposterior stability and articular contact force with the graft fixed at 30° of flexion. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Anterior cruciate ligament reconstruction and cartilage contact forces – a 3D computational simulation

    Science.gov (United States)

    Wang, Lianxin; Lin, Lin; Feng, Yong; Fernandes, Tiago Lazzaretti; Asnis, Peter; Hosseini, Ali; Li, Guoan

    2015-01-01

    Background Clinical outcome studies showed a high incidence of knee osteoarthritis after anterior cruciate ligament reconstruction. Abnormal joint kinematics and loading conditions were assumed as risking factors. However, little is known on cartilage contact forces after the surgery. Methods A validated computational model was used to simulate anatomic and transtibial single-bundle anterior cruciate ligament reconstructions. Two graft fixation angles (0° and 30°) were simulated for each reconstruction. Biomechanics of the knee was investigated in intact, anterior cruciate ligament deficient and reconstructed conditions when the knee was subjected to 134N anterior load and 400N quadriceps load at 0°, 30°, 60° and 90° of flexion. The tibial translation and rotation, graft forces, medial and lateral contact forces were calculated. Findings When the graft was fixed at 0°, the anatomic reconstruction resulted in slightly larger lateral contact force at 0° compared to the intact knee while the transtibial technique led to higher contact force at both 0° and 30° under the muscle load. When graft was fixed at 30°, the anatomic reconstruction overstrained the knee at 0° with larger contact forces, while the transtibial technique resulted in slightly larger contact forces at 30°. Interpretation This study suggests that neither the anatomic nor the transtibial reconstruction can consistently restore normal knee biomechanics at different flexion angles. The anatomic reconstruction may better restore anteroposterior stability and contact force with the graft fixed at 0°. The transtibial technique may better restore knee anteroposterior stability and articular contact force with the graft fixed at 30° of flexion. PMID:26320976

  18. The Effects of Functional Knee Brace on Postural Control in Patients Who Underwent Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Salehi

    2016-09-01

    Full Text Available Background The current study aimed to evaluate the postural control in patients underwent anterior cruciate ligament reconstruction pre and post wearing functional knee brace. Methods Eighteen athletes undergone unilateral anterior cruciate ligament reconstruction included in the study. They had unilateral anterior cruciate ligament reconstruction at least six months before session test. Postural control was assessed pre and post wearing custom-fit functional knee brace using a posturographic platform prokin 254. The balance tests included: 1 standing on prokin platform with eyes open/closed on anterior cruciate ligament reconstruction limb, 2 standing on prokin platform with eyes open/closed on both limbs. The standard deviation (SD of body sway along the anteroposterior (AP and mediolateral (ML axis, mean velocity of center of pressure (COP along AP/ ML axis and the area ellipse (measured in 2 mm were calculated. Results Results of the paired T-test revealed a significant effect on selected postural control variables for the brace conditions especially in low challengeable conditions (double leg, eyes open test situations (P < 0.05. But in high challengeable conditions this effect was not significant. Conclusions Functional knee brace improved postural control in the simple balancing task in the subjects with anterior cruciate ligament reconstruction. But this improvement in more difficult balancing task was limited.

  19. Effectiveness of cryotherapy after anterior cruciate ligament reconstruction

    OpenAIRE

    Dambros, Camila; Martimbianco, Ana Luiza Cabrera; Polachini, Luis Otávio; Lahoz, Gisele Landim; Chamlian, Therezinha Rosane; Cohen, Moisés

    2012-01-01

    OBJETIVO: Avaliar a efetividade da crioterapia no pós-operatório imediato de reconstrução do ligamento cruzado anterior (LCA), em relação à redução da dor e melhora da amplitude de movimento (ADM) do joelho. MÉTODOS: Trata-se do estudo piloto de um ensaio clínico prospectivo randomizado. Os pacientes (n=25) foram randomizados em dois grupos: (A) Grupo Intervenção (n=10) que realizou um protocolo fisioterapêutico e fez uso do gelo por 20 minutos, duas vezes ao dia; e o Grupo (B) Controle (n=9)...

  20. Postural control in patients with anterior cruciate ligament injury

    OpenAIRE

    Borin, Gabriela; Masullo, Catia de Lourdes; Bonfim, Thatia Regina; Oliveira, Anamaria Siriani de; Paccola, Cleber Antônio Jansen; Barela, José Ângelo; Bevilaqua-Grossi, Débora

    2010-01-01

    A lesão do ligamento cruzado anterior (LCA) do joelho acarreta alterações somatosensoriais em função da perda de informações provenientes dos mecanorreceptores presentes no LCA. Esses receptores constituem importante fonte de informação sensorial, afetando o desempenho de vários atos motores, dentre os quais o controle postural. O estudo objetivou analisar o controle postural de indivíduos com joelhos normais e com lesão unilateral do LCA. Participaram 15 voluntários com lesão do LCA (grupo l...

  1. IN VIVO MOTION OF FEMORAL CONDYLES DURING WEIGHT-BEARING FLEXION AFTER ANTERIOR CRUCIATE LIGAMENT RUPTURE USING BIPLANE RADIOGRAPHY

    Directory of Open Access Journals (Sweden)

    Kaining Chen

    2013-09-01

    Full Text Available The purpose of this study was to investigate in vivo three- dimensional tibiofemoral kinematics and femoral condylar motion in knees with anterior cruciate ligament (ACL deficiency during a knee bend activity. Ten patients with unilateral ACL rupture were enrolled. Both the injured and contralateral normal knees were imaged using biplane radiography at extension and at 15°, 30°, 60°, 90°, and 120° of flexion. Bilateral knees were next scanned by computed tomography, from which bilateral three-dimensional knee models were created. The in vivo tibiofemoral motion at each flexion position was reproduced through image registration using the knee models and biplane radiographs. A joint coordinate system containing the geometric center axis of the femur was used to measure the tibiofemoral motion. In ACL deficiency, the lateral femoral condyle was located significantly more posteriorly at extension and at 15° (p < 0.05, whereas the medial condylar position was changed only slightly. This constituted greater posterior translation and external rotation of the femur relative to the tibia at extension and at 15° (p < 0.05. Furthermore, ACL deficiency led to a significantly reduced extent of posterior movement of the lateral condyle during flexion from 15° to 60° (p < 0.05. Coupled with an insignificant change in the motion of the medial condyle, the femur moved less posteriorly with reduced extent of external rotation during flexion from 15° to 60° in ACL deficiency (p < 0.05. The medial- lateral and proximal-distal translations of the medial and lateral condyles and the femoral adduction-abduction rotation were insignificantly changed after ACL deficiency. The results demonstrated that ACL deficiency primarily changed the anterior-posterior motion of the lateral condyle, producing not only posterior subluxation at low flexion positions but also reduced extent of posterior movement during flexion from 15° to 60°

  2. Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with Inability to Flex the Knee

    Directory of Open Access Journals (Sweden)

    Jake Sloane

    2010-01-01

    Full Text Available A 41-year-old female presented with a 3-month history of gradually worsening anterior knee pain, swelling and inability to flex the knee. Magnetic resonance imaging (MRI revealed a large intra-articular cystic swelling anterior to the anterior cruciate ligament (ACL, extending into the Hoffa's infrapatellar fat pad. Following manipulation under anaesthesia and arthroscopic debridement of the cyst, the patient's symptoms were relieved with restoration of normal knee motion. ACL ganglion cysts are uncommon intra-articular pathological entities, which are usually asymptomatic and diagnosed incidentally by MRI. This is the first reported case of an ACL cyst being so large as to cause a mechanical block to knee flexion.

  3. [One-stage repair and reconstruction of knee anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament].

    Science.gov (United States)

    Chen, Pingquan; Zhu, Zhenkang; Wang, Sheng

    2012-06-01

    To investigate the effectiveness of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction combined with limited open repair of medial collateral ligament (MCL) in recovering the stability and the function of the knee. Between April 2003 and October 2010, 14 patients (14 knees) with multiple injuries of ACL, PCL, and MCL were treated. There were 10 males and 4 females with an average age of 41 years (range, 21-71 years). Injury was caused by traffic accident in 11 cases and falling in 3 cases. The average time from injury to admission was 2 days (range, 1-4 days). Lysholm score was 17.00 +/- 8.29, and the International Knee Documentation Committee (IKDC) score was 20.93 +/- 8.28. The complicated injuries included dislocation of the knee joint in 9 cases and meniscus injury in 5 cases. Allogeneic tendons (2 cases) and autologous harmstring tendon (12 cases) were used to reconstruct ACL and PCL under arthroscopy, and all cases underwent limited open repair of MCL. All incisions healed by first intention. Numbness of the lower limb occurred in 3 cases and alleviated spontaneously. All patients were followed up 14 months on average (range, 12-18 months). The knee flexion was 120 degrees and extension was 0 degrees at 3 months of follow-up. After 1 year of follow-up, IKDC score and Lysholm score were 89.93 +/- 6.26 and 88.93 +/- 4.82, respectively, showing significant differences when compared with preoperative scores (P injuries of the knee ligaments, an arthroscope with limited open repair and reconstruction of the knee ligament can avoid open joint chamber, reduce postoperative articular adhesion, and encourage the joint function recovery.

  4. Knee joint accessory motion following anterior cruciate ligament allograft reconstruction: a preliminary report.

    Science.gov (United States)

    Jenkins, W L; Munns, S W; Loudon, J

    1998-07-01

    Early in the postoperative period, changes in tibial translation have been noted in patient populations following anterior cruciate ligament reconstructive surgery. Deformation due to a lengthening of the ligament graft has been the most widely accepted reason for the change in tibial translation. Treatment techniques have not been proven successful in the abatement or reversal of this graft lengthening. The purpose of this study was to investigate the effect of functional bracing on tibial translation during the first year postoperatively in a group of patients with early changes in tibial translation. Three consecutive patients with early increases in KT-2000 manual maximum total drawer following bone-patellar tendon-bone allograft reconstruction were identified as subjects in the control group. Five consecutive anterior cruciate ligament bone-patellar tendon-bone allografts with early increases in KT-2000 manual maximum total drawer were identified as subjects in the treatment group. These patients were followed monthly during the first year postoperatively by manual maximum total drawer KT-2000 testing. Criteria for inclusion in the treatment and control groups included KT-2000 testing, with an increase in translation of greater than or equal to 2 mm when compared with the uninvolved knee during the first year postoperatively. The treatment group was required to wear a functional knee brace during all weight-bearing activities until KT-2000 displacement measures were stabilized for 3 consecutive months. Treatment with the functional brace resulted in a mean 2.3-mm decrease in tibial translation in the manual maximum total drawer KT-2000 when comparing the involved and uninvolved knee prebracing with posttreatment. All five subjects in the treatment group had a decrease in tibial translation. A Median Test comparing the control and treatment group's KT-2000 scores was significant at the p anterior cruciate ligament reconstructions may be assisted in a reduction

  5. Electromyographic analysis of anterior cruciate deficient knees with and without functional bracing during lunge exercise.

    Science.gov (United States)

    Jalali, Maryam; Farahmand, Farzam; Rezaeian, Tahmineh; Ramsey, Daniel K; Mousavi, Seyed Mohammad Ebrahim

    2016-04-01

    The use of functional knee braces for returning to sports or during demanding activities following anterior cruciate ligament rupture is common; yet despite being commonly prescribed, its mechanism of action remains unknown. To examine the effect of functional knee braces on mean muscle activity when performing lunge exercises. Pre-/post-test (within-subject research design). A total of 10 male participants with unilateral isolated anterior cruciate ligament deficiency participated. Electromyographic activities of six muscles around the knee were recorded during lunge exercises, with and without wearing a custom functional knee brace. The lunge cycle movement was subdivided into three phases: eccentric, isometric, and concentric. The quadriceps and hamstrings were no different in the braced and unbraced conditions. When braced, the mean amplitude of the medial gastrocnemius was significantly lower throughout the whole movement (p = 0.01) and during the concentric (p = 0.006) and eccentric (p = 0.028) phases, but not within the isometric phase. The lateral gastrocnemius was found to have lower mean amplitude in the isometric phase (p = 0.044). With its origin on the medial femoral condyle, perhaps reduced medial gastrocnemius activity may better guide knee rotation and assist the joint achieving a healthier kinematic pattern. Lower medial gastrocnemius activity may facilitate lower medial compartment contact pressure, for which greater loading is known to increase the risk of osteoarthritis in anterior cruciate ligament-deficient (ACLD) knees. However, further research is needed. © The International Society for Prosthetics and Orthotics 2014.

  6. Do psychosocial interventions improve rehabilitation outcomes after anterior cruciate ligament reconstruction? A systematic review.

    Science.gov (United States)

    Coronado, Rogelio A; Bird, Mackenzie L; Van Hoy, Erin E; Huston, Laura J; Spindler, Kurt P; Archer, Kristin R

    2017-08-01

    To examine the role of psychosocial interventions in improving patient-reported clinical outcomes, including return to sport/activity, and intermediary psychosocial factors after anterior cruciate ligament reconstruction. MEDLINE/PubMed, CINAHL, PsycINFO, and Web of Science were searched from each database's inception to March 2017 for published studies in patients after anterior cruciate ligament reconstruction. Studies were included if they reported on the effects of a postoperative psychosocial intervention on a patient-reported clinical measure of disability, function, pain, quality of life, return to sport/activity, or intermediary psychosocial factor. Data were extracted using a standardized form and summary effects from each article were compiled. The methodological quality of randomized trials was assessed using the Physiotherapy Evidence Database Scale and scores greater than 5/10 were considered high quality. A total of 893 articles were identified from the literature search. Of these, four randomized trials ( N = 210) met inclusion criteria. The four articles examined guided imagery and relaxation, coping modeling, and visual imagery as postoperative psychosocial interventions. Methodological quality scores of the studies ranged from 5 to 9. There were inconsistent findings for the additive benefit of psychosocial interventions for improving postoperative function, pain, or self-efficacy and limited evidence for improving postoperative quality of life, anxiety, or fear of reinjury. No study examined the effects of psychosocial interventions on return to sport/activity. Overall, there is limited evidence on the efficacy of postoperative psychosocial interventions for improving functional recovery after anterior cruciate ligament reconstruction.

  7. [Transplantation of adipose derived mesenchymal stem cells alleviated osteoarthritis induced with anterior cruciate ligament transection].

    Science.gov (United States)

    Zhou, J; Wang, Y; Cui, W; Xie, J W; Li, J P; Yang, J Y; Xu, H S; Liang, L Q; Yang, X Y; Lian, F

    2016-04-05

    To explore the therapeutic potential of transplantation of adipose derived mesenchymal stem cells (ADMSCs) in rats osteoarthritis caused by anterior cruciate ligament transection. Rats peritoneal adipose tissues were used to extract ADMSCs.Cell morphological appearance was documented and flow cytometric cell cycle was used to identify ADMSCs. Anterior cruciate ligament transection was used to induce knee osteoarthritis in rats. ADMSCs were injected into the knee cavities. Knee joint pathology was performed to observe the treatment effects. QRT-PCR and Western blot were used to identify the targets of ADMSCs. ADMSCs were successfully extracted, separated, cultured and identified. Two and eight weeks after ADMSCs transplantation, pathology showed significantly attenuation of arthritis including osteophyte and synovitis, reflecting in significantly improvement of both osteophyte and synovitis grading compared to the controls. QRT-PCR and Western blot revealed that collagen Ⅱ expression was significantly up-regulated after ADMSCs transplantation compared to the controls.MMP-13, but not other MMP-1, MMP-3 or MMP-9 was reduced when ADMSCs were co-cultured with primary chondrocytes. DDR-2 expression in chondrocyte was heavily up-regulated when stimulated by TNF-α in vitro. However, ADMSCs could reverse the effect when co-cultured with chondrocyte, implying that ADMSCs may suppress the expression of DDR-2. IL-1β suppressed the cartilage differentiation of ADMSCs, and Actinomycin D (DDR-2 inhibitor) could reverse the effect. ADMSCs can attenuate osteoarthritis induced by anterior cruciate ligament transection in rats by suppressing the expression of MMP-13, and the upstream target spot may be DDR-2.

  8. Evaluation of functional rehabilitation physiotherapy protocol in the postoperative patients with anterior cruciate ligament reconstruction through clinical prognosis: an observational prospective study

    OpenAIRE

    do Carmo Almeida, Tabata Cristina; de Alcantara Sousa, Luiz Vinicius; de Melo Lucena, Diego Monteiro; dos Santos Figueiredo, Francisco Winter; Valenti, Vitor Engr?cia; da Silva Paiva, La?rcio; de Abreu, Luiz Carlos; Adami, Fernando

    2016-01-01

    Abstract Background The aim of the study was to evaluate the evolution of patients subject to physical treatment based on guidelines of functional rehabilitation after surgery anterior cruciate ligament reconstruction. Methods This is a prospective study of 177 patients with anterior cruciate ligament injury, who underwent surgery and physical therapy guideline con...

  9. 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.

  10. Postoperative evaluation after anterior cruciate ligament reconstruction: Measurements and abnormalities on radiographic and CT imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Cheol; Choi, Yun Sun; KIm, Hyoung Seop; Choi, Nam Hong [Nowon Eulji Medical Center, Eulji University, Seoul (Korea, Republic of)

    2016-11-15

    Reconstruction of a ruptured anterior cruciate ligament (ACL) is a well-established procedure for repair of ACL injury. Despite improvement of surgical and rehabilitation techniques over the past decades, up to 25% of patients still fail to regain satisfactory function after an ACL reconstruction. With development of CT imaging techniques for reducing metal artifacts, multi-planar reconstruction, and three-dimensional reconstruction, early post-operative imaging is increasingly being used to provide immediate feedback to surgeons regarding tunnel positioning, fixation, and device placement. Early post-operative radiography and CT imaging are easy to perform and serve as the baseline examinations for future reference.

  11. Single-Bundle Anatomic Anterior Cruciate Ligament Reconstruction: Surgical Technique Pearls and Pitfalls.

    Science.gov (United States)

    Malempati, Chaitu S; Metzler, Adam V; Johnson, Darren L

    2017-01-01

    Anterior cruciate ligament (ACL) ruptures are some of the most common sports-related injuries. Treatment of these injuries with ACL reconstruction has evolved over the last several decades. Anatomic single-bundle ACL reconstruction offers an accurate and reproducible method to reproduce native knee anatomy, restore knee kinematics, and ultimately restore function and decrease long-term degenerative effects. The importance of adequate arthroscopic visualization and a thorough understanding of the native anatomic ACL landmarks are discussed in this article. Furthermore, surgical technique, pearls, pitfalls, potential complications, rehabilitation, and outcomes are reviewed. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Anterior cruciate ligament tear in a 7-year-old athlete.

    Science.gov (United States)

    Collins, Sara L; Van Valin, Scott E

    2013-01-01

    We present the case study of a 7-year-old boy with an initial partial anterior cruciate ligament (ACL) tear. Initially, this patient was treated conservatively due to his age and immature skeletal structure. He returned to competitive sports, but reinjured the knee resulting in a complete ACL tear. The purpose of this paper is to outline the incidence, mechanism of injury, treatment and prevention of ACL injuries in the pediatric population. Evaluation of the injury and treatment options, including complex reconstruction will be presented via a case study approach and review of the literature. The focus of this review for treatment of ACL tear was in those younger than 14 years.

  13. Management of Anterior Cruciate Ligament Injury: What's In and What's Out?

    Science.gov (United States)

    Raines, Benjamin Todd; Naclerio, Emily; Sherman, Seth L

    2017-01-01

    Sports medicine physicians have a keen clinical and research interest in the anterior cruciate ligament (ACL). The biomechanical, biologic, and clinical data researchers generate, help drive injury management and prevention practices globally. The current concepts in ACL injury and surgery are being shaped by technological advances, expansion in basic science research, resurging interest in ACL preservation, and expanding efforts regarding injury prevention. As new methods are being developed in this field, the primary goal of safely improving patient outcomes will be a unifying principle. With this review, we provide an overview of topics currently in controversy or debate, and we identify paradigm shifts in the understanding, management, and prevention of ACL tears.

  14. Stump entrapment of the anterior cruciate ligament in late childhood and adolescence

    Energy Technology Data Exchange (ETDEWEB)

    Meyers, Arthur B.; Laor, Tal; Zbojniewicz, Andrew M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2011-08-15

    Displacement of a portion of the torn anterior cruciate ligament (ACL) into the intercondylar notch can cause a focal fibrotic reaction similar to that seen following ACL reconstruction. This displacement, which can result in locking or limitation of knee extension, is termed stump entrapment and is described in adult MR imaging literature. We present a pictorial essay of the etiology and appearance of stump entrapment on MR imaging of the knee in an older child and adolescents and review the significance of this finding. (orig.)

  15. Asymmetry and Thigh Muscle Coactivity in Fatigued Anterior Cruciate Ligament-Reconstructed Elite Skiers

    DEFF Research Database (Denmark)

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

    2017-01-01

    PURPOSE: The acute effects of fatigue on functional interlimb asymmetry and quadriceps/hamstring muscle activity levels, including preparatory coactivation during squat jump takeoff and landing, were evaluated in elite alpine ski racers with/without anterior cruciate ligament reconstruction (ACLR......). METHODS: Twenty-two elite ski racers (ACLR, n = 11; control, n = 11) performed an 80-s repeated squat jump test (jump test) on a dual force plate system with simultaneous EMG recordings in vastus lateralis, vastus medialis, semitendinosus, and biceps femoris. Asymmetry index (AI) and jump height of body...

  16. Patellar tendon donor-site healing during six and twelve months after Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Yazdanshenas, Hamed; Madadi, Firooz; Madadi, Firoozeh; Washington, Eleby Rudolph; Jones, Kristofer; Shamie, Arya Nick

    2015-12-01

    Bone-Patellar Tendon-Bone Graft is one of the most acceptable methods of treatment for Anterior Cruciate Ligament rupture (ACL). This study evaluates the recovery process of the graft donor site. This study evaluates the graft donor site recovery in 23 patients with ACL reconstruction, 6 and 12 months after the patellar tendon graft surgery. In 70 percent of the cases, the healing process was completed after 6 months and the remaining 30 percent recovered after 12 months. Time is an important factor in the recovery process of the patellar tendon for reconstruction of the ACL.

  17. Magnetic resonance imaging of double-bundle anterior cruciate ligament reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Poellinger, Alexander; Hamm, Bernd; Asbach, Patrick [Charite, Department of Radiology, Berlin (Germany); Scheffler, Sven [Charite, Department for Orthopaedic Surgery and Traumatology, Center for Musculoskeletal Surgery, Berlin (Germany)

    2009-04-15

    Reconstruction of the anterior cruciate ligament (ACL) using the double-bundle technique is getting highly increasing attention. This surgical approach uses two separate tendon grafts with the intention to reconstruct both anatomic bundles in order to restore the full biomechanical function of the original ligament. With the increasing popularity of this technique, radiologists will be more frequently confronted with patients who underwent this surgical procedure. The aims of this essay are to briefly describe the basic biomechanical and surgical principles and to summarize the magnetic resonance imaging findings of the knee after double-bundle ACL reconstruction. (orig.)

  18. Mucoid Degeneration of the Anterior Cruciate Ligament: Magnetic Resonance Imaging Findings of an Underdiagnosed Entity

    Energy Technology Data Exchange (ETDEWEB)

    Fernandes, J.L.; Viana, S.L.; Mendonca, J.L.F.; Freitas, F.M.O.; Bezerra, A.S.A.; Lima, G.A.S.; Matos, V.L.; Cunha, N.F.; Martins, R.R.; Freitas, R.M.O. (Magnetic Resonance Dept., Clinica Radiologica Vila Rica, Brasilia (Brazil))

    2008-02-15

    Although imaging and clinical criteria are already established for the diagnosis of mucoid degeneration of the anterior cruciate ligament (ACL), many radiologists remain unaware of their existence. Once regarded as a rare occurrence, it has been recently suggested that its incidence is in fact very much higher than previously thought, and that it is probably underdiagnosed or misdiagnosed as partial ruptures of the ACL or as cystic ganglia. In this review, the authors revisit the literature concerning this subject and present their personal experience with it, stressing the paramount importance of magnetic resonance imaging and correlation with clinical data for a correct diagnosis

  19. Anterior cruciate ligament rupture secondary to a 'heel hook': a dangerous martial arts technique.

    Science.gov (United States)

    Baker, Joseph F; Devitt, Brian M; Moran, Ray

    2010-01-01

    The 'heel hook' is a type of knee lock used in some forms of martial arts to stress the knee and cause opponent to concede defeat. While the knee is in a flexed and valgus disposition, an internal rotation force is applied to the tibia. Reports are lacking on serious knee trauma as a result of this technique. We report the case of a 32-year-old Mixed Martial Arts exponent who sustained complete anterior cruciate ligament rupture and an medial collateral ligament injury from the use of a 'heel hook'.

  20. Secondary Stabilizers of Tibial Rotation in the Intact and Anterior Cruciate Ligament Deficient Knee.

    Science.gov (United States)

    Kaplan, Daniel James; Jazrawi, Laith M

    2018-01-01

    The controversy regarding the existence and function of the anterolateral ligament or anterolateral complex has reinvigorated interest in rotational stability of the knee joint. This is particularly true of anterolateral rotary instability, as many patients, despite anatomic reconstruction of their anterior cruciate ligament, continue to experience instability. Many experts point toward compromised anterolateral restraints as the underlying culprit, namely, the anterolateral complex, which includes the iliotibial band, anterolateral capsule, lateral meniscus, and lateral collateral ligament. This article provides a breakdown of these structures, their function, biomechanical properties, and clinical importance, based on a thorough review of available literature. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Postoperative Evaluation after Anterior Cruciate Ligament Reconstruction: Measurements and Abnormalities on Radiographic and CT Imaging.

    Science.gov (United States)

    Kim, Minchul; Choi, Yun Sun; Kim, Hyoungseop; Choi, Nam-Hong

    2016-01-01

    Reconstruction of a ruptured anterior cruciate ligament (ACL) is a well-established procedure for repair of ACL injury. Despite improvement of surgical and rehabilitation techniques over the past decades, up to 25% of patients still fail to regain satisfactory function after an ACL reconstruction. With development of CT imaging techniques for reducing metal artifacts, multi-planar reconstruction, and three-dimensional reconstruction, early post-operative imaging is increasingly being used to provide immediate feedback to surgeons regarding tunnel positioning, fixation, and device placement. Early post-operative radiography and CT imaging are easy to perform and serve as the baseline examinations for future reference.

  2. Mapping current research trends on anterior cruciate ligament injury risk against the existing evidence: In vivo biomechanical risk factors.

    Science.gov (United States)

    Sharir, Raihana; Rafeeuddin, Radin; Staes, Filip; Dingenen, Bart; George, Keith; Vanrenterghem, Jos; Robinson, Mark A

    2016-08-01

    Whilst many studies measure large numbers of biomechanical parameters and associate these to anterior cruciate ligament injury risk, they cannot be considered as anterior cruciate ligament injury risk factors without evidence from prospective studies. A review was conducted to systematically assess the in vivo biomechanical literature to identify biomechanical risk factors for non-contact anterior cruciate ligament injury during dynamic sports tasks; and to critically evaluate the research trends from retrospective and associative studies investigating non-contact anterior cruciate ligament injury risk. An electronic literature search was undertaken on studies examining in vivo biomechanical risk factors associated with non-contact anterior cruciate ligament injury. The relevant studies were assessed by classification; level 1 - a prospective cohort study, level 2 - a retrospective study or level 3 - an associative study. An initial search revealed 812 studies but this was reduced to 1 level 1 evidence study, 20 level 2 evidence studies and 175 level 3 evidence studies that met all inclusion criteria. Level 1 evidence showed that the knee abduction angle, knee abduction moment and ground reaction force were biomechanical risk factors. Nine level 2 studies and eighty-three level 3 studies used these to assess risk factors in their study. Inconsistencies in results and methods were observed in level 2 and 3 studies. There is a lack of high quality, prospective level 1 evidence related to biomechanical risk factors for non-contact anterior cruciate ligament injury. More prospective cohort studies are required to determine risk factors and provide improved prognostic capability. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Osteoarthritis prevalence following anterior cruciate ligament reconstruction: a systematic review and numbers-needed-to-treat analysis.

    Science.gov (United States)

    Luc, Brittney; Gribble, Phillip A; Pietrosimone, Brian G

    2014-01-01

    To determine the prophylactic capability of anterior cruciate ligament (ACL) reconstruction in decreasing the risk of knee osteoarthritis (OA) when compared with ACL-deficient patients, as well as the effect of a concomitant meniscectomy. We also sought to examine the influence of study design, publication date, and graft type as well as the magnitude of change in physical activity from preinjury Tegner scores in both cohorts. We searched Web of Science and PubMed databases from 1960 through 2012 with the search terms osteoarthritis, meniscectomy, anterior cruciate ligament, anterior cruciate ligament reconstruction, and anterior cruciate ligament deficient. Articles that reported the prevalence of tibiofemoral or patellofemoral OA based on radiographic assessment were included. We calculated numbers needed to treat and relative risk reduction with associated 95% confidence intervals for 3 groups (1) patients with meniscal and ACL injury, (2) patients with isolated ACL injury, and (3) total patients (groups 1 and 2). A total of 38 studies met the criteria. Of these, 27 assessed the presence of tibiofemoral osteoarthritis in patients treated with anterior cruciate ligament reconstruction. Overall, ACL reconstruction (ACL-R) yielded a numbers needed to treat to harm of 16 with a relative risk increase of 16%. Anterior cruciate ligament reconstruction along with meniscectomy yielded a numbers needed to treat to benefit of 15 and relative risk reduction of 11%. Isolated ACL-R showed a numbers needed to treat to harm of 8 and relative risk increase of 43%. Activity levels were decreased in both ACL-R (d = -0.90; 95% confidence interval = 0.77, 1.13) and ACL-deficient (d = -1.13; 95% confidence interval = 0.96, 1.29) patients after injury. The current literature does not provide substantial evidence to suggest that ACL-R is an adequate intervention to prevent knee osteoarthritis. With regard to osteoarthritis prevalence, the only patients benefiting from ACL-R were those

  4. Hip joint biomechanics in those with and without post-traumatic knee osteoarthritis after anterior cruciate ligament injury.

    Science.gov (United States)

    Wellsandt, E; Zeni, J A; Axe, M J; Snyder-Mackler, L

    2017-12-01

    Anterior cruciate ligament injury results in altered kinematics and kinetics in the knee and hip joints that persist despite surgical reconstruction and rehabilitation. Abnormal movement patterns and a history of osteoarthritis are risk factors for articular cartilage degeneration in additional joints. The purpose of this study was to determine if hip joint biomechanics early after anterior cruciate ligament injury and reconstruction differ between patients with and without post-traumatic knee osteoarthritis 5years after reconstruction. The study's rationale was that individuals who develop knee osteoarthritis after anterior cruciate ligament injury may also demonstrate large alterations in hip joint biomechanics. Nineteen athletes with anterior cruciate ligament injury completed standard gait analysis before (baseline) and after (post-training) extended pre-operative rehabilitation and at 6months, 1year, and 2years after reconstruction. Weightbearing knee radiographs were completed 5years after reconstruction to identify medial compartment osteoarthritis. Five of 19 patients had knee osteoarthritis at 5years after anterior cruciate ligament reconstruction. Patients with knee osteoarthritis at 5years walked with smaller sagittal plane hip angles (P: 0.043) and lower sagittal (P: 0.021) and frontal plane (P: 0.042) external hip moments in the injured limb before and after reconstruction compared to those without knee osteoarthritis. The current findings suggest hip joint biomechanics may be altered in patients who develop post-traumatic knee osteoarthritis. Further study is needed to confirm whether the risk of non-traumatic hip pathology is increased after anterior cruciate ligament injury and if hip joint biomechanics influence its development. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Anterior cruciate ligament reconstruction in a 75 years old man: a case report with review of literature

    Directory of Open Access Journals (Sweden)

    Vaishya Raju

    2014-04-01

    Full Text Available Anterior cruciate ligament (ACL reconstruction is usually recommended for young patients. Several recent articles have however reported comparable outcomes of ACL reconstruction between youth and patients in fourth or fifth age group. But in the literature there are not many reports about ACL reconstruction in patients over 70 years old. We report a case of a successful arthroscopic ACL reconstruction (using single bundle quadrupled hamstring graft in an active 75-yearold medical practitioner. Successful outcome after ACL reconstruction can be achieved in selected older patients; chronological age is no barrier. Key words: Anterior cruciate ligament reconstruction; Knee; Age factors

  6. Correlation between dynamic postural stability and muscle strength, anterior instability, and knee scale in anterior cruciate ligament deficient knees.

    Science.gov (United States)

    Park, Won-Hah; Kim, Do-Kyung; Yoo, Jae Chul; Lee, Yong Seuk; Hwang, Ji-Hye; Chang, Moon Jong; Park, Yong Serk

    2010-08-01

    The purpose of this study was to assess the correlations between dynamic postural stability and muscle strength, anterior instability, and knee scores in anterior cruciate ligament (ACL) deficient knees. We examined 40 male patients with ACL injury prior to surgery. Maximal torques of flexors and extensors of the injured knee at 60 and 180 degrees /s were evaluated using an isokinetic testing device. Anterior translations of the tibia were measured using a KT-2000 arthrometer, and dynamic postural stabilities were measured during single-leg stance using the Biodex Stability System (BSS). Knee statuses were evaluated using Lysholm and International Knee Documentation Committee (IKDC) knee scores. Correlations between dynamic postural stability and muscle strength, anterior instability, and knee scores were determined. Significant correlations were found between maximal torques of the extensor of injured knees at 60 and 180 degrees /s (r = -0.52, p = 0.048 and r = -0.46, p = 0.019, respectively) and dynamic postural stability, and maximal torques of flexors of injured knees showed similar relations (r = -0.51, p = 0.0048 and r = -0.47, p = 0.016, respectively). Lysholm and IKDC knee scores were also found to be correlated with dynamic postural stability (r = -0.49, p = 0.001 and r = -0.52, p = 0.005, respectively). However, no correlation was found between grade of anterior translation measured using the KT-2000 arthrometer and dynamic postural stability (p = 1.0). Dynamic postural stability determined using the BSS appears to be influenced by muscle strength, as determined by isokinetic testing, but not with grade of anterior translation measured using a KT-2000 arthrometer. Subjective knee scores appear to improve in parallel with dynamic postural stability.

  7. [Evaluation of Outcomes after Anterior Cruciate Ligament Reconstruction in Children and Adolescents].

    Science.gov (United States)

    Philippou, T; Kautzner, J; Hladký, V; Šťastný, E; Havlas, V

    2015-01-01

    Treatment for tears of the anterior cruciate ligament (ACL) in paediatric patients has been a long-discussed issue because of complications associated with ligament reconstruction in the presence of growth plates. Various fixation materials and their efficiency as well as ACL techniques are still under investigation. The aim of our study was to find an optimal strategy of treating acute intra-articular ACL injury in childhood. The paediatric patients treated for primary traumatic ACL injury between 2003 and 2013 were retrospectively evaluated. Only patients with a healthy contralateral knee (with no signs of instability or previous injury) and no record of previous ACL repair were included. A total of 78 patients were assessed; there were 39 girls and 39 boys with an average age of 15.4 years (11 - 16). The physical development of the patients was assessed on the Tanner scale, their satisfaction was recorded on the basis of the IKDC subjective knee evaluation form and the Tegner-Lysholm scoring system. The instrumented Lachman test using a rollimeter was performed to assess knee stability at 12 and 24 months of follow-up. In addition, the range of knee motion in comparison with the other side, complications and the re-rupture rate of reconstructed ACLs were recorded. Four patients with open growth plates were operated on using the transepiphyseal technique, the remaining 74 underwent reconstruction by the standard transphyseal method. The average Tegner-Lysholm scores were 54 (41-62) pre-operatively and 86.1 (74-96) at 24 months post-operatively. The average IKDC score increased from 48 (42-56) points to 91 (73-97) points. The Lachman test was positive in all patients before ACL reconstruction and negative in 96% of them at 12 and 24 months after surgery. The full range of joint motion was restored after ACL surgery, with minimal motion restriction in flexion and extension, in 70 (89.7%) patients. Motion restriction by 15° or less in flexion and 5° or less in

  8. FEMORAL TUNNELS' LENGTH CHANGES WITH KNEE FLEXION ANGLE IN ANATOMICAL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION.

    Science.gov (United States)

    Gali, Julio Cesar; de Sousa Oliveira, Heetor Campora; Ciancio, Bruno Asprino; Palma, Marcos Vianna; Kobayashi, Ricardo; Caetano, Edie Benedito

    2012-01-01

    The objective of our study was to evaluate the effect that knee flexion angle while femoral tunnels are being drilled may have on the length of these tunnels, in anatomical reconstruction of the anterior cruciate ligament. We measured the lengths of anteromedial and posterolateral tunnels for the anterior cruciate ligament in 20 unpaired anatomical knee specimens (10 right and 10 left knees), all with the cartilage and cruciate ligaments intact. Tunnels were drilled with the knees flexed at 90°, 110° and 130°, through the accessory anteromedial portal, with a 2.5 mm drill. The statistical analysis was done by means of Friedman's variance analysis and the Mann-Whitney U test. The mean anteromedial femoral tunnel lengths measured with the knees flexed at 90°, 110° and 130° were 33.7 (± 3.72) mm, 37.4 (± 2.93) mm and 38.8 (± 3.31) mm, respectively. For the posterolateral femoral tunnel lengths, the results were 32.1 (± 4.24) mm, 37.3 (± 4.85) mm and 38.4 (± 2.51) mm, respectively. Friedman's variance analysis showed that there was a significant difference between the lengths of the tunnels drilled with 90° and 110° of flexion angle, but showed that there was no significant difference between the tunnels drilled with flexion of 110° and 130° (P tunnels through the accessory anteromedial tunnel with the knee flexed at 110° in such a way as to produce a tunnel of sufficient length for a good bone-graft interface.

  9. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using In Situ Hamstring Graft With 4 Tunnels

    Science.gov (United States)

    Wagih, Ahmad M.

    2013-01-01

    A careful review of the literature suggests that a significant number of patients undergoing anterior cruciate ligament (ACL) reconstruction have less-than-optimal results. Although overall outcomes of ACL reconstruction are favorable, there remains considerable room for improvement. Anatomically, the ACL consists of 2 major functional bundles, the anteromedial bundle and the posterolateral bundle. Biomechanically, both bundles contribute significantly to the anterior and rotational stability of the knee. Therefore anatomic double-bundle ACL reconstruction techniques may further improve the outcomes in ACL surgery. This article presents a technique for arthroscopic double-bundle ACL reconstruction that includes the use of 2 femoral and 2 tibial tunnels to restore both the anteromedial and posterolateral bundles of the ACL with minimal hardware for fixation. PMID:24749023

  10. Assessment of functional knee bracing: an in vivo three-dimensional kinematic analysis of the anterior cruciate deficient knee.

    Science.gov (United States)

    Ramsey, D K; Lamontagne, M; Wretenberg, P F; Valentin, A; Engström, B; Németh, G

    2001-01-01

    To describe three-dimensional tibial and femoral movements in vivo and examine the effect of a brace on knee kinematics during moderate to intense activity. Skeletal kinematics of anterior cruciate ligament deficient knees was measured with and without braces during moderate to intense activity. Invasive markers implanted into the tibia and femur are the most accurate means to directly measure skeletal motion and may provide a more sensitive measure of the differences between brace conditions. Steinmann traction pins were implanted into the femur and tibia of four subjects having a partial or complete anterior cruciate ligament rupture. Non-braced and braced conditions were randomly assigned and subjects jumped for maximal horizontal distance to sufficiently stress the anterior cruciate ligament. Intra-subject peak vertical force and posterior shear force were generally consistent between conditions. Intra-subject kinematics was repeatable but linear displacements between brace conditions were small. Differences in angular and linear skeletal motion were observed across subjects. Bracing the anterior cruciate ligament deficient knee resulted in only minor kinematic changes in tibiofemoral joint motion. In this study, no consistent reductions in anterior tibial translations were observed as a function of the knee brace tested. Relevance. Investigations have reported that knee braces fail when high loads are encountered or when load is applied in an unpredictable manner. Questions remain regarding tibiofemoral joint motion, in particular linear displacements. The pin technique is a means for direct skeletal measurement and may provide a more sensitive measure of the differences between brace conditions.

  11. [The effects of functional knee bracing after anterior cruciate ligament reconstruction].

    Science.gov (United States)

    Dubljanin-Raspopović, Emilija; Bumbasirević, Marko; Devecerski, Gordana; Matanović, Dragana

    2009-01-01

    Limited surgical technology in treating injuries of the anterior cruciate ligament (ACL) in the past led to the development of a huge number of functional braces. Today, with the advance of the surgical techniques and a more aggressive rehabilitation approach in the postoperative course the use of functional braces after the ACL reconstruction is seriously questioned. The aim of this study was to review the basic functions of functional braces. Mechanical, and biomechanical functions of functional braces have been described, the psychological aspect of wearing them, their impact on thigh circumference, functional performance, muscle activity and postural control and propriocepation have also been addressed. Functional braces definitely increase the knee stability under low clinical loads. However, biomechanical investigations show that functional knee braces do not restore the normal knee stability under high forces related to certain activities. Furthermore, functional braces do not significantly influence proprioceptive abilities, nor functional performance, but have a negative impact on thigh atrophy, and inhibit joint muscle stabilizing activity. Given the generally high surgical success rates, there has been no scientific evidence so far to support the routine use of a functional knee brace following a successful anterior cruciate ligament reconstruction in the controlled rehabilitative postoperative course.

  12. Functional knee brace effects during walking in patients with anterior cruciate ligament reconstruction.

    Science.gov (United States)

    DeVita, P; Lassiter, T; Hortobagyi, T; Torry, M

    1998-01-01

    The purpose of this study was to compare lower extremity joint kinematics and kinetics during walking with and without a functional knee brace in patients with recent anterior cruciate ligament reconstructions. Seven volunteers walked at 1.26 m/s with and without one of two functional knee braces 3 weeks after surgery. Eleven uninjured subjects were also tested as a control group. Video and ground-reaction data were collected and combined with inverse dynamics to estimate the joint positions, moments, and powers during the stance phase. Patients with ligament reconstructions were more erect with the brace, using 19% less knee flexion compared with walking without the brace. Areas under the internal extensor moment curve (angular impulse) and power curve (work) at the hip increased 40% and 44%, respectively, while walking with the brace. Extensor angular impulse decreased 41% at the knee while using the brace, and plantar flexor angular impulse and work increased 21% and 30%, respectively, at the ankle. While walking with the brace, the patients still had different kinematics, moments, and powers than the control subjects. The reduced extensor moment at the knee in the braced condition indicated that the load on the recently reconstructed ligament was reduced and that the brace protected the ligament during the stance phase of walking. We concluded that functional knee braces may be one means of developing neuromuscular adaptations during gait after anterior cruciate ligament reconstruction surgery.

  13. Effects of knee bracing on the sensorimotor function of subjects with anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Wu, G K; Ng, G Y; Mak, A F

    2001-01-01

    The sensorimotor performance of the knee joint in 31 subjects who had undergone unilateral anterior cruciate ligament reconstruction at least 5 months previously was tested under three bracing conditions, 1) the DonJoy Legend brace, 2) a mechanical placebo brace, and 3) no brace, in random order. The accuracy of the subjects' ability to reproduce specified knee joint angles was tested as well as the isokinetic performance of their knee muscles at 60 and 180 deg/sec. The results showed that subjects with the brace or placebo brace performed similarly in reproducing the knee joint positions, but both groups performed better than the subjects without a brace. Isokinetic tests revealed no difference among the three groups in extensor and flexor peak torque production at 60 deg/sec or total work done by the extensors and flexors at 60 and 180 deg/sec. These results suggest that knee bracing can improve the static proprioception of the knee joint, but not the muscle contractile function, in subjects with anterior cruciate ligament reconstruction under isokinetic testing conditions. The finding of similar performances for joint angle reproduction in the brace and placebo brace groups suggests that the apparent improvement in proprioception with knee bracing was not due to the mechanical restraining action of the brace.

  14. Biologic Approaches for the Treatment of Partial Tears of the Anterior Cruciate Ligament

    Science.gov (United States)

    Dallo, Ignacio; Chahla, Jorge; Mitchell, Justin J.; Pascual-Garrido, Cecilia; Feagin, John A.; LaPrade, Robert F.

    2017-01-01

    Background: Anterior cruciate ligament reconstruction (ACLR) has been established as the gold standard for treatment of complete ruptures of the anterior cruciate ligament (ACL) in active, symptomatic individuals. In contrast, treatment of partial tears of the ACL remains controversial. Biologically augmented ACL-repair techniques are expanding in an attempt to regenerate and improve healing and outcomes of both the native ACL and the reconstructed graft tissue. Purpose: To review the biologic treatment options for partial tears of the ACL. Study Design: Review. Methods: A literature review was performed that included searches of PubMed, Medline, and Cochrane databases using the following keywords: partial tear of the ACL, ACL repair, bone marrow concentrate, growth factors/healing enhancement, platelet-rich plasma (PRP), stem cell therapy. Results: The use of novel biologic ACL repair techniques, including growth factors, PRP, stem cells, and bioscaffolds, have been reported to result in promising preclinical and short-term clinical outcomes. Conclusion: The potential benefits of these biological augmentation approaches for partial ACL tears are improved healing, better proprioception, and a faster return to sport and activities of daily living when compared with standard reconstruction procedures. However, long-term studies with larger cohorts of patients and with technique validation are necessary to assess the real effect of these approaches. PMID:28210653

  15. Patient Understanding, Expectations, Outcomes, and Satisfaction Regarding Anterior Cruciate Ligament Injuries and Surgical Management.

    Science.gov (United States)

    Cole, Brian J; Cotter, Eric J; Wang, Kevin C; Davey, Annabelle

    2017-05-01

    Patient satisfaction has become an increasingly important outcome metric in orthopaedics and medicine in general as many initiatives at both the state and national levels aim to improve the efficiency and quality of health care. Anterior cruciate ligament injuries are among the most common injuries in orthopaedics, with anterior cruciate ligament reconstruction (ACLR) surgery consistently reported as one of the most frequently performed procedures by orthopaedic surgeons. Patient-reported outcomes are frequently used to evaluate outcomes from the patient's perspective, and many physicians also ask patients about their satisfaction with treatment. A growing volume of literature has investigated the relation between preoperative patient expectations and postoperative patient satisfaction. The quality of online resources, patient expectations for ACLR, and factors associated with and/or predictive of either poor or good to excellent outcomes after surgery are described. This article critically reviews the orthopaedic literature on this important topic and identifies variables that influence patient expectations and satisfaction to help treating physicians better counsel and evaluate patients and ultimately improve outcomes of and satisfaction with ACLR surgery. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  16. Outcome of cartilage at 12years of follow-up after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Cantin, O; Lustig, S; Rongieras, F; Saragaglia, D; Lefèvre, N; Graveleau, N; Hulet, C

    2016-11-01

    In cases of chronic anterior laxity, reconstruction of the anterior cruciate ligament (ACL) can slow the development of osteoarthritis. This study was conducted to determine the overall prevalence of osteoarthritis and to identify the risk factors after ACL reconstruction. Meniscus tears, time from injury to surgery, body mass index (BMI), residual laxity, and cartilage lesions influence the progression towards osteoarthritis. This multicenter, retrospective study on the outcome of cruciate ligaments at 12 years of follow-up was conducted within the 2014 SOFCOT Symposium. The cohort included 675 arthroscopic reconstructions of the ACL from January 2002 to December 2003. The clinical evaluation included the objective and subjective IKDC score. Osteoarthritis was analyzed on 589 knee X-rays according to the IKDC classification. The predictive factors of osteoarthritis development studied were age, gender, BMI, time from injury to surgery, activity level, medial or lateral meniscectomy, type of graft, medial or lateral chondropathy, tunnel positioning, and residual laxity. Univariate and multivariate analyses with logistic regression were performed. The mean follow-up was 11.9±0.8 years. The subjective IKDC score was 83.7±13. At 12 years, the rate of moderate to severe osteoarthritis l (IKDCC or D) was 19% (16% medial tibiofemoral osteoarthritis, 4% lateral tibiofemoral osteoarthritis, and 2% patellofemoral osteoarthritis). The prognostic factors were age at surgery greater than 34 years (Preconstruction. Retrospective cohort study, level IV. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. Risk Factors and Prevention Strategies of Anterior Cruciate Ligament Injuries in Young Females Athletes

    Directory of Open Access Journals (Sweden)

    Cristina Forcada

    2017-04-01

    Full Text Available AIM: Anterior cruciate ligament (ACL injuries are more common in young female athletes than in males, and its frequency is increasing. The aim of the present study is to determine the risk factors that promote these injuries and study the available strategy to prevent ACL injuries in young female athletes. MATERIALS AND METHODS: Different database were used to perform the research (PubMed, Cochrane Plus, Trip Database, using the following keywords: anterior cruciate ligament injury, risk factors, prevention, female and athlete. RESULTS: Risk factors for ACL injuries include: dry weather, high temperatures, playing indoors, artificial boil, sleepless, fatigue, stress, sport specialization, burnout, low self-esteem, incorrect pivoting and landing techniques. Avoiding or modifying these risk factors could prevent ACL injuries as well as performing a specific neuromuscular training. CONCLUSION: There are different ways to prevent ACL injuries that have been proven to be effective, a passive one avoiding the risk factors, and active one, by practicing a specific neuromuscular training.

  18. Medio-lateral knee fluency in anterior cruciate ligament-injured athletes during dynamic movement trials.

    Science.gov (United States)

    Panos, Joseph A; Hoffman, Joshua T; Wordeman, Samuel C; Hewett, Timothy E

    2016-03-01

    Correction of neuromuscular impairments after anterior cruciate ligament injury is vital to successful return to sport. Frontal plane knee control during landing is a common measure of lower-extremity neuromuscular control and asymmetries in neuromuscular control of the knee can predispose injured athletes to additional injury and associated morbidities. Therefore, this study investigated the effects of anterior cruciate ligament injury on knee biomechanics during landing. Two-dimensional frontal plane video of single leg drop, cross over drop, and drop vertical jump dynamic movement trials was analyzed for twenty injured and reconstructed athletes. The position of the knee joint center was tracked in ImageJ software for 500 milliseconds after landing to calculate medio-lateral knee motion velocities and determine normal fluency, the number of times per second knee velocity changed direction. The inverse of this calculation, analytical fluency, was used to associate larger numerical values with fluent movement. Analytical fluency was decreased in involved limbs for single leg drop trials (P=0.0018). Importantly, analytical fluency for single leg drop differed compared to cross over drop trials for involved (Pfluency values exhibited a stepwise trend in relative magnitudes. Decreased analytical fluency in involved limbs is consistent with previous studies. Fluency asymmetries observed during single leg drop tasks may be indicative of abhorrent landing strategies in the involved limb. Analytical fluency differences in unilateral tasks for injured limbs may represent neuromuscular impairment as a result of injury. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. [Arthroscopic double strand wire fixation anteriorly and posteriorly to anterior cruciate ligament for tibial intercondylar eminence fracture].

    Science.gov (United States)

    Jiang, Jun; Chen, Jian

    2014-10-28

    To explore the clinical outcomes of arthroscopic double strand wire fixation anteriorly and posteriorly to anterior cruciate ligament (ACL) for tibial intercondylar eminence fracture. From January 2009 to February 2012, 12 patients with tibial intercondylar eminence fracture were selected. There were 4 males and 8 females with an average age of 19.5 ± 10 (10-50) years. Time from injury to operation was 4 days to 2 years. All cases belonged to Meyers-Mekeever type II and type III. Arthroscopic double strand wire compressive fixation was performed anteriorly and posteriorly to ACL. Other measures included postoperative rehabilitation and supports with brace in knee extension when weight-bearing for 4-6 weeks. The average follow-up period was 15.6 (6-30) months. Final clinical results showed good range of motion and good knee stability. On postoperative radiology, there were good reduction of intercondylar eminence fracture and excellent healing. There was no occurrence of wire rupture. Postoperative IKDC and Lysholm scores were excellent (n = 10) and good (n = 2). There was no such complication as fragmentation of intercondylar eminence fracture bone, neurovascular injury or infection. Arthroscopic double strand compressive fixation for tibial intercondylar eminence fracture may be easily performed without injury to ACL substance. The reduction is both stable and reliable. And the clinical outcome is excellent.

  20. American Society of Biomechanics Clinical Biomechanics Award 2015: MRI assessments of cartilage mechanics, morphology and composition following reconstruction of the anterior cruciate ligament.

    Science.gov (United States)

    Kaiser, Jarred; Vignos, Michael F; Liu, Fang; Kijowski, Richard; Thelen, Darryl G

    2016-05-01

    The pathogenesis of osteoarthritis following anterior cruciate ligament (ACL) reconstruction is currently unknown. The study purpose was to leverage recent advances in quantitative and dynamic MRI to test the hypothesis that abnormal joint mechanics within four years of reconstruction is accompanied by evidence of early compositional changes in cartilage. Static MR imaging was performed bilaterally on eleven subjects with an ACL reconstruction (1-4years post-surgery) and on twelve healthy subjects to obtain tibial cartilage thickness maps. Quantitative imaging (mcDESPOT) was performed unilaterally on all subjects to assess the fraction of bound water in the tibial plateau cartilage. Finally, volumetric dynamic imaging was performed to assess cartilage contact patterns during an active knee flexion-extension task. A repeated-measures ANOVA was used to test for the effects of surgical reconstruction and location on cartilage thickness, bound water fractions, and contact across the medial and lateral tibia plateaus. No significant differences in cartilage thickness were found between groups. However, there was a significant reduction in the fraction of water bound by proteoglycan in the ACL reconstructed knees, most notably along the anterior portion of the medial plateau and the weight-bearing lateral plateau. During movement, reconstructed knees exhibited greater contact along the medial spine in the medial plateau and along the posterior aspect of the lateral plateau, when compared with their healthy contralateral knees and healthy controls. This study provides evidence that abnormal mechanics in anterior cruciate ligament reconstructed knees are present coincidently with early biomarkers of cartilage degeneration. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. High incidence and costs for anterior cruciate ligament reconstructions performed in Australia from 2003-2004 to 2007-2008: time for an anterior cruciate ligament register by Scandinavian model?

    NARCIS (Netherlands)

    Janssen, K.W.; Orchard, J.W.; Driscoll, T.R.; van Mechelen, W.

    2012-01-01

    The aim of this paper was to provide a descriptive epidemiology of anterior cruciate ligament (ACL) reconstructions in Australia. Data on all ACL reconstructions were collected from July 1, 2003 till June 30, 2008. Main outcome measures were the incidence of ACL reconstructions for Australia, per

  2. Comparison of the effectiveness of femoral fixation techniques (Aperfix and Endobutton in anterior cruciate ligament surgery: A clinical trial in men with complete anterior cruciate ligament rupture

    Directory of Open Access Journals (Sweden)

    Seyyed Raza Sharifzadeh

    2017-09-01

    Full Text Available Background Anterior cruciate ligament (ACL is a Strengthener ligament of the knee. About 50 persons per 100,000 annually counter ACL rupture. Based on studies, the majority of people who have high mobility jobs, and had reconstruction surgery after ACL rupture, have returned to pre-injury level of activity. Aims We compared two methods of surgery (aperfix and endobutton in this article. We want to answer these two main questions in this study:1 is the effectiveness of surgical methods (aperfix and endobutton in patients with anterior cruciate ligament rupture, the same?.2 Are the aspects of the knee function, in two surgical methods (aperfix and endobutton after ACL reconstruction surgery, the same? Methods This study is a prospective clinical trial on patients who had complete ACL rupture in an isolated trauma, who were nominated for ACL reconstruction surgery. We excluded the cases that had underlying disease or other damages from the study. 100 patients were randomly divided into two groups of 50 individuals. Then each group underwent surgery. The femoral fixations were by the two common methods of ";;;;;;;;;;;Aperfix";;;;;;;;;;; or ";;;;;;;;;;;Endobutton";;;;;;;;;;;. We followed up, the cases one year after surgery and evaluated them by lysholm score as well as with IKDC score. Results The mean lysholm score and IKDC score do not have statistically significant difference in the two groups. (Mean lysholm score in Aperfix group=95.66 vs. 94.56 in Endobutton group (p=0.057 and IKDC score=92.32 in Aperfix group vs 92.20 in Endobutton group (p=0.28. However, in some aspects of knee function, such as locking, Swelling, and climbing stairs, patients who had undergone Aperfix approach, had better results. Conclusion Surgical methods have little difference however due to better results in some aspects of knee functions in this study and due to other studies, it can be said Aperfix method slightly has more benefits. Further investigations with larger

  3. Changes in landing mechanics in patients following anterior cruciate ligament reconstruction when wearing an extension constraint knee brace.

    Science.gov (United States)

    Butler, Robert J; Dai, Boyi; Garrett, William E; Queen, Robin M

    2014-05-01

    Anterior cruciate ligament (ACL) reconstruction is associated with a high incidence of second tears (graft tears and contralateral ACL tears). These secondary tears have been attributed to asymmetrical lower extremity mechanics. Knee bracing is one potential intervention that can be used during rehabilitation that has the potential to normalize lower extremity asymmetry; however, little is known about the effect of bracing on movement asymmetry in patients following ACL reconstruction. Wearing a knee brace would increase knee joint flexion and joint symmetry. It was also expected that the joint mechanics would become more symmetrical in the braced condition. To examine how knee bracing affects knee joint function and symmetry over the course of rehabilitation in patients 6 months following ACL reconstruction. Controlled laboratory study. Level 3. Twenty-three adolescent patients rehabilitating from ACL reconstruction surgery were recruited for the study. The subjects all underwent a motion analysis assessment during a stop-jump activity with and without a functional knee brace on the surgical side that resisted extension for 6 months following the ACL reconstruction surgery. Statistical analysis utilized a 2 × 2 (limb × brace) analysis of variance with a significant alpha level of 0.05. Subjects had increased knee flexion on the surgical side when they were braced. The brace condition increased knee flexion velocity, decreased the initial knee flexion angle, and increased the ground reaction force and knee extension moment on both limbs. Side-to-side asymmetry was present across conditions for the vertical ground reaction force and knee extension moment. Wearing a knee brace appears to increase lower extremity compliance and promotes normalized loading on the surgical side. Knee extension constraint bracing in postoperative ACL patients may improve symmetry of lower extremity mechanics, which is potentially beneficial in progressing rehabilitation and reducing

  4. Genome-wide association analysis in dogs implicates 99 loci as risk variants for anterior cruciate ligament rupture

    Science.gov (United States)

    Baker, Lauren A.; Kirkpatrick, Brian; Rosa, Guilherme J. M.; Gianola, Daniel; Valente, Bruno; Sumner, Julia P.; Baltzer, Wendy; Hao, Zhengling; Binversie, Emily E.; Volstad, Nicola; Piazza, Alexander; Sample, Susannah J.

    2017-01-01

    Anterior cruciate ligament (ACL) rupture is a common condition that can be devastating and life changing, particularly in young adults. A non-contact mechanism is typical. Second ACL ruptures through rupture of the contralateral ACL or rupture of a graft repair is also common. Risk of rupture is increased in females. ACL rupture is also common in dogs. Disease prevalence exceeds 5% in several dog breeds, ~100 fold higher than human beings. We provide insight into the genetic etiology of ACL rupture by genome-wide association study (GWAS) in a high-risk breed using 98 case and 139 control Labrador Retrievers. We identified 129 single nucleotide polymorphisms (SNPs) within 99 risk loci. Associated loci (P<5E-04) explained approximately half of phenotypic variance in the ACL rupture trait. Two of these loci were located in uncharacterized or non-coding regions of the genome. A chromosome 24 locus containing nine genes with diverse functions met genome-wide significance (P = 3.63E-0.6). GWAS pathways were enriched for c-type lectins, a gene set that includes aggrecan, a gene set encoding antimicrobial proteins, and a gene set encoding membrane transport proteins with a variety of physiological functions. Genotypic risk estimated for each dog based on the risk contributed by each GWAS locus showed clear separation of ACL rupture cases and controls. Power analysis of the GWAS data set estimated that ~172 loci explain the genetic contribution to ACL rupture in the Labrador Retriever. Heritability was estimated at 0.48. We conclude ACL rupture is a moderately heritable highly polygenic complex trait. Our results implicate c-type lectin pathways in ACL homeostasis. PMID:28379989

  5. 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.

  6. Muscle Activity Onset Prior to Landing in Patients after Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Daniel Theisen

    Full Text Available Muscle activation during landing is paramount to stabilise lower limb joints and avoid abnormal movement patterns. Delayed muscle activity onset measured by electromyography (EMG has been suggested to be associated with anterior cruciate ligament (ACL injury. Therefore, the aim of this systematic review and meta-analysis was to test the hypothesis if ACL-injured patients display different results for muscle onset timing during standard deceleration tasks compared to healthy control participants. PubMed, Embase, Scopus and ScienceDirect databases were systematically searched over the period from January 1980 to February 2015, yielding a total of 1461 citations. Six studies meeting inclusion criteria underwent quality assessment, data extraction and re-computing procedures for the meta-analysis. The quality was rated "moderate" for 2 studies and "poor" for 4. Patients included and procedures used were highly heterogeneous. The tasks investigated were single leg hopping, decelerating from running or walking, tested on a total of 102 ACL-injured participants and 86 controls. EMG analyses of the muscles vastus lateralis, vastus medialis, lateral and medial hamstrings revealed trivial and non-significant standardised mean differences (SMD0.05 between patients and control participants. Furthermore, no differences were found between the contralateral leg of patients and controls for muscle activity onset of the medial and lateral gastrocnemius (SMD0.05. Based on 3 studies, the involved legs of ACL-injured patients showed overall earlier muscle activity onset compared to control participants for the medial gastrocnemius (SMD = 0.5; p = 0.05. Similar results were found for the lateral gastrocnemius (SMD = 2.1; p<0.001, with a greater effect size but based only on a single study. We conclude that there are no differences between leg muscles of ACL-injured patients and healthy controls regarding the muscle activity onset during landing. However, current

  7. Muscle Activity Onset Prior to Landing in Patients after Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Theisen, Daniel; Rada, Isabel; Brau, Amélie; Gette, Paul; Seil, Romain

    2016-01-01

    Muscle activation during landing is paramount to stabilise lower limb joints and avoid abnormal movement patterns. Delayed muscle activity onset measured by electromyography (EMG) has been suggested to be associated with anterior cruciate ligament (ACL) injury. Therefore, the aim of this systematic review and meta-analysis was to test the hypothesis if ACL-injured patients display different results for muscle onset timing during standard deceleration tasks compared to healthy control participants. PubMed, Embase, Scopus and ScienceDirect databases were systematically searched over the period from January 1980 to February 2015, yielding a total of 1461 citations. Six studies meeting inclusion criteria underwent quality assessment, data extraction and re-computing procedures for the meta-analysis. The quality was rated "moderate" for 2 studies and "poor" for 4. Patients included and procedures used were highly heterogeneous. The tasks investigated were single leg hopping, decelerating from running or walking, tested on a total of 102 ACL-injured participants and 86 controls. EMG analyses of the muscles vastus lateralis, vastus medialis, lateral and medial hamstrings revealed trivial and non-significant standardised mean differences (SMD0.05) between patients and control participants. Furthermore, no differences were found between the contralateral leg of patients and controls for muscle activity onset of the medial and lateral gastrocnemius (SMD0.05). Based on 3 studies, the involved legs of ACL-injured patients showed overall earlier muscle activity onset compared to control participants for the medial gastrocnemius (SMD = 0.5; p = 0.05). Similar results were found for the lateral gastrocnemius (SMD = 2.1; pmuscles of ACL-injured patients and healthy controls regarding the muscle activity onset during landing. However, current evidence is scarce and weak, which highlights the need for further research in this area.

  8. Genome-wide association analysis in dogs implicates 99 loci as risk variants for anterior cruciate ligament rupture.

    Directory of Open Access Journals (Sweden)

    Lauren A Baker

    Full Text Available Anterior cruciate ligament (ACL rupture is a common condition that can be devastating and life changing, particularly in young adults. A non-contact mechanism is typical. Second ACL ruptures through rupture of the contralateral ACL or rupture of a graft repair is also common. Risk of rupture is increased in females. ACL rupture is also common in dogs. Disease prevalence exceeds 5% in several dog breeds, ~100 fold higher than human beings. We provide insight into the genetic etiology of ACL rupture by genome-wide association study (GWAS in a high-risk breed using 98 case and 139 control Labrador Retrievers. We identified 129 single nucleotide polymorphisms (SNPs within 99 risk loci. Associated loci (P<5E-04 explained approximately half of phenotypic variance in the ACL rupture trait. Two of these loci were located in uncharacterized or non-coding regions of the genome. A chromosome 24 locus containing nine genes with diverse functions met genome-wide significance (P = 3.63E-0.6. GWAS pathways were enriched for c-type lectins, a gene set that includes aggrecan, a gene set encoding antimicrobial proteins, and a gene set encoding membrane transport proteins with a variety of physiological functions. Genotypic risk estimated for each dog based on the risk contributed by each GWAS locus showed clear separation of ACL rupture cases and controls. Power analysis of the GWAS data set estimated that ~172 loci explain the genetic contribution to ACL rupture in the Labrador Retriever. Heritability was estimated at 0.48. We conclude ACL rupture is a moderately heritable highly polygenic complex trait. Our results implicate c-type lectin pathways in ACL homeostasis.

  9. Double-layer versus single-layer bone-patellar tendon-bone anterior cruciate ligament reconstruction: a prospective randomized study with 3-year follow-up.

    Science.gov (United States)

    Mei, Xiaoliang; Zhang, Zhenxiang; Yang, Jingwen

    2016-12-01

    To evaluate the clinical results of a randomized controlled trial of single-layer versus double-layer bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction. Fifty-eight subjects who underwent primary ACL reconstruction with a BPTB allograft were prospectively randomized into two groups: single-layer reconstruction (n = 31) and double-layer reconstruction (n = 27). The following evaluation methods were used: clinical examination, KT-1000 arthrometer measurement, muscle strength, Tegner activity score, Lysholm score, subjective rating scale regarding patient satisfaction and sports performance level, graft retear, contralateral ACL tear, and additional meniscus surgery. Forty-eight subjects (24 in single-layer group and 24 in double-layer group) who were followed up for 3 years were evaluated. Preoperatively, there were no differences between the groups. At 3-year follow-up, the Lachman and pivot-shift test results were better in the double-layer group (P = 0.019 and P reconstruction, double-layer BPTB reconstruction was significantly better than single-layer reconstruction regarding anterior and rotational stability at 3-year follow-up. The results of KT measurements and the Lachman and pivot-shift tests were significantly better in the double-layer group, whereas there was no difference in the anterior drawer test results. The Tegner score was also better in the double-layer group; however, there were no differences in the other subjective findings.

  10. Knee mechanics during landing in anterior cruciate ligament patients: A longitudinal study from pre- to 12 months post-reconstruction.

    Science.gov (United States)

    Oberländer, Kai Daniel; Brüggemann, Gert-Peter; Höher, Jürgen; Karamanidis, Kiros

    2014-05-01

    Patients with a history of anterior cruciate ligament rupture are at elevated risk of developing knee osteoarthritis. Altered knee kinematics and kinetics during functional activities have been viewed as risk factors for cartilage breakdown and, therefore, one of the primary goals of anterior cruciate ligament reconstruction is to restore knee joint function. Patients' (n=18) knee mechanics while performing a single leg hop for distance were calculated for both legs using a soft-tissue artifact optimized rigid lower-body model at the pre-reconstruction state and six and twelve months after anterior cruciate ligament reconstruction. Independent of the analyzed time point the involved leg showed a lower external flexion and adduction moment at the knee, and an increased anterior translation and external rotational offset of the shank with respect to the thigh compared to the uninvolved leg. There were no differences for any of the analyzed knee kinematic and kinetic parameters within the control subject group. The identified kinematic changes can cause a shift in the normal load-bearing regions of the knee and may support the view that the risk of developing knee osteoarthritis in an anterior cruciate ligament ruptured joint while performing activities involving frequent landing and stopping actions is less likely to be associated with the knee adduction moment and is rather due to kinematic changes. Anterior cruciate ligament reconstruction surgery failed to restore normal knee kinematics during landing, potentially explaining the persistent risk for the development of knee osteoarthritis in patients who have returned to sports following reconstruction surgery. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Dual-tasking effects on dynamic postural stability in athletes with and without anterior cruciate ligament reconstruction

    NARCIS (Netherlands)

    Mohammadi-Rad, Shahrzad; Salavati, Mahyar; Ebrahimi-Takamjani, Ismail; Akhbari, Behnam; Sherafat, Shiva; Negahban, Hossein; Lali, Pezhman; Mazaheri, Masood

    2016-01-01

    Purpose: To compare the effect of dual tasking on postural stability between patients with anterior cruciate ligament reconstruction (ACL-R) and healthy controls. Methods: Single-limb postural stability was assessed in 17 athletes with ACL-R and 17 healthy matched athletes while standing on a Biodex

  12. The Association Between Knee Confidence and Muscle Power, Hop Performance, and Postural Orientation in People With Anterior Cruciate Ligament Injury

    DEFF Research Database (Denmark)

    Ageberg, Eva; Roos, Ewa M

    2016-01-01

    Study Design Cross-sectional. Background The association between muscle function and lack of knee confidence in people with anterior cruciate ligament (ACL) injury has not been well investigated. Such knowledge would help in the design of training programs for this population. Objective...

  13. Optimization of the anterior cruciate ligament injury prevention paradigm: novel feedback techniques to enhance motor learning and reduce injury risk

    NARCIS (Netherlands)

    Ariel V. Dowling; Gregory D. Myer; Timothy E. Hewett; Anne Benjaminse; James A. Onate; Alli Gokeler; Avery Faigenbaum; Kevin R. Ford; Bert Otten

    2015-01-01

    Primary anterior cruciate ligament (ACL) injury prevention programs effectively reduce ACL injury risk in the short term. Despite these programs, ACL injury incidence is still high, making it imperative to continue to improve cur- rent prevention strategies. A potential limitation of current ACL

  14. Optimization of the Anterior Cruciate Ligament Injury Prevention Paradigm : Novel Feedback Techniques to Enhance Motor Learning and Reduce Injury Risk

    NARCIS (Netherlands)

    Benjaminse, Anne; Gokeler, Alli; Dowling, Ariel V.; Faigenbaum, Avery; Ford, Kevin R.; Hewett, Timothy E.; Onate, James A.; Otten, Bert; Myer, Gregory D.

    SYNOPSIS: Primary anterior cruciate ligament (ACL) injury prevention programs effectively reduce ACL injury risk in the short term. Despite these programs, ACL injury incidence-is still high, making it imperative to continue to improve current prevention strategies. A potential limitation of current

  15. Home-based intravenous analgesia with elastomeric pump as an outpatient procedure for pain control after anterior cruciate ligament repair.

    Science.gov (United States)

    Villalba, J; Peñalver, J; Torner, P; Serra, M; Planell, J

    To follow up pain in the immediate postoperative period, using an elastomeric pump in anterior cruciate ligament surgery. 309 patients who had undergone anterior cruciate ligament repair with bone-tendon-bone allograft. Pain control was assessed with a visual analogue scale (VAS) during the immediate postoperative period, in the postoperative care unit, in the recovery room, and after the first 24-48-72hours following home discharge. The need for rescue medication, adverse effects observed and emergency visits were also registered. 309 patients were assessed (264 males, 45 females), mean age 33 (range: 18 - 55). Postoperative pain was mild in 44.7% of patients, and 38.5% were pain-free. At discharge, 41.1% of patients reported mild pain and 57% were pain-free. At home, mild to moderate levels of pain were maintained and over 97% of patients presented VAS values ≤ 3. Fewer than 3% had adverse effects, 8.7% had to use analgesic medication at some point. Pruritus occurred in less than 1% of patients receiving intravenous analgesia at home, and fewer than 2% had device-related complications. There is no consensus regarding the postoperative management of anterior cruciate ligament lesions, although most surgeons use multimode anaesthesia and different combinations of analgesics to reduce postoperative pain. The use of an intravenous elastomeric pump as postoperative analgesia for anterior cruciate ligamentoplasty has yielded good results. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  16. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care

    NARCIS (Netherlands)

    Wagemakers, H.P.; Luijsterburg, P.A.; Boks, S.S.; Heintjes, E.M.; Berger, M.Y.; Verhaar, J.A.; Koes, B.W.; Bierma-Zeinstra, S.M.

    2010-01-01

    Wagemakers HP, Luijsterburg PA, Boks SS, Heintjes EM, Berger MY, Verhaar JA, Koes BK, Bierma-Zeinstra SM. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care. Arch Phys Med Rehabil 2010;91:1452-9. Objective: To

  17. CT arthrography and virtual arthroscopy in the diagnosis of the anterior cruciate ligament and meniscal abnormalities of the knee joint

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Whal; Chung, Jin-Wook; Kang, Heung-Sik; Hong, Sung-Hwan; Choi, Ja-Young [Seoul National University, Seoul (Korea, Republic of); Kim, Ho-Sung; Kim, Seok-Jung; Kim, Hyung-Ho [Aeromedical Center, Seoul (Korea, Republic of)

    2004-03-15

    To determine the diagnostic accuracy of CT arthrography and virtual arthroscopy in the diagnosis of anterior cruciate ligament and meniscus pathology. Thirty-eight consecutive patients sho underwent CT arthrography and arthroscopy of the knee were included in this study. The ages of the patients ranged from 19 to 52 years and all of the patients were male. Sagittal, coronal, transverse and oblique coronal multiplanar reconstruction images were reformatted from CT arthrography. Virtual arthroscopy was performed from 6 standard views using a volume rendering technique. Three radiologists analyzed the MPR images and two orthopedic surgeons analyzed the virtual arthroscopic images. The sensitivity and specificity of CT arthrography for the diagnosis of anterior cruciate ligament abnormalities were 87.5%-100% and 93.3%-96.7%, respectively and those for meniscus abnormalities were 91.7%-100% and 98.1%, respectively. The sensitivity and specificity of virtual arthroscopy for the diagnosis of anterior cruciate ligament abnormalities were 87.5% and 83.3%-90%, respectively, and those for meniscus abnormalities were 83.3%-87.5% and 96.1-98.1%, respectively. CT arthrography and virtual arthroscopy showed good diagnostic accuracy for anterior cruciate ligament and meniscal abnormalities.

  18. In-situ mechanical behavior and slackness of the anterior cruciate ligament at multiple knee flexion angles

    NARCIS (Netherlands)

    Rachmatt, H.H.; Janssen, D.; Verkerke, Gijsbertus Jacob; Diercks, R.L.; Verdonschot, Nicolaas Jacobus Joseph

    2015-01-01

    In this study the in-situ tensile behavior and slackness of the anterior cruciate ligament (ACL) was evaluated at various knee flexion angles. In four cadaveric knees the ACL was released at the tibial insertion, after which it was re-connected to a tensiometer. After pre-tensioning (10 N) the ACL

  19. In-situ mechanical behavior and slackness of the anterior cruciate ligament at multiple knee flexion angles

    NARCIS (Netherlands)

    Rachmat, Hendi; Janssen, D.; Verkerke, Gijsbertus; Diercks, Ronald; Verdonschot, N.

    In this study the in-situ tensile behavior and slackness of the anterior cruciate ligament (ACL) was evaluated at various knee flexion angles. In four cadaveric knees the ACL was released at the tibial insertion, after which it was re-connected to a tensiometer. After pre-tensioning (10 N) the ACL

  20. 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

  1. In-situ mechanical behavior and slackness of the anterior cruciate ligament at multiple knee flexion angles

    NARCIS (Netherlands)

    Rachmat, H.H.; Janssen, D.W.; Verkerke, G.J.; Diercks, R.L.; Verdonschot, N.J.J.

    2016-01-01

    In this study the in-situ tensile behavior and slackness of the anterior cruciate ligament (ACL) was evaluated at various knee flexion angles. In four cadaveric knees the ACL was released at the tibial insertion, after which it was re-connected to a tensiometer. After pre-tensioning (10 N) the ACL

  2. The relative incidence of anterior cruciate ligament injury in men and women at the United States Naval Academy.

    Science.gov (United States)

    Gwinn, D E; Wilckens, J H; McDevitt, E R; Ross, G; Kao, T C

    2000-01-01

    The purpose of this study was to evaluate the relative risk of anterior cruciate ligament injury in female versus male midshipmen at the United States Naval Academy. From 1991 to 1997, we recorded the incidence of anterior cruciate ligament injury during intercollegiate athletics, intramural athletics, and military training. The subjects were male and female varsity athletes, coed intramural athletes, and participants in military training consisting of the obstacle course and instructional wrestling. All patient data were collected at the time of injury. Records filed at the intramural sports office, along with a questionnaire completed by coaches and trainers, were used to estimate midshipmen exposures. Results showed that in intercollegiate soccer, basketball, and rugby, women had a relative injury risk of 3.96 compared with men. In coed soccer, basketball, softball, and volleyball, the women's relative injury risk was 1.40 compared with men. In military training, women had a relative injury risk of 9.74 compared with men. In comparing overall annual anterior cruciate ligament injury rates among midshipmen, we found that women had a relative injury risk of 2.44 compared with men. We concluded that female midshipmen have an increased relative risk of anterior cruciate ligament injury as compared with men in intercollegiate athletics, basic military training, and throughout their service academy career. This increase was not statistically significant at the intramural level of athletics.

  3. Five-year follow-up of knee joint cartilage thickness changes after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Eckstein, F; Wirth, W; Lohmander, Stefan

    2015-01-01

    Objective: Anterior cruciate ligament (ACL) rupture involves increased risk of osteoarthritis. We explored cartilage thickness changes over five years after ACL rupture. Methods: 121 young active adults (26% women, age 18-35 years) with acute traumatic ACL rupture were studied (the KANON...

  4. Comparison between two different experimental models of osteoarthritis in rabbits. Intra-articular collagenase injection and anterior cruciate ligament transection.

    Science.gov (United States)

    Hermeto, Larissa Correa; Rossi, Rafael De; Jardim, Paulo Henrique de Affonseca; Santana, Aureo Evangelista; Rinaldi, Jaqueline de Carvalho; Justulin, Luis Antonio

    2016-09-01

    To compare two different experimental models of osteoarthritis in rabbits: intra-articular collagenase injection and anterior cruciate ligament transection. Ten adult rabbits were randomly divided in two groups: COLL (collagenase group) and ACLT (anterior cruciate ligament transection). The COLL group was treated with 0.5 ml collagenase solution (2mg collagenase/0.5 ml sterile PBS), and the ACTL group was subjected to anterior cruciate ligament. After six and twelve weeks, respectively, the animals in the COLL and ACTL groups were euthanized. The gross appearance and histological examinations conducted in the cartilage articular surface was blindly scored according to the criteria developed by Yoshimi et al. (1994) and Mankin et al. (1971), respectively. The gross morphologic observation, macroscopic score and histological examinations have demonstrated that the ACTL group presented the highest scores, and lesions more severe than those in the COLL group. Both methods, anterior cruciate ligament transection and collagenase, applied to the stifle joint of the rabbits have effectively induced degenerative changes in the cartilage tissue, through statistically significant analysis (p≤0.05). The ACTL method has presented more severe lesions.

  5. Pain and knee function in relation to degree of bone bruise after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Szkopek, K; Warming, Torsten; Neergaard, K

    2012-01-01

    It is unknown whether the bone bruise that occurs in connection with acute anterior cruciate ligament (ACL) rupture is causing pain and dysfunction. We followed prospectively 17 patients [10 men, seven women, mean age 28 years (range 23-34)] with acute ACL rupture for 2 months. A magnetic resonance...

  6. Association between sensory function and hop performance and self-reported outcomes in patients with anterior cruciate ligament injury

    DEFF Research Database (Denmark)

    Cronström, Anna; Roos, Ewa M.; Ageberg, Eva

    2017-01-01

    BACKGROUND: In patients with anterior cruciate ligament (ACL) deficiency (ACLD) or reconstruction (ACLR), sensory deficits are commonly assessed as knee kinesthesia using time-consuming laboratory equipment. Portable equipment such as that used for evaluation of vibration sense would be preferable...

  7. Superior return to sports rate after patellar tendon autograft over patellar tendon allograft in revision anterior cruciate ligament reconstruction.

    NARCIS (Netherlands)

    Keizer, Michèle N. J.; Hoogeslag, Roy A. G.; van Raay, Jos J. A. M.; Otten, Bert; Brouwer, Reinoud

    2017-01-01

    PURPOSE: After revision anterior cruciate ligament reconstruction (ACLR), the rate of return to the pre-injury type of sport (RTS type) is low and graft choice might be an important factor. The aim of this study was to determine whether there is a difference in outcome after revision ACLR using a

  8. Tissue engineering of ligaments : A comparison of bone marrow stromal cells, anterior cruciate ligament, and skin fibroblasts as cell source

    NARCIS (Netherlands)

    Van Eijk, F; Riesle, J; Willems, WJ; Van Blitterswijk, CA; Verbout, AJ; Dhert, WJA

    Anterior cruciate ligament (ACL) reconstruction surgery still has important problems to overcome, such as "donor site morbidity" and the limited choice of grafts in revision surgery. Tissue engineering of ligaments may provide a solution for these problems. Little is known about the optimal cell

  9. Can joint contact dynamics be restored by anterior cruciate ligament reconstruction?

    Science.gov (United States)

    Hoshino, Yuichi; Fu, Freddie H; Irrgang, James J; Tashman, Scott

    2013-09-01

    Rotational kinematics has become an important consideration after ACL reconstruction because of its possible influence on knee degeneration. However, it remains unknown whether ACL reconstruction can restore both rotational kinematics and normal joint contact patterns, especially during functional activities. We asked whether knee kinematics (tibial anterior translation and axial rotation) and joint contact mechanics (tibiofemoral sliding distance) would be restored by double-bundle (DB) or single-bundle (SB) reconstruction. We retrospectively studied 17 patients who underwent ACL reconstruction by the SB (n = 7) or DB (n = 10) procedure. We used dynamic stereo x-ray to capture biplane radiographic images of the knee during downhill treadmill running. Tibial anterior translation, axial rotation, and joint sliding distance in the medial and lateral compartments were compared between reconstructed and contralateral knees in both SB and DB groups. We observed reduced anterior tibial translation and increased knee rotation in the reconstructed knees compared to the contralateral knees in both SB and DB groups. The mean joint sliding distance on the medial compartment was larger in the reconstructed knees than in the contralateral knees for both the SB group (9.5 ± 3.9 mm versus 7.5 ± 4.3 mm) and the DB group (11.1 ± 1.3 mm versus 7.9 ± 3.8 mm). Neither ACL reconstruction procedure restored normal knee kinematics or medial joint sliding. Further study is necessary to understand the clinical significance of abnormal joint contact, identify the responsible mechanisms, and optimize reconstruction procedures for restoring normal joint mechanics after ACL injury.

  10. Can a knee brace reduce the strain in the anterior cruciate ligament? A study using combined in vivo/in vitro method.

    Science.gov (United States)

    Hangalur, Gajendra; Brenneman, Elora; Nicholls, Micah; Bakker, Ryan; Laing, Andrew; Chandrashekar, Naveen

    2016-06-01

    It is unknown whether prophylactic knee braces can reduce the strain in the anterior cruciate ligament during dynamic activities. An athlete, who had characteristics of high anterior cruciate ligament injury risk, was chosen. A motion capture system (Optotrak Certus; Northern Digital, Waterloo, ON, Canada) was used to record dynamic trials during drop-landing activity of this subject with and without the knee brace being worn. A musculoskeletal model was used to estimate the muscle forces during this activity. A dynamic knee simulator then applied kinematics and muscle forces on a cadaver knee with and without the brace mounted on it. The anterior cruciate ligament strain was measured. The peak strain in the anterior cruciate ligament was substantially lower for the braced (7%) versus unbraced (20%) conditions. Functional knee braces could decrease the strain in the anterior cruciate ligament during dynamic activities in a high-risk subject. However, the reduction seems to be a result of altered muscle firing pattern due to the brace. Prophylactic knee brace could reduce the strain in the anterior cruciate ligament of high-risk subjects during drop-landing through altered muscle firing pattern associated with brace wear. This could help reduce the anterior cruciate ligament injury risk. © The International Society for Prosthetics and Orthotics 2015.

  11. Prevenção de lesões do ligamento cruzado anterior em futebolistas Prevention of Injuries of the anterior cruciate ligament in soccer players

    Directory of Open Access Journals (Sweden)

    João Brito

    2009-02-01

    Full Text Available A lesão do joelho é a mais comum entre as lesões graves apresentadas por futebolistas, destacando-se o ligamento cruzado anterior como um dos ligamentos do joelho mais frequentemente lesados. Assim, a prevenção de lesões do ligamento cruzado anterior em futebolistas deve ser encarada como uma preocupação constante para todos os agentes ligados à modalidade, independentemente do nível competitivo, idade e sexo dos praticantes. OBJETIVOS: O objetivo deste trabalho é a análise da importância do trabalho de prevenção de lesões do LCA em futebolistas que possa ser incorporado no treino de futebol. METODOLOGIA: A metodologia utilizada neste trabalho foi uma revisão da literatura. CONCLUSÕES: Propõe-se um programa de prevenção de lesões do ligamento cruzado anterior em futebolistas, com três sessões de treino semanais, englobando treino neuromuscular e treino proprioceptivo.Knee injury is the commonest severe injury presented by football players and the anterior cruciate ligament appears as one of the most frequently injured knee ligaments. Thus, prevention of anterior cruciate ligament injuries must be a priority in soccer practice, regardless of the athletes' competitive level, age or sex. OBJECTIVES: the objective of this work is to analyze the importance of prevention of the anterior cruciate ligament injury in soccer players which can be incorporated in the training program. METHODOLOGY: the methodology used was a review of the literature. CONCLUSIONS: A program with three weekly sessions, composed by neuromuscular and proprioceptive training is proposed to prevent anterior cruciate ligament injuries in soccer players.

  12. Medium-term (5-year) comparison of the functional outcomes of combined anterior cruciate ligament and posterolateral corner reconstruction compared with isolated anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Cartwright-Terry, Matthew; Yates, Jonny; Tan, Chin K; Pengas, Ioannis P; Banks, Joanne V; McNicholas, Michael J

    2014-07-01

    To present a 5-year comparison of the functional outcomes of combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) reconstruction with those of isolated ACL reconstruction. All patients were reviewed clinically and completed knee function questionnaires prospectively, by use of the International Knee Documentation Committee (IKDC) 2000, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm scoring systems, preoperatively and at 1, 2, and 5 years postoperatively. Patients who underwent combined ACL-PLC reconstruction were identified and reviewed. These patients had intact lateral collateral ligaments. A comparison group was created from a group of patients who underwent isolated ACL reconstruction. The ACL group was selected to have the same profile with regard to age, sex, and meniscal procedure. There were 25 patients in the ACL-PLC group and 100 in the ACL group. All patients underwent restoration of their PLC function as shown on dial testing. The preoperative values for all KOOS measures and the Lysholm score were significantly lower in the ACL-PLC group than in the ACL group (P reconstruction. The KOOS for sport outcomes suggests that sports were resumed at lower functional levels. Level III, case-control study. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  13. Diagnostic Value of Knee Arthrometry in the Prediction of Anterior Cruciate Ligament Strain During Landing

    Science.gov (United States)

    Kiapour, Ata M.; Wordeman, Samuel C.; Paterno, Mark V.; Quatman, Carmen E.; Levine, Jason W.; Goel, Vijay K.; Demetropoulos, Constantine K.; Hewett, Timothy E.

    2014-01-01

    Background Previous studies have indicated that higher knee joint laxity may be indicative of an increased risk of anterior cruciate ligament (ACL) injuries. Despite the frequent clinical use of knee arthrometry in the evaluation of knee laxity, little data exist to correlate instrumented laxity measures and ACL strain during dynamic high-risk activities. Purpose/Hypotheses The purpose of this study was to evaluate the relationships between ACL strain and anterior knee laxity measurements using arthrometry during both a drawer test and simulated bipedal landing (as an identified high-risk injurious task). We hypothesized that a high correlation exists between dynamic ACL strain and passive arthrometry displacement. The secondary hypothesis was that anterior knee laxity quantified by knee arthrometry is a valid predictor of injury risk such that specimens with greater anterior knee laxity would demonstrate increased levels of peak ACL strain during landing. Study Design Controlled laboratory study. Methods Twenty cadaveric lower limbs (mean age, 46 ± 6 years; 10 female and 10 male) were tested using a CompuKT knee arthrometer to measure knee joint laxity. Each specimen was tested under 4 continuous cycles of anterior-posterior shear force (±134 N) applied to the tibial tubercle. To quantify ACL strain, a differential variable reluctance transducer (DVRT) was arthroscopically placed on the ACL (anteromedial bundle), and specimens were retested. Subsequently, bipedal landing from 30 cm was simulated in a subset of 14 specimens (mean age, 45 ± 6 years; 6 female and 8 male) using a novel custom-designed drop stand. Changes in joint laxity and ACL strain under applied anterior shear force were statistically analyzed using paired sample t tests and analysis of variance. Multiple linear regression analyses were conducted to determine the relationship between anterior shear force, anterior tibial translation, and ACL strain. Results During simulated drawer tests, 134 N

  14. Lower extremity muscle activation onset times during the transition from double-leg stance to single-leg stance in anterior cruciate ligament reconstructed subjects.

    Science.gov (United States)

    Dingenen, Bart; Janssens, Luc; Claes, Steven; Bellemans, Johan; Staes, Filip F

    2016-06-01

    Previous studies mainly focused on muscles at the operated knee after anterior cruciate ligament reconstruction, less on muscles around other joints of the operated and non-operated leg. The aim of this study was to investigate muscle activation onset times during the transition from double-leg stance to single-leg stance in anterior cruciate ligament reconstructed subjects. Lower extremity muscle activation onset times of both legs of 20 fully returned to sport anterior cruciate ligament reconstructed subjects and 20 non-injured control subjects were measured during the transition from double-leg stance to single-leg stance in eyes open and eyes closed conditions. Analysis of covariance (ANCOVA) was used to evaluate differences between groups and differences between legs within both groups, while controlling for peak center of pressure velocity. Significantly delayed muscle activation onset times were found in the anterior cruciate ligament reconstructed group compared to the control group for gluteus maximus, gluteus medius, vastus medialis obliquus, medial hamstrings, lateral hamstrings and gastrocnemius in both eyes open and eyes closed conditions (Panterior cruciate ligament reconstructed group, no significant different muscle activation onset times were found between the operated and non-operated leg (P>.05). Despite completion of rehabilitation and full return to sport, the anterior cruciate ligament reconstructed group showed neuromuscular control deficits that were not limited to the operated knee joint. Clinicians should focus on relearning multi-segmental anticipatory neuromuscular control strategies after anterior cruciate ligament reconstruction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Management of combined anterior or posterior cruciate ligament and posterolateral corner injuries: a systematic review.

    Science.gov (United States)

    Rochecongar, G; Plaweski, S; Azar, M; Demey, G; Arndt, J; Louis, M-L; Limozin, R; Djian, P; Sonnery-Cottet, B; Bousquet, V; Bajard, X; Wajsfisz, A; Boisrenoult, P

    2014-12-01

    Combined injuries to the posterolateral corner and cruciate ligaments are uncommon. The heterogeneity of injury patterns in many studies complicates the assessment of outcomes. To assess the prognosis and functional outcomes after surgery for combined injuries to the posterolateral corner and to the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL). We systematically reviewed the literature for articles reporting outcomes 1 year or more after surgery for combined injuries to the posterolateral corner and ACL (n=4) or PCL (n=9). Patients with bicruciate injuries were not studied. Overall, 65% of patients were IKDC A or B after surgery. The mean Lysholm score improved from 67 to 90. Mean time to surgery was 4.43 months in the group with ACL tears and 18.4 months in the group with PCL tears, and mean follow-up was 34.4 and 40.7 months in these two groups, respectively. In the groups with ACL and PCL tears, the proportions of patients classified as IKDC A or B at last follow-up were 81.6% and 81.0%, respectively, whereas 88% and 99% of patients, respectively, were IKDC grade C or D before surgery. The mean Lysholm score improved from 77 to 92 in the group with ACL tears and from 65 to 89 in the group with PCL tears. Improvements in laxity ranged from 28% to 79% in the group with PCL tears. Most of the articles selected for our review provided level III or IV evidence. Functional outcomes were satisfactory but less good than those reported after surgical reconstruction of isolated cruciate ligament tears. Full reconstruction seems the best strategy in patients with combined ACL/posterolateral corner injuries. Outcomes were also good but more variable in the group with PCL/posterolateral corner injuries. The time to surgery, which reflected the time to diagnosis, was shorter in patients with ACL than with PCL tears in addition to the posterolateral corner injury. Level III (systematic literature review). Copyright © 2014 Elsevier Masson SAS. All

  16. Can platelet-rich plasma enhance anterior cruciate ligament and meniscal repair?

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    Hutchinson, Ian D; Rodeo, Scott A; Perrone, Gabriel S; Murray, Martha M

    2015-02-01

    The use of platelet-rich plasma (PRP) to improve clinical outcome following a soft tissue injury, regeneration, and repair has been the subject of intense investigation and discussion. This article endeavors to relate clinical and basic science strategies focused on biological augmentation of the healing response in anterior cruciate ligament (ACL) and meniscus repair and replacement using PRP. Therein, a translational feedback loop is created in the literature and targeted towards the entire multidisciplinary team. Ultimately, it is hoped that the theoretical benefits of PRP on soft-tissue interfacial healing will emerge clinically following a careful, focused characterization at the benchtop, and prospective randomized controlled clinical study. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. State-of-the-art anterior cruciate ligament tears: A primer for primary care physicians.

    Science.gov (United States)

    Salzler, Matt; Nwachukwu, Benedict U; Rosas, Samuel; Nguyen, Chau; Law, Tsun Yee; Eberle, Thomas; McCormick, Frank

    2015-05-01

    The purpose of this article is to provide primary care physicians and other members of the medical community with an updated, general review on the subject of anterior cruciate ligament (ACL) tears. We aim to enhance awareness of these injuries and to prepare those practicing in the primary care setting to address these injuries. Because ACL injuries are quite common, it is very likely that a primary care physician will encounter these injuries and need to address them acutely. The current literature is replete with new concepts and controversies regarding ACL injuries, and this article provides a concise review for our target audience in regard to the care of a patient with an ACL injury. This article is composed of an overview with current epidemiologic data, basic anatomy and physiology, clinical presentation, physical examination findings, imaging modalities, and treatment options. After reading this short article, a medical care provider should understand ACL injuries and their appropriate management.

  18. All-inside anterior cruciate ligament graft link: graft preparation technique.

    Science.gov (United States)

    Lubowitz, James H

    2012-12-01

    The anatomic single-bundle, all-inside anterior cruciate ligament graft-link technique requires meticulous graft preparation. The graft choice is no-incision allograft or gracilis-sparing, posterior semitendinosus autograft. The graft is linked, like a chain, to femoral and tibial TightRope cortical suspensory fixation devices with adjustable-length graft loops (Arthrex, Naples, FL) in the following manner: the graft is quadrupled, and the free ends are first whip-stitched and then sutured with a buried-knot technique, 4 times through each strand in a loop. The graft is placed on a tensioning station under approximately 20 lb of tension during arthroscopic preparation of the knee and then removed from the tensioner and inserted into all-inside femoral and tibial sockets through the anteromedial arthroscopic portal.

  19. Septic arthritis caused by Granulicatella adiacens after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Mena Rosón, A; Valencia García, H; Moreno Coronas, F J

    2018-02-05

    Septic arthritis after knee arthroscopy is an extremely rare condition. A rate of 0.15-0.84% cases of postoperative infection is estimated in several series. The arthroscopy procedure most frequently related with an infectious complication is anterior cruciate ligament (ACL) reconstruction, with a prevalence of 0.3-1.7% cases. Staphylococcus sp. is the pathogen most commonly cultured. We describe a case of septic arthritis after ACL reconstruction. We found no published case of septic arthritis caused by this microorganism after knee arthroscopy. It is probably the first case published in the literature. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Articular cartilage damage with intramedullary lesion (bone bruise) in anterior cruciate ligament rupture

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    Ide, Shuya; Ohdera, Toshihiro; Tokunaga, Masami; Hiroshima, Shiro; Yoshimoto, Eiji [Fukuoka Orthopaedic Hospital (Japan)

    2002-09-01

    We evaluated the relationship between the intramedullary lesion on MRI and cartilage damage in patients associated with acute anterior cruciate ligament (ACL) rupture. Thirty-two cases documented by MRI and arthroscopy within one month from injury underwent ACL reconstruction using ST-G, and arthroscopy was performed again after surgery. The mean term between reconstruction and postoperative arthroscopy was twelve months. The cartilage damage on arthroscopy was compared with the intramedullary lesion on MRI. Cartilage damage was observed in 9 cases (28.1%) during the initial arthroscopy and in 16 cases (50.0%) during the second arthroscopy. Intramedullary lesion was detected in all 32 cases (total: 73 lesions) on MRI. Intramedullary lesion leading to cartilage damage was common in the geographic-type lateral femoral condyle. There was significant difference between the lateral meniscus tear and the cartilage damage of the lateral compartment. (author)

  1. Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques

    Science.gov (United States)

    Domnick, Christoph; Raschke, Michael J; Herbort, Mirco

    2016-01-01

    The influences and mechanisms of the physiology, rupture and reconstruction of the anterior cruciate ligament (ACL) on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades. The knee is a complex joint with shifting contact points, pressures and axes that are affected when a ligament is injured. The ACL, as one of the intra-articular ligaments, has a strong influence on the resulting kinematics. Often, other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes. Knowing the surgical options, anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome. PMID:26925379

  2. Management of Anterior Cruciate Ligament Injury: What's In and What's Out?

    Science.gov (United States)

    Raines, Benjamin Todd; Naclerio, Emily; Sherman, Seth L

    2017-01-01

    Sports medicine physicians have a keen clinical and research interest in the anterior cruciate ligament (ACL). The biomechanical, biologic, and clinical data researchers generate, help drive injury management and prevention practices globally. The current concepts in ACL injury and surgery are being shaped by technological advances, expansion in basic science research, resurging interest in ACL preservation, and expanding efforts regarding injury prevention. As new methods are being developed in this field, the primary goal of safely improving patient outcomes will be a unifying principle. With this review, we provide an overview of topics currently in controversy or debate, and we identify paradigm shifts in the understanding, management, and prevention of ACL tears. PMID:28966380

  3. Regeneration of the anterior cruciate ligament: Current strategies in tissue engineering

    Science.gov (United States)

    Nau, Thomas; Teuschl, Andreas

    2015-01-01

    Recent advancements in the field of musculoskeletal tissue engineering have raised an increasing interest in the regeneration of the anterior cruciate ligament (ACL). It is the aim of this article to review the current research efforts and highlight promising tissue engineering strategies. The four main components of tissue engineering also apply in several ACL regeneration research efforts. Scaffolds from biological materials, biodegradable polymers and composite materials are used. The main cell sources are mesenchymal stem cells and ACL fibroblasts. In addition, growth factors and mechanical stimuli are applied. So far, the regenerated ACL constructs have been tested in a few animal studies and the results are encouraging. The different strategies, from in vitro ACL regeneration in bioreactor systems to bio-enhanced repair and regeneration, are under constant development. We expect considerable progress in the near future that will result in a realistic option for ACL surgery soon. PMID:25621217

  4. Extra-Articular Lateral Tenodesis for Anterior Cruciate Ligament Deficient Knee: A Case Report

    Directory of Open Access Journals (Sweden)

    Diego García-Germán

    2013-01-01

    Full Text Available We present the case of an extra-articular lateral tenodesis for an anterior cruciate ligament (ACL deficient knee. A 46-year-old male patient sustained an ACL graft rupture after a motorcycle accident. He complained of rotational instability and giving-way episodes. His previous graft was fixed by an intra-articular femoral staple that was not possible to remove at the time of the ACL revision. A modified Lemaire procedure was then performed. He gained rotational stability and was able to resume his sporting activities. We believe that isolated extra-articular reconstructions may still have a role in selected indications including moderate-demand patients complaining of rotational instability after ACL graft failure.

  5. Anterior cruciate ligament graft tensioning. Is the maximal sustained one-handed pull technique reproducible?

    Directory of Open Access Journals (Sweden)

    Hirpara Kieran M

    2011-07-01

    Full Text Available Abstract Background Tensioning of anterior cruciate ligament (ACL reconstruction grafts affects the clinical outcome of the procedure. As yet, no consensus has been reached regarding the optimum initial tension in an ACL graft. Most surgeons rely on the maximal sustained one-handed pull technique for graft tension. We aim to determine if this technique is reproducible from patient to patient. Findings We created a device to simulate ACL reconstruction surgery using Ilizarov components and porcine flexor tendons. Six experienced ACL reconstruction surgeons volunteered to tension porcine grafts using the device to see if they could produce a consistent tension. None of the surgeons involved were able to accurately reproduce graft tension over a series of repeat trials. Conclusions We conclude that the maximal sustained one-handed pull technique of ACL graft tensioning is not reproducible from trial to trial. We also conclude that the initial tension placed on an ACL graft varies from surgeon to surgeon.

  6. Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee.

    Science.gov (United States)

    Smith, James O; Yasen, Sam K; Lord, Breck; Wilson, Adrian J

    2015-11-01

    Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomic, biomechanical and radiological characteristics of the native anterolateral ligament (ALL) of the knee have led to a resurgent interest in reconstruction of this structure as part of the management of knee instability. This technical note describes our readily reproducible combined minimally invasive technique to reconstruct both the ACL and ALL anatomically using autologous semitendinosus and gracilis grafts. This method of ALL reconstruction can be easily integrated with all-inside ACL reconstruction, requiring minimal additional operative time, equipment and expertise. Level of evidence V.

  7. Anterior cruciate ligament tear induces a sustained loss of muscle fiber force production.

    Science.gov (United States)

    Gumucio, Jonathan P; Sugg, Kristoffer B; Sibilsky Enselman, Elizabeth R; Konja, Alexis C; Eckhardt, Logan R; Bedi, Asheesh; Mendias, Christopher L

    2018-01-18

    Patients with anterior cruciate ligament (ACL) tears have persistent quadriceps strength deficits that are thought to be due to altered neurophysiological function. Our goal was to determine the changes in muscle fiber contractility independent of the ability of motor neurons to activate fibers. We obtained quadriceps biopsies of patients undergoing ACL reconstruction, and additional biopsies one, two, and six months after surgery. Muscles fiber contractility was assessed in vitro, along with whole muscle strength testing. Compared to controls, patients had a 30% reduction in normalized muscle fiber force at the time of surgery. One month later the force deficit was 41%, and at 6 months the deficit was 23%. Whole muscle strength testing demonstrated similar trends. While neurophysiological dysfunction contributes to whole muscle weakness, there is also a reduction in the force generating capacity of individual muscle cells independent of alpha motor neuron activation. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

  8. Military movement training program improves jump-landing mechanics associated with anterior cruciate ligament injury risk.

    Science.gov (United States)

    Owens, Brett D; Cameron, Kenneth L; Duffey, Michele L; Vargas, Donna; Duffey, Michael J; Mountcastle, Sally B; Padua, Darin; Nelson, Bradley J

    2013-01-01

    As part of the physical education program at the United States Military Academy, all cadets complete a movement training course designed to develop skills and improve performance in military-related physical tasks as well as obstacle navigation. The purpose of this study was to determine if completion of this course would also result in changes in jump-landing technique that reduce the risk of anterior cruciate ligament (ACL) injury. Analysis of landing mechanics on a two-footed jump landing from a height of 30 cm with a three-dimensional motion capture system synchronized with two force plates revealed both positive and negative changes. Video assessment using the Landing Error Scoring System (LESS) revealed an overall improved landing technique (p=.001) when compared to baseline assessments. The studied military movement course appears to elicit mixed but overall improved lower extremity jump-landing mechanics associated with risk for ACL injury.

  9. Efficacy of an Intra-Operative Imaging Software System for Anatomic Anterior Cruciate Ligament Reconstruction Surgery

    Directory of Open Access Journals (Sweden)

    Xudong Zhang

    2012-01-01

    Full Text Available An imaging software system was studied for improving the performance of anatomic anterior cruciate ligament (ACL reconstruction which requires identifying ACL insertion sites for bone tunnel placement. This software predicts and displays the insertion sites based on the literature data and patient-specific bony landmarks. Twenty orthopaedic surgeons performed simulated arthroscopic ACL surgeries on 20 knee specimens, first without and then with the visual guidance by fluoroscopic imaging, and their tunnel entry positions were recorded. The native ACL insertion morphologies of individual specimens were quantified in relation to CT-based bone models and then used to evaluate the software-generated insertion locations. Results suggested that the system was effective in leading surgeons to predetermined locations while the application of averaged insertion morphological information in individual surgeries can be susceptible to inaccuracy and uncertainty. Implications on challenges associated with developing engineering solutions to aid in re-creating or recognizing anatomy in surgical care delivery are discussed.

  10. Anterior cruciate ligament graft tensioning. Is the maximal sustained one-handed pull technique reproducible?

    LENUS (Irish Health Repository)

    O'Neill, Barry J

    2011-07-20

    Abstract Background Tensioning of anterior cruciate ligament (ACL) reconstruction grafts affects the clinical outcome of the procedure. As yet, no consensus has been reached regarding the optimum initial tension in an ACL graft. Most surgeons rely on the maximal sustained one-handed pull technique for graft tension. We aim to determine if this technique is reproducible from patient to patient. Findings We created a device to simulate ACL reconstruction surgery using Ilizarov components and porcine flexor tendons. Six experienced ACL reconstruction surgeons volunteered to tension porcine grafts using the device to see if they could produce a consistent tension. None of the surgeons involved were able to accurately reproduce graft tension over a series of repeat trials. Conclusions We conclude that the maximal sustained one-handed pull technique of ACL graft tensioning is not reproducible from trial to trial. We also conclude that the initial tension placed on an ACL graft varies from surgeon to surgeon.

  11. Posttraumatic incarceration of medial collateral ligament into knee joint with anterior cruciate ligament injury.

    Science.gov (United States)

    Kini, Sunil-Gurpur; du Pre, Karel; Bruce, Warwick

    2015-01-01

    Medial collateral ligament of the knee is an important coronal stabiliser and often injured in isolation or as combination of injuries. The article reports a case of incarcerated medial collateral ligament (MCL) injury in combination with anterior cruciate ligament (ACL) injury in 20 year old male who presented to us 4 weeks after injury. Clinical examination and MRI was correlated to complete ACL tear with torn distal MCL and incarceration into the joint. Patient was taken up for ACL hamstring graft reconstruction with mini-arthrotomy and repair of the torn MCL. Patient was followed up with dedicated rehabilitation protocol with good functional results. At one year follow-up, patient exhibited full range of motion with negative Lachman, Pivot shift and valgus stress tests. This article highlights the rare pattern of MCL tear and also reviews the literature on this pattern of injury.

  12. Automated fiber tracking and tissue characterization of the anterior cruciate ligament with optical coherence tomography

    Science.gov (United States)

    Balasubramanian, Priya S.; Guo, Jiaqi; Yao, Xinwen; Qu, Dovina; Lu, Helen H.; Hendon, Christine P.

    2017-02-01

    The directionality of collagen fibers across the anterior cruciate ligament (ACL) as well as the insertion of this key ligament into bone are important for understanding the mechanical integrity and functionality of this complex tissue. Quantitative analysis of three-dimensional fiber directionality is of particular interest due to the physiological, mechanical, and biological heterogeneity inherent across the ACL-to-bone junction, the behavior of the ligament under mechanical stress, and the usefulness of this information in designing tissue engineered grafts. We have developed an algorithm to characterize Optical Coherence Tomography (OCT) image volumes of the ACL. We present an automated algorithm for measuring ligamentous fiber angles, and extracting attenuation and backscattering coefficients of ligament, interface, and bone regions within mature and immature bovine ACL insertion samples. Future directions include translating this algorithm for real time processing to allow three-dimensional volumetric analysis within dynamically moving samples.

  13. X-ray computed tomography of the anterior cruciate ligament and patellar tendon

    Science.gov (United States)

    Shearer, Tom; Rawson, Shelley; Castro, Simon Joseph; Balint, Richard; Bradley, Robert Stephen; Lowe, Tristan; Vila-Comamala, Joan; Lee, Peter David; Cartmell, Sarah Harriet

    2014-01-01

    Summary The effect of phosphotungstic acid (PTA) and iodine solution (IKI) staining was investigated as a method of enhancing contrast in the X-ray computed tomography of porcine anterior cruciate ligaments (ACL) and patellar tendons (PT). We show that PTA enhanced surface contrast, but was ineffective at penetrating samples, whereas IKI penetrated more effectively and enhanced contrast after 70 hours of staining. Contrast enhancement was compared when using laboratory and synchrotron based X-ray sources. Using the laboratory source, PT fascicles were tracked and their alignment was measured. Individual ACL fascicles could not be identified, but identifiable features were evident that were tracked. Higher resolution scans of fascicle bundles from the PT and ACL were obtained using synchrotron imaging techniques. These scans exhibited greater contrast between the fascicles and matrix in the PT sample, facilitating the identification of the fascicle edges; however, it was still not possible to detect individual fascicles in the ACL. PMID:25332942

  14. CADAVERIC EVALUATION OF THE LATERAL-ANTERIOR DRAWER TEST FOR EXAMINING POSTERIOR CRUCIATE LIGAMENT INTEGRITY

    Science.gov (United States)

    Seeber, Gesine H.; Wilhelm, Marc P.; Windisch, Gunther; Appell Coriolano, Hans-Joachim; Matthijs, Omer C.; Sizer, Philip S.

    2017-01-01

    Background Common clinical tests often fail to identify posterior cruciate ligament (PCL) ruptures, leading to undetected tears and potential degenerative changes in the knee. The lateral-anterior drawer (LAD) test has been proposed but not yet evaluated regarding its effectiveness for diagnosing PCL-ruptures. Hypothesis The LAD will show greater tibial translation values in lateral-anterior direction in a PCL-Cut condition compared to a PCL-Intact condition, thus serving as a useful test for clinical diagnosis of PCL integrity. Study Design Descriptive laboratory study. Methods Threaded markers were inserted into the distal femur and proximal tibia in eighteen cadaveric knees. Each femur was stabilized and the tibia translated in lateral-anterior direction for the LAD test versus in a straight posterior direction for the posterior sag sign (PSS). Each test was repeated three times with the PCL both intact and then cut, in that order. During each trial, digital images were captured at start and finish positions for the evaluation of tibial marker displacement. Tibial marker translation during each trial was digitally analyzed using photography. The PSS values served as a reference standard. Results The LAD tibial translation was significantly greater (U=-3.680; pphysical examination tool for diagnosing PCL injuries. Level of Evidence 2 (laboratory study) PMID:28900563

  15. Comparison of different methods of femoral fixation anterior cruciate ligament reconstruction.

    Directory of Open Access Journals (Sweden)

    Alireza Eajazi

    2013-07-01

    Full Text Available The aim of this study is to compare three modes of femoral fixation, namely Aperfix, Rigidfix and Endobutton, in anterior cruciate ligament (ACL reconstruction. 120 patients were randomly assigned to three groups, each consisting of 40 patients, and each group was treated by one of the above mentioned methods of femoral fixation. All patients were examined prior to and 24 months after surgery, and they were compared for anterior tibial displacement using the Lysholm score and KT-1000. The three modes of femoral fixation were not significantly different in terms of time of surgery. In the Endobutton group, the Lysholm score rose from 63.21±18.59 prior to ACL reconstruction to 90.64±9.47 after the surgery, while it rose from 65.72±18.74 to 96.22±5.35 in the Aperfix group and from 69.21±17.45 to 90.64±9.47 in the Rigidfix group. Anterior tibial displacement was 3.96±1.58 mm for Endobutton, 4.28±1.48 mm for Rigidfix and 4.03±1.79 mm for Aperfix. Aperfix was indicated to yield a better outcome in terms of instant stability and general results.

  16. Comparison of different methods of femoral fixation anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Eajazi, Alireza; Madadi, Firooz; Madadi, Firoozeh; Boreiri, Majid

    2013-08-07

    The aim of this study is to compare three modes of femoral fixation, namely Aperfix, Rigidfix and Endobutton, in anterior cruciate ligament (ACL) reconstruction. 120 patients were randomly assigned to three groups, each consisting of 40 patients, and each group was treated by one of the above mentioned methods of femoral fixation. All patients were examined prior to and 24 months after surgery, and they were compared for anterior tibial displacement using the Lysholm score and KT-1000. The three modes of femoral fixation were not significantly different in terms of time of surgery. In the Endobutton group, the Lysholm score rose from 63.21±18.59 prior to ACL reconstruction to 90.64±9.47 after the surgery, while it rose from 65.72±18.74 to 96.22±5.35 in the Aperfix group and from 69.21±17.45 to 90.64±9.47 in the Rigidfix group. Anterior tibial displacement was 3.96±1.58 mm for Endobutton, 4.28±1.48 mm for Rigidfix and 4.03±1.79 mm for Aperfix. Aperfix was indicated to yield a better outcome in terms of instant stability and general results.

  17. The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

    Science.gov (United States)

    Simon, David; Saltzman, Bryan M.; Rollins, Meaghan; Bach, Bernard R.; MacDonald, Peter

    2015-01-01

    Anterior cruciate ligament (ACL) tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA) of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the normal physiologic knee bending culminating in increased anterior tibial translation and increased internal tibial rotation. This leads to increased mean contact stresses in the posterior medial and lateral compartments under anterior and rotational loading. However, surgical reconstruction of the ACL has not been shown to reduce the risk of future OA development back to baseline and has variability based on operative factors of graft choice, timing of surgery, presence of meniscal and chondral abnormalities, and surgical technique. Known strategies to prevent OA development are applicable to patients with ACL deficiency or after ACL reconstruction and include weight management, avoidance of excessive musculoskeletal loading, and strength training. Reconstruction of the ACL does not necessarily prevent osteoarthritis in many of these patients and may depend on several external variables. PMID:25954533

  18. No difference in anterior tibial translation with and without posterior cruciate ligament in less invasive total knee replacement.

    Science.gov (United States)

    Christen, Bernhard; Neukamp, Michal; Aghayev, Emin

    2012-03-01

    The relative advantages of cruciate retaining or cruciate resecting total knee replacement are still controversial. If the posterior cruciate ligament (PCL) is preserved, it should be properly balanced. In a previous study, it was demonstrated that increasing the flexion gap leads to an anterior translation of the tibia relative to the femur. Based on these results, we hypothesized that cutting the PCL increases the flexion gap and lessens anterior tibial translation. The amount of anterior tibial translation versus distraction force in the flexion gap was measured in 88 total knee replacements with a less invasive midvastus approach using a custom-made tensioner. Measurements were performed with intact and resected PCL. The difference in tibial translation with and without PCL is not significant. A 1-mm increase in the flexion gap led to an average anterior translation of 0.6 mm with intact PCL and 0.4 mm with cut PCL, which is less than that reported in a previous study. The results have not confirmed our initial hypothesis. The reasons for this may be other soft tissue structures that prevent anterior tibial translation, such as the collateral ligaments, and/or the extensor apparatus. Moreover, the knee flexion angle for the used specific implant may play a role. Prospective comparative study, Level II.

  19. An implant-free double-bundle reconstruction of the anterior cruciate ligament: operative technique and influence on tibiofemoral kinematics.

    Science.gov (United States)

    Wünschel, Markus; Treffler, Florian; Ketelsen, Dominik; Lo, Jiahsuan; Müller, Otto; Suckel, Andreas

    2011-08-01

    Reconstruction of the anterior cruciate ligament is a standard surgical procedure in sports traumatology. The widespread replacement method using hamstring tendons has an important shortcoming namely delayed or missing bony healing in contrast to patellar tendon grafts where implant-free fixation is established by using the adjacent bone blocks. The purpose of this study was to describe a new implant-free surgical procedure using hamstring tendon grafts and to analyse the influence on tibiofemoral kinematics in vitro. Nine human knee specimens with arthroscopically transected anterior cruciate ligaments were mounted on a dynamic knee simulator and weight-bearing muscle-loaded knee flexions were simulated while a robotic universal force sensor system was used to provide external tibial loads. Three different loading conditions were simulated including partial body weight only, an additional 50 N anterior tibial force or an additional Five Nm of internal rotational torque. After reconstruction of the anterior cruciate ligament using a tibial bone block hybrid technique these three trials were repeated. The kinematics was measured with an ultrasonic measuring system and different loading and ligament conditions were examined. Graft tunnel placement was verified by computed tomography. Our fixation method achieved stability to anterior tibial drawer force whereas internal tibial rotation did not change before and after the reconstruction. Computed tomography confirmed anatomical graft and tunnel placement. The presented operative procedure is technically feasible and leads to reproducible results concerning knee joint kinematics and graft placement. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Mechanical stretch increases CCN2/CTGF expression in anterior cruciate ligament-derived cells

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    Miyake, Yoshiaki [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Furumatsu, Takayuki, E-mail: matino@md.okayama-u.ac.jp [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Kubota, Satoshi; Kawata, Kazumi [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Ozaki, Toshifumi [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Takigawa, Masaharu [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)

    2011-06-03

    Highlights: {yields} CCN2/CTGF localizes to the ligament-to-bone interface, but is not to the midsubstance region of human anterior cruciate ligament (ACL). {yields} Mechanical stretch induces higher increase of CCN2/CTGF gene expression and protein secretion in ACL interface cells compared with ACL midsubstance cells. {yields} CCN2/CTGF treatment stimulates the proliferation of ACL interface cells. -- Abstract: Anterior cruciate ligament (ACL)-to-bone interface serves to minimize the stress concentrations that would arise between two different tissues. Mechanical stretch plays an important role in maintaining cell-specific features by inducing CCN family 2/connective tissue growth factor (CCN2/CTGF). We previously reported that cyclic tensile strain (CTS) stimulates {alpha}1(I) collagen (COL1A1) expression in human ACL-derived cells. However, the biological function and stress-related response of CCN2/CTGF were still unclear in ACL fibroblasts. In the present study, CCN2/CTGF was observed in ACL-to-bone interface, but was not in the midsubstance region by immunohistochemical analyses. CTS treatments induced higher increase of CCN2/CTGF expression and secretion in interface cells compared with midsubstance cells. COL1A1 expression was not influenced by CCN2/CTGF treatment in interface cells despite CCN2/CTGF stimulated COL1A1 expression in midsubstance cells. However, CCN2/CTGF stimulated the proliferation of interface cells. Our results suggest that distinct biological function of stretch-induced CCN2/CTGF might regulate region-specific phenotypes of ACL-derived cells.

  1. Anterior cruciate ligament reconstruction in skeletally immature patients : a systematic review.

    Science.gov (United States)

    Longo, U G; Ciuffreda, M; Casciaro, C; Mannering, N; Candela, V; Salvatore, G; Denaro, V

    2017-08-01

    Different methods of anterior cruciate ligament (ACL) reconstruction have been described for skeletally immature patients before closure of the growth plates. However, the outcome and complications following this treatment remain unclear. The aim of this systematic review was to analyse the outcome and complications of different techniques which may be used for reconstruction of the ACL in these patients. We performed a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This involved a comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar databases using the following combinations of keywords, "knee", "anterior cruciate ligament", "reconstruction", "injury", "children", "adolescent", "skeletally immature", "open physis" and "surgery". A total of 53 studies met the inclusion criteria and were included for analysis. The overall rate of disturbance of growth after ACL reconstruction was 2.6%, with no statistical difference between transphyseal and physeal-sparing techniques. Physeal-sparing techniques had a lower rate of post-operative complications compared with transphyseal techniques (p = 0.0045). Outcomes assessed were Lysholm score, International Knee Documentation Committee (IKDC) score, the IKDC grade, the Tegner score and the KT-1000. Both techniques had similar clinical outcomes. This review reveals low rates of disturbance of growth after ACL reconstruction in skeletally immature patients. Although limited, the available evidence did not support any particular surgical technique when considering disturbance of growth or clinical outcome. Further randomised controlled trials are needed to investigate the efficacy of differing surgical techniques on outcomes in skeletally immature patients. Cite this article: Bone Joint J 2017;99-B:1053-60. ©2017 The British Editorial Society of Bone & Joint Surgery.

  2. Flexor-extensor relationship knee after reconstruction of the anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Cristiano Ingo Dagnoni

    Full Text Available Introduction The incidence of knee injuries is very high in young adults. Anterior cruciate ligament (ACL rupture is the most frequent of them. The isokinetic dynamometry evaluation determines the functional patterns of strength and muscle balance.Objective To compare the isokinetic hamstring/quadriceps peak torque and work ratios of young adults after surgical reconstruction of the anterior cruciate ligament.Methods We selected 33 medical records filed by the Isokinetic laboratory of the Physiotherapy Clinic of the Catholic University of Paraná (PUCPR, which belonged to patients who had undergone isokinetic assessment at the request of a physiotherapist or physician in Curitiba, Paraná. The tabulated data were: Hamstring/Quadriceps peak torque and work ratios of all injured and non-injured limbs at an angular velocity of 60°/s. Data were processed by the statistical software LHstat. Inferential statistics was used in order to apply the comparison test between means (unpaired t-test with a confidence interval of 95%.Results The average flexion-extension ratio of the non-involved limb was lower than the involved limb both for peak torque (peak torque ratio of the non-involved limb: 56.1%; peak torque ratio of the involved limb: 66.3%; difference: 10.2% and work (work ratio of the non-involved limb: 60.1%; work ratio of involved limb: 66.1%; difference: 6%.Conclusion : The average flexion/extension ratio found was adequate for both limbs and variables, however, the subjects presented a greater number of muscle asymmetries in the involved limb than in the non-involved limb.

  3. Cryotherapy with dynamic intermittent compression for analgesia after anterior cruciate ligament reconstruction. Preliminary study.

    Science.gov (United States)

    Murgier, J; Cassard, X

    2014-05-01

    Cryotherapy is a useful adjunctive analgesic measure in patients with postoperative pain following anterior cruciate ligament (ACL) surgery. Either static permanent compression or dynamic intermittent compression can be added to increase the analgesic effect of cryotherapy. Our objective was to compare the efficacy of these two compression modalities combined with cryotherapy in relieving postoperative pain and restoring range of knee motion after ligament reconstruction surgery. When combined with cryotherapy, a dynamic and intermittent compression is associated with decreased analgesic drug requirements, less postoperative pain, and better range of knee motion compared to static compression. We conducted a case-control study of consecutive patients who underwent anterior cruciate ligament reconstruction at a single institution over a 3-month period. Both groups received the same analgesic drug protocol. One group was managed with cryotherapy and dynamic intermittent compression (Game Ready(®)) and the other with cryotherapy and static compression (IceBand(®)). Of 39 patients, 20 received dynamic and 19 static compression. In the post-anaesthesia recovery unit, the mean visual analogue scale (VAS) pain score was 2.4 (range, 0-6) with dynamic compression and 2.7 (0-7) with static compression (P=0.3); corresponding values were 1.85 (0-9) vs. 3 (0-8) (P=0.16) after 6 hours and 0.6 (0-3) vs. 1.14 (0-3) (P=0.12) at discharge. The cumulative mean tramadol dose per patient was 57.5mg (0-200mg) with dynamic compression and 128.6 mg (0-250 mg) with static compression (P=0.023); corresponding values for morphine were 0mg vs. 1.14 mg (0-8 mg) (Pcryotherapy decreases analgesic drug requirements after ACL reconstruction and improves the postoperative recovery of range of knee motion. Level III, case-control study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  4. Association between matrix metalloproteinase-3 polymorphism and anterior cruciate ligament ruptures.

    Science.gov (United States)

    Malila, S; Yuktanandana, P; Saowaprut, S; Jiamjarasrangsi, W; Honsawek, S

    2011-10-31

    Anterior cruciate ligament (ACL) ruptures are considered to be the most severe joint injury in sports. However, the precise etiologies of ACL injuries are not fully understood. Recently, the gene encoding the matrix metalloproteinase-3 (MMP-3, stromelysin-1) was shown to be associated with anterior cruciate ligament ruptures. The 5A/6A polymorphism in the promoter of the MMP-3 gene affects the regulation of MMP-3 gene expression. We examined the association between polymorphism within -1612 of the MMP-3 gene and ACL rupture in an independent population. Eighty-six participants between 20 and 40 years of age with surgically diagnosed ACL ruptures and 100 healthy controls between 18 and 28 years of age without history of ligament or tendon injuries were recruited for the study. All participants were genotyped for the MMP-3 polymorphism (-1612 5A/6A). Statistical analyses of genotype frequencies between patients and healthy controls were performed by the chi-square test. A significant difference was found between ACL rupture subgroups in terms of genotype association (5A+ (5A/5A, 5A/6A): 37.5% in contact sports vs 20% in non-contact sports; P = 0.02). In allelic association, there were significant differences (6A: 81.2% in contact sports vs 89.1% in non-contact sports, 5A: 18.8% in contact sports vs 10.9% in non-contact sports, P = 0.01). The 5A+ genotype of MMP-3 was represented in ACL ruptures in contact sport participants. We propose that this sequence variant is a specific genetic element that should be included in a multifactorial model to understand the etiologies and risk factors for ACL rupture.

  5. Medio-lateral Knee Fluency in Anterior Cruciate Ligament-Injured Athletes During Dynamic Movement Trials

    Science.gov (United States)

    Panos, Joseph A.; Hoffman, Joshua T.; Wordeman, Samuel C.; Hewett, Timothy E.

    2016-01-01

    Background Correction of neuromuscular impairments after anterior cruciate ligament injury is vital to successful return to sport. Frontal plane knee control during landing is a common measure of lower-extremity neuromuscular control and asymmetries in neuromuscular control of the knee can predispose injured athletes to additional injury and associated morbidities. Therefore, this study investigated the effects of anterior cruciate ligament injury on knee biomechanics during landing. Methods Two-dimensional frontal plane video of single leg drop, cross over drop, and drop vertical jump dynamic movement trials was analyzed for twenty injured and reconstructed athletes. The position of the knee joint center was tracked in ImageJ software for 500 milliseconds after landing to calculate medio-lateral knee motion velocities and determine normal fluency, the number of times per second knee velocity changed direction. The inverse of this calculation, analytical fluency, was used to associate larger numerical values with fluent movement. Findings Analytical fluency was decreased in involved limbs for single leg drop trials (P=0.0018). Importantly, analytical fluency for single leg drop differed compared to cross over drop trials for involved (P<0.001), but not uninvolved limbs (P=0.5029). For involved limbs, analytical fluency values exhibited a stepwise trend in relative magnitudes. Interpretation Decreased analytical fluency in involved limbs is consistent with previous studies. Fluency asymmetries observed during single leg drop tasks may be indicative of abhorrent landing strategies in the involved limb. Analytical fluency differences in unilateral tasks for injured limbs may represent neuromuscular impairment as a result of injury. PMID:26895446

  6. Flexible instruments outperform rigid instruments to place anatomic anterior cruciate ligament femoral tunnels without hyperflexion.

    Science.gov (United States)

    Steiner, Mark E; Smart, L Ryan

    2012-06-01

    This study evaluated the ability of flexible instruments compared with rigid instruments to place anatomic femoral tunnels in anterior cruciate ligament reconstructions by use of both transtibial drilling and anteromedial drilling without hyperflexion. Rigid and flexible pins were placed in 12 matched pairs of cadaveric knees with transtibial drilling (6 pairs) and anteromedial drilling (6 pairs) at 110° of flexion. Intraosseous pin lengths, femoral exit locations, and tunnel alignment were measured. Transtibial drilling with rigid pins placed relatively vertical femoral tunnels 5.8 ± 1.0 mm superior to the central anterior cruciate ligament insertion. Transtibial drilling with flexible pins placed tunnels in the center of the femoral attachment, but the tunnels were relatively close to the posterior femoral cortex, with a mean distance of 8.0 ± 5.9 mm (P Tunnel lengths with flexible pins were longer (42.0 ± 7.2 mm) compared with tunnel lengths with rigid pins (32.5 ± 7.1 mm) (P tunnels. Transtibial drilling with flexible pins produced anatomic tunnels, but the tunnels were close to the posterior femoral cortex. Anteromedial drilling without hyperflexion produced anatomic tunnels by use of rigid and flexible instruments, but with flexible instruments, the tunnels were longer and were farther from the posterior femoral cortex. Anteromedial drilling with flexible pins produced tunnels with good length and the best position. Flexible instruments compared with rigid instruments can facilitate the creation of anatomic femoral tunnels by use of anteromedial drilling without hyperflexion. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  7. A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics.

    Science.gov (United States)

    Joseph, Allan M; Collins, Christy L; Henke, Natalie M; Yard, Ellen E; Fields, Sarah K; Comstock, R Dawn

    2013-01-01

    The knee joint is the second most commonly injured body site after the ankle and the leading cause of sport-related surgeries. Knee injuries, especially of the anterior cruciate ligament (ACL), are among the most economically costly sport injuries, frequently requiring expensive surgery and rehabilitation. To investigate the epidemiology of ACL injuries among high school athletes by sport and sex. Descriptive epidemiology study. Using an Internet-based data-collection tool, Reporting Information Online (RIO), certified athletic trainers from 100 nationally representative US high schools reported athlete-exposure and injury data for athletes from 9 sports during the 2007/08-2011/12 academic years. The outcome of interest in this study was ACL injuries. During the study period, 617 ACL injuries were reported during 9 452 180 athlete exposures (AEs), for an injury rate of 6.5 per 100 000 AEs. Nationally, in the 9 sports studied, an estimated 215 628 ACL injuries occurred during the study period. The injury rate was higher in competition (17.6) than practice (2.4; rate ratio [RR] = 7.3, 95% confidence interval [CI] = 6.08, 8.68). Girls' soccer had the highest injury rate (12.2) followed by boys' football (11.1), with boys' basketball (2.3) and boys' baseball (0.7) having the lowest rates. In sex-comparable sports, girls had a higher rate (8.9) than boys (2.6; RR = 3.4, 95% CI = 2.64, 4.47). Overall, 76.6% of ACL injuries resulted in surgery. The most common mechanisms of injury were player-to-player contact (42.8%) and no contact (37.9%). Anterior cruciate ligament injury rates vary by sport, sex, and type of exposure. Recognizing such differences is important when evaluating the effectiveness of evidence-based, targeted prevention efforts.

  8. Hamstrings stiffness and landing biomechanics linked to anterior cruciate ligament loading.

    Science.gov (United States)

    Blackburn, J Troy; Norcross, Marc F; Cannon, Lindsey N; Zinder, Steven M

    2013-01-01

    Greater hamstrings stiffness is associated with less anterior tibial translation during controlled perturbations. However, it is unclear how hamstrings stiffness influences anterior cruciate ligament (ACL) loading mechanisms during dynamic tasks. To evaluate the influence of hamstrings stiffness on landing biomechanics related to ACL injury. Cross-sectional study. Research laboratory. A total of 36 healthy, physically active volunteers (18 men, 18 women; age = 23 ± 3 years, height = 1.8 ± 0.1 m, mass = 73.1 ± 16.6 kg). Hamstrings stiffness was quantified via the damped oscillatory technique. Three-dimensional lower extremity kinematics and kinetics were captured during a double-legged jump-landing task via a 3-dimensional motion-capture system interfaced with a force plate. Landing biomechanics were compared between groups displaying high and low hamstrings stiffness via independent-samples t tests. Hamstrings stiffness was normalized to body mass (N/m·kg(-1)). Peak knee-flexion and -valgus angles, vertical and posterior ground reaction forces, anterior tibial shear force, internal knee-extension and -varus moments, and knee-flexion angles at the instants of each peak kinetic variable were identified during the landing task. Forces were normalized to body weight, whereas moments were normalized to the product of weight and height. Internal knee-varus moment was 3.6 times smaller in the high-stiffness group (t22 = 2.221, P = .02). A trend in the data also indicated that peak anterior tibial shear force was 1.1 times smaller in the high-stiffness group (t22 = 1.537, P = .07). The high-stiffness group also demonstrated greater knee flexion at the instants of peak anterior tibial shear force and internal knee-extension and -varus moments (t22 range = 1.729-2.224, P prevention programs.

  9. Morphological changes in femoral tunnels after anatomic anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Tachibana, Yuta; Mae, Tatsuo; Shino, Konsei; Kanamoto, Takashi; Sugamoto, Kazuomi; Yoshikawa, Hideki; Nakata, Ken

    2015-12-01

    Few studies investigated the enlargement inside the tunnel as well as the morphological change at the aperture after anterior cruciate ligament (ACL) reconstruction, whereas the tunnel enlargement has been well documented. The purposes were to evaluate the change in the cross-sectional area along the femoral tunnel and to morphologically clarify the enlargement at the femoral tunnel aperture after anatomic triple-bundle (ATB) ACL reconstruction. The study included 15 patients with unilateral ACL rupture. ATB ACL reconstruction was performed using semitendinosus tendon autografts. Three-dimensional computer models of the femur and bone tunnels were reconstructed from computed tomography images obtained 3 weeks and 1 year postoperatively. The cross-sectional area at the aperture as well as inside the tunnel was compared between the two periods. Likewise, the location of tunnel walls and center in the tunnel footprint were evaluated. The cross-sectional area enlarged by 22.7 % for anteromedial/intermediate graft (P = 0.002) and 28.6 % for posterolateral graft (P = 0.002) at the aperture, while decreased by 36.2 % at 10 mm from the aperture for anteromedial/intermediate graft (P = 0.004). Both the anterior and posterior walls shifted anteriorly, while the distal wall shifted distally in both tunnels. Consequently, the center in the footprint significantly shifted anteriorly (4.9-6.6 %) and distally (2.2-2.6 %) in both tunnels. The femoral tunnel enlargement occurred at the aperture after ATB ACL reconstruction, but did not occur in the middle of the femoral tunnel. The morphology at the aperture changed with time after surgery as the tunnel walls translated anteriorly and distally. Case series, Level IV.

  10. Mechanisms of anterior cruciate ligament injury in World Cup alpine skiing: a systematic video analysis of 20 cases.

    Science.gov (United States)

    Bere, Tone; Flørenes, Tonje Wåle; Krosshaug, Tron; Koga, Hideyuki; Nordsletten, Lars; Irving, Christopher; Muller, Erich; Reid, Robert Cortas; Senner, Veit; Bahr, Roald

    2011-07-01

    There is limited insight into the mechanisms of anterior cruciate ligament injuries in alpine skiing, particularly among professional ski racers. This study was undertaken to qualitatively describe the mechanisms of anterior cruciate ligament injury in World Cup alpine skiing. Case series; Level of evidence, 4. Twenty cases of anterior cruciate ligament injuries reported through the International Ski Federation Injury Surveillance System for 3 consecutive World Cup seasons (2006-2009) were obtained on video. Seven international experts in the field of skiing biomechanics and sports medicine related to alpine skiing performed visual analyses of each case to describe the injury mechanisms in detail (skiing situation, skier behavior, biomechanical characteristics). Three main categories of injury mechanisms were identified: slip-catch, landing back-weighted, and dynamic snowplow. The slip-catch mechanism accounted for half of the cases (n = 10), and all these injuries occurred during turning, without or before falling. The skier lost pressure on the outer ski, and while extending the outer knee to regain grip, the inside edge of the outer ski caught abruptly in the snow, forcing the knee into internal rotation and valgus. The same loading pattern was observed for the dynamic snowplow (n = 3). The landing back-weighted category included cases (n = 4) where the skier was out of balance backward in flight after a jump and landed on the ski tails with nearly extended knees. The suggested loading mechanism was a combination of tibiofemoral compression, boot-induced anterior drawer, and quadriceps anterior drawer. Based on this video analysis of 20 injury situations, the main mechanism of anterior cruciate ligament injury in World Cup alpine skiing appeared to be a slip-catch situation where the outer ski catches the inside edge, forcing the outer knee into internal rotation and valgus. A similar loading pattern was observed for the dynamic snowplow. Injury prevention

  11. Topographical investigation of changes in depth-wise proteoglycan distribution in rabbit femoral articular cartilage at 4 weeks after transection of the anterior cruciate ligament.

    Science.gov (United States)

    Arokoski, Mikko E A; Tiitu, Virpi; Jurvelin, Jukka S; Korhonen, Rami K; Fick, James M

    2015-09-01

    In this study, we explore topographical changes in proteoglycan distribution from femoral condylar cartilage in early osteoarthritis, acquired from both the lateral and medial condyles of anterior cruciate ligament transected (ACLT) and contralateral (CNTRL) rabbit knee joints, at 4 weeks post operation. Four sites across the cartilage surface in a parasagittal plane were defined across tissue sections taken from femoral condyles, and proteoglycan (PG) content was quantified using digital densitometry. The greatest depth-wise change in PG content due to an ACLT (compared to the CNTRL group) was observed anteriorly (site C) from the most weight-bearing location within the lateral compartment. In the medial compartment, the greatest change was observed in the most weight-bearing location (site B). The depth-wise changes in PG content were observed up to 48% and 28% depth from the tissue surface at these aforementioned sites, respectively (p < 0.05). The smallest depth-wise change in PG content was observed posteriorly (site A) from the most weight-bearing location within both femoral condyles (up to 20% and up to 5% depth from the tissue surface at lateral and medial compartments, respectively). This study gives further insight into how early cartilage deterioration progresses across the parasagittal plane of the femoral condyle. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  12. Intratunnel versus extratunnel fixation of hamstring autograft for anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Han, Dave Lee Yee; Nyland, John; Kendzior, Matthew; Nawab, Akbar; Caborn, David N M

    2012-10-01

    To determine which is more effective: intratunnel or extratunnel anterior cruciate ligament soft-tissue graft fixation. A secondary purpose was to determine whether groups displayed differing relations between objective International Knee Documentation Committee (IKDC) grade and the timing of full weight bearing (FWB), jogging/running, and return to sports. The study hypotheses were that intratunnel fixation would display a greater percentage of normal or nearly normal objective IKDC grades and enable earlier FWB, return to jogging/running, and return to sports. We performed a systematic review of prospective, Studies with Level I or II evidence published from 2000 to 2011 with at least 2 years' follow-up that used interference screw hamstring autograft fixation (intratunnel group) or button, staple, or post hamstring autograft fixation (extratunnel group) for primary anterior cruciate ligament reconstruction. We also compared IKDC grades; Tegner and Lysholm scores; instrumented anterior laxity and pivot-shift test findings; timing of FWB, jogging/running, and return to sports; and modified Coleman Methodology Scores. The groups showed comparable modified Coleman Methodology Scores, objective IKDC grades, Lysholm and Tegner scores, instrumented anterior laxity and pivot-shift test findings, and return-to-sports timing. The intratunnel group displayed earlier FWB and jogging/running; however, return-to-sports timing did not differ between groups. Early FWB and the percentage of patients with normal or nearly normal objective IKDC grades were directly related for the extratunnel group. Patients who received intratunnel fixation were released earlier to FWB and jogging/running, supporting the study hypotheses. Groups did not differ in return-to-sports timing or objective IKDC grades, not supporting the study hypotheses. Early FWB in the extratunnel group was related to a greater percentage of patients having normal or nearly normal objective IKDC grades. Return

  13. Morphological changes in tibial tunnels after anatomic anterior cruciate ligament reconstruction with hamstring tendon graft.

    Science.gov (United States)

    Ohori, Tomoki; Mae, Tatsuo; Shino, Konsei; Tachibana, Yuta; Sugamoto, Kazuomi; Yoshikawa, Hideki; Nakata, Ken

    2017-09-15

    Three-dimensional (3D) reconstructed computed tomography (CT) is crucial for the reliable and accurate evaluation of tunnel enlargement after anterior cruciate ligament (ACL) reconstruction. The purposes of this study were to evaluate the tibial tunnel enlargement at the tunnel aperture and inside the tunnel and to clarify the morphological change at the tunnel footprint 1 year after the anatomic triple-bundle (ATB) ACL reconstruction using 3D CT models. Eighteen patients with unilateral ACL rupture were evaluated. The ATB ACL reconstruction with a semitendinosus tendon autograft was performed. 3D computer models of the tibia and the three tibial tunnels were reconstructed from CT data obtained 3 weeks and 1 year after surgery. The cross-sectional areas (CSAs) of the two anterior and the one posterior tunnels were measured at the tunnel aperture and 5 and 10 mm distal from the aperture and compared between the two periods. The locations of the center and the anterior, posterior, medial, and lateral edges of each tunnel footprint were also measured and compared between the two periods. The CSA of the posterior tunnel was significantly enlarged at the aperture by 40.4%, whereas that of the anterior tunnels did not change significantly, although the enlargement rate was 6.1%. On the other hand, the CSA was significantly reduced at 10 mm distal from the aperture in the anterior tunnels. The enlargement rate in the posterior tunnel was significantly greater than that in the anterior tunnels at the aperture. The center of the posterior tunnel footprint significantly shifted postero-laterally. The anterior and posterior edges of the posterior tunnel footprint demonstrated a significant posterior shift, while the lateral edge significantly shifted laterally. There was no significant shift of the center or all the edges of the anterior tunnels footprint. The posterior tibial tunnel was significantly enlarged at the aperture by 40% with the morphological change in the

  14. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus

    NARCIS (Netherlands)

    Melick, N. van; Cingel, R.E. van; Brooijmans, F.; Neeter, C.; Tienen, T. van; Hullegie, W.; Sanden, M.W. van der

    2016-01-01

    AIM: The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction. DESIGN: Clinical practice guideline underpinned by systematic review and

  15. Evaluation of functional rehabilitation physiotherapy protocol in the postoperative patients with anterior cruciate ligament reconstruction through clinical prognosis: an observational prospective study

    National Research Council Canada - National Science Library

    do Carmo Almeida, Tabata Cristina; de Alcantara Sousa, Luiz Vinicius; de Melo Lucena, Diego Monteiro; dos Santos Figueiredo, Francisco Winter; Valenti, Vitor Engrácia; da Silva Paiva, Laércio; de Abreu, Luiz Carlos; Adami, Fernando

    2016-01-01

      Background The aim of the study was to evaluate the evolution of patients subject to physical treatment based on guidelines of functional rehabilitation after surgery anterior cruciate ligament reconstruction...

  16. Anterior Cruciate Ligament Injury Prevention Training in Female Athletes: A Systematic Review of Injury Reduction and Results of Athletic Performance Tests

    National Research Council Canada - National Science Library

    Noyes, Frank R; Barber Westin, Sue D

    2012-01-01

    Context: Many anterior cruciate ligament (ACL) injury prevention training programs have been published, but few have assessed the effects of training on both ACL injury rates and athletic performance tests. Objective...

  17. Osteoarthritis Prevalence Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Numbers-Needed-to-Treat Analysis

    Science.gov (United States)

    Luc, Brittney; Gribble, Phillip A.; Pietrosimone, Brian G.

    2014-01-01

    Objective: To determine the prophylactic capability of anterior cruciate ligament (ACL) reconstruction in decreasing the risk of knee osteoarthritis (OA) when compared with ACL-deficient patients, as well as the effect of a concomitant meniscectomy. We also sought to examine the influence of study design, publication date, and graft type as well as the magnitude of change in physical activity from preinjury Tegner scores in both cohorts. Data Sources: We searched Web of Science and PubMed databases from 1960 through 2012 with the search terms osteoarthritis, meniscectomy, anterior cruciate ligament, anterior cruciate ligament reconstruction, and anterior cruciate ligament deficient. Study Selection: Articles that reported the prevalence of tibiofemoral or patellofemoral OA based on radiographic assessment were included. We calculated numbers needed to treat and relative risk reduction with associated 95% confidence intervals for 3 groups (1) patients with meniscal and ACL injury, (2) patients with isolated ACL injury, and (3) total patients (groups 1 and 2). Data Extraction: A total of 38 studies met the criteria. Of these, 27 assessed the presence of tibiofemoral osteoarthritis in patients treated with anterior cruciate ligament reconstruction. Data Synthesis: Overall, ACL reconstruction (ACL-R) yielded a numbers needed to treat to harm of 16 with a relative risk increase of 16%. Anterior cruciate ligament reconstruction along with meniscectomy yielded a numbers needed to treat to benefit of 15 and relative risk reduction of 11%. Isolated ACL-R showed a numbers needed to treat to harm of 8 and relative risk increase of 43%. Activity levels were decreased in both ACL-R (d = −0.90; 95% confidence interval = 0.77, 1.13) and ACL-deficient (d = −1.13; 95% confidence interval = 0.96, 1.29) patients after injury. Conclusions: The current literature does not provide substantial evidence to suggest that ACL-R is an adequate intervention to prevent knee osteoarthritis

  18. Comparison of Anterior Cruciate Ligament Graft Isometry between Paired Femoral and Tibial Tunnels.

    Science.gov (United States)

    Cain, E Lyle; Biggers, Marcus D; Beason, David P; Emblom, Benton A; Dugas, Jeffrey R

    2017-11-01

    Accurate tunnel placement is important for a successful anterior cruciate ligament (ACL) reconstruction. Controversy exists concerning the preferred method of femoral tunnel preparation, with proponents of both medial portal and transtibial drilling techniques. Current ACL literature suggests that placement of the femoral ACL attachment site posterior or "low" in the ACL footprint leads to more anatomically correct ACL mechanics and better rotational control. There is limited literature focusing on ACL graft displacement through knee range of motion based on specific paired placement of femoral and tibial tunnels. Our purpose was to assess ACL isometry between multiple combinations of femoral and tibial tunnels. We hypothesized that placement of the graft at the posterior aspect of the ACL footprint on the femur would be significantly less isometric and lead to more graft displacement as compared with central or anterior placement. The ACL of matched pairs of cadaveric knees was arthroscopically debrided while leaving the soft tissue footprint on the femur and tibia intact. One knee from each pair underwent notchplasty. In all knees, three femoral and three tibial tunnels were created at the anterior, central, and posterior aspects of the ACL footprint. A suture was passed through each tunnel combination (nine potential pairs), and the change in isometry was measured throughout full knee range of motion. Placement of the femoral tunnel along the posterior aspect of the ACL footprint was less isometric compared with a central or anterior position in the femoral footprint. Placement of a posterior tibial tunnel also led to decreased isometry, but tibial tunnel placement affected isometry to a lesser extent than femoral tunnel placement. The combination of a posterior femoral and posterior tibial tunnel resulted in greater than 1 cm of graft excursion from full flexion to extension. Placement of ACL tunnels at anisometric sites may adversely affect the mechanical

  19. Effect of Muscle Loads and Torque Applied to the Tibia on the Strain Behavior of the Anterior Cruciate Ligament: An In Vitro Investigation

    Science.gov (United States)

    Fujiya, Hiroto; Kousa, Petteri; Fleming, Braden C; Churchill, David L; Beynnon, Bruce D

    2011-01-01

    Background Very little is known about the effects of applied torque about the long axis of the tibia in combination with muscle loads on anterior cruciate ligament biomechanics. The purpose of this study was to determine the effect of muscle contraction and tibial torques applied about the long axis of the tibia on anterior cruciate ligament strain behavior. Methods Six cadaver knee specimens were used to measure the strain behaviour of the anterior cruciate ligament. Internal and external axial torques were applied to the tibia when the knee was between 30° and 120° of flexion in combination with the conditions of no muscle load, isolated quadriceps load, and simultaneous quadriceps and hamstring loading. Findings The highest anterior cruciate ligament strain values were measured when the muscles were not loaded, when the knee was at 120° of flexion, and when internal tibial torques were applied to the knee. During muscle loading the highest anterior cruciate ligament strain values were measured at 30° of flexion and then the strain values gradually decreased with increase in knee flexion. During co-contraction of the quadriceps and hamstring muscles the anterior cruciate ligament was unstrained or minimally strained at 60°, 90° and 120° of knee flexion. Intepretation This study suggests that quadriceps and hamstring muscle co-contraction has a potential role in reducing the anterior cruciate ligament strain values when the knee is in deep flexion. These results can be used to gain insight into anterior cruciate ligament injury mechanisms and to design rehabilitation regimens. PMID:21816523

  20. Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: a systematic review and meta-analysis.

    Science.gov (United States)

    Bates, Nathaniel A; Myer, Gregory D; Shearn, Jason T; Hewett, Timothy E

    2015-01-01

    Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Anterior Cruciate Ligament Biomechanics During Robotic and Mechanical Simulations of Physiologic and Clinical Motion Tasks: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Bates, Nathaniel A.; Myer, Gregory D.; Shearn, Jason T.; Hewett, Timothy E.

    2014-01-01

    Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined. PMID:25547070

  2. Clinically Relevant Injury Patterns After an Anterior Cruciate Ligament Injury Provide Insight Into Injury Mechanisms

    Science.gov (United States)

    Levine, Jason W.; Kiapour, Ata M.; Quatman, Carmen E.; Wordeman, Samuel C.; Goel, Vijay K.; Hewett, Timothy E.; Demetropoulos, Constantine K.

    2014-01-01

    Background The functional disability and high costs of treating anterior cruciate ligament (ACL) injuries have generated a great deal of interest in understanding the mechanism of noncontact ACL injuries. Secondary bone bruises have been reported in over 80% of partial and complete ACL ruptures. Purpose The objectives of this study were (1) to quantify ACL strain under a range of physiologically relevant loading conditions and (2) to evaluate soft tissue and bony injury patterns associated with applied loading conditions thought to be responsible for many noncontact ACL injuries. Study Design Controlled laboratory study. Methods Seventeen cadaveric legs (age, 45 ± 7 years; 9 female and 8 male) were tested utilizing a custom-designed drop stand to simulate landing. Specimens were randomly assigned between 2 loading groups that evaluated ACL strain under either knee abduction or internal tibial rotation moments. In each group, combinations of anterior tibial shear force, and knee abduction and internal tibial rotation moments under axial impact loading were applied sequentially until failure. Specimens were tested at 25° of flexion under simulated 1200-N quadriceps and 800-N hamstring loads. A differential variable reluctance transducer was used to calculate ACL strain across the anteromedial bundle. A general linear model was used to compare peak ACL strain at failure. Correlations between simulated knee injury patterns and loading conditions were evaluated by the χ2 test for independence. Results Anterior cruciate ligament failure was generated in 15 of 17 specimens (88%). A clinically relevant distribution of failure patterns was observed including medial collateral ligament tears and damage to the menisci, cartilage, and subchondral bone. Only abduction significantly contributed to calculated peak ACL strain at failure (P = .002). While ACL disruption patterns were independent of the loading mechanism, tibial plateau injury patterns (locations) were

  3. Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes.

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    Magnussen, Robert A; Reinke, Emily K; Huston, Laura J; Hewett, Timothy E; Spindler, Kurt P

    2016-12-01

    Knee laxity in the setting of suspected anterior cruciate ligament (ACL) injury is frequently assessed through physical examination using the Lachman, pivot-shift, and anterior drawer tests. The degree of laxity noted on these examinations may influence treatment decisions and prognosis. Increased preoperative knee laxity would be associated with increased risk of subsequent revision ACL reconstruction and worse patient-reported outcomes 2 years postoperatively. Cohort study; Level of evidence, 2. From an ongoing prospective cohort study, 2333 patients who underwent primary isolated ACL reconstruction without collateral or posterior cruciate ligament injury were identified. Patients reported by the operating surgeons as having an International Knee Documentation Committee (IKDC) grade D for Lachman, anterior drawer, or pivot-shift examination were classified as having high-grade laxity. Multiple logistic regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with increased odds of undergoing revision ACL reconstruction within 2 years of the index procedure, controlling for patient age, sex, Marx activity level, level of competition, and graft type. Multiple linear regression modeling was used to evaluate whether having high-grade preoperative laxity was associated with worse IKDC score or Knee injury and Osteoarthritis Outcome Score Knee-Related Quality of Life subscale (KOOS-QOL) scores at a minimum 2 years postoperatively, controlling for baseline score, patient age, ethnicity, sex, body mass index, marital status, smoking status, sport participation, competition level, Marx activity rating score, graft type, and articular cartilage and meniscus status. Pre-reconstruction laxity data were available for 2325 patients (99.7%). Two-year revision data were available for 2259 patients (96.8%), and patient-reported outcomes were available for 1979 patients (84.8%). High-grade preoperative laxity was noted in 743 patients

  4. Prospectively Identified Deficits in Sagittal Plane Hip-Ankle Coordination in Female Athletes who Sustain a Second Anterior Cruciate Ligament Injury after Anterior Cruciate Ligament Reconstruction and Return to Sport

    Science.gov (United States)

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

    2015-01-01

    Background Athletes who return to sport after anterior cruciate ligament reconstruction are at increased risk of future ACL injury. Altered coordination of lower extremity motion may increase this risk. The purpose of this study was to prospectively determine if altered lower extremity coordination patterns exist in athletes who go on to sustain a 2nd anterior cruciate ligament injury. Methods Sixty-one female athletes who were medically cleared to return to sport after anterior cruciate ligament reconstruction were included. Hip-ankle coordination was assessed prior to return to sport with a dynamic postural coordination task. Within 12 months, 14 patients sustained a 2nd ACL injury. Fourteen matched subjects were selected for comparative analysis. Cross-recurrence quantification analysis characterized hip-ankle coordination patterns. A group × target speed (slow vs. fast) × leg (involved vs. uninvolved) analysis of variance was used to identify coordination differences. Findings A main effect of group (p = 0.02) indicated that the single injury group exhibited more stable hip-ankle coordination [166.2 (18.9)] compared to the 2nd injury group [108.4 (10.1)]. A leg × group interaction was also observed (p = .04). The affected leg of the single injury group exhibited more stable coordination [M = 187.1 (23.3)] compared to the affected leg of the 2nd injury group [M = 110.13 (9.8)], p = 0.03. Interpretation Hip-ankle coordination was altered in female athletes who sustained a 2nd anterior cruciate ligament injury after return to sport. Failure to coordinate lower extremity movement in the absence of normal knee proprioception may place the knee at high-risk. PMID:26416200

  5. Effect of vision on postural sway in anterior cruciate ligament injured knees.

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    Okuda, Kazuhiro; Abe, Nobuhiro; Katayama, Yoshimi; Senda, Masuo; Kuroda, Takayuki; Inoue, Hajime

    2005-05-01

    Recent clinical studies have investigated postural sway characteristics in anterior cruciate ligament (ACL)-deficient knees, but the relative contributions of vision and ACL remain unclear. In the current study, we measured and compared postural sway during one-leg standing with eyes open and closed to assess the difference between legs with and without ACL injury, and we discuss the contribution of the ligament relative to vision and to postural sway in patients. We examined 32 patients (17 males, 15 females) with ACL injury before surgery from March 2001 through January 2004. None presented obvious dysfunction in the lower limbs or central nervous system. Using a gravicorder, we measured locus length per time (LG) and environmental area (AR) as the factors of postural sway during two-leg and one-leg standing with eyes open or closed. In the ACL-injured knee, the amount of postural sway increased significantly during injured leg standing with eyes closed (LG, P postural sway and the anterior translation of the tibia measured by arthrometer KT2000 or between the muscle strength around the knee. We concluded that the amount of postural sway in the ACL-injured knee increased significantly on injured leg standing with eyes closed, and that vision appears to be dominant in compensating for the decreased contribution of the injured ACL.

  6. Anterior cruciate ligament injuries in soccer: Loading mechanisms, risk factors, and prevention programs

    Directory of Open Access Journals (Sweden)

    Boyi Dai

    2014-12-01

    Full Text Available Anterior cruciate ligament (ACL injuries are common in soccer. Understanding ACL loading mechanisms and risk factors for ACL injury is critical for designing effective prevention programs. The purpose of this review is to summarize the relevant literature on ACL loading mechanisms, ACL injury risk factors, and current ACL injury prevention programs for soccer players. Literature has shown that tibial anterior translation due to shear force at the proximal end of tibia is the primary ACL loading mechanism. No evidence has been found showing that knee valgus moment is the primary ACL loading mechanism. ACL loading mechanisms are largely ignored in previous studies on risk factors for ACL injury. Identified risk factors have little connections to ACL loading mechanisms. The results of studies on ACL injury prevention programs for soccer players are inconsistent. Current ACL injury prevention programs for soccer players are clinically ineffective due to low compliance. Future studies are urgently needed to identify risk factors for ACL injury in soccer that are connected to ACL loading mechanisms and have cause-and-effect relationships with injury rate, and to develop new prevention programs to improve compliance.

  7. Nutrition of the anterior cruciate ligament. Effects of continuous passive motion.

    Science.gov (United States)

    Skyhar, M J; Danzig, L A; Hargens, A R; Akeson, W H

    1985-01-01

    Twelve freshly killed mature male rabbits were used to study the effects of continuous passive motion (CPM) on regional and overall nonvascular nutritional pathways of the anterior cruciate ligament (ACL). One hundred fifty microcuries of 35sulphate was injected intraarticularly into each knee joint. The right knee underwent CPM for 1 hour, while the left knee remained immobilized. Both knee joints were then isolated and immediately frozen. The ACLs were removed while still mostly frozen, and sectioned into anterior, middle, and posterior thirds for the six rabbits in Group 1, and proximal, middle, and distal thirds for the six rabbits in Group 2. In addition, quadriceps tendon samples were harvested from each limb of three rabbits. After appropriate processing, all samples were counted in a scintillation counter, and counts per minute per milligram of tissue were calculated. There was significantly higher uptake in rest extremity ACLs compared to CPM extremity ACLs (P = 0.0001). No significant difference was demonstrated in regional uptake comparing respective thirds of the ACL in either Group 1 or Group 2. Quadriceps tendon uptake trended higher in the limbs exposed to CPM compared to those maintained at rest (P = 0.14). The ACL uses diffusion as a primary nutrient pathway. CPM does not increase nutrient uptake by the ACL in this avascular model, but CPM may facilitate transport of metabolites out of the joint. No regional differences in uptake within the ACL occurred in either group.

  8. Impact of Partial and complete rupture of anterior cruciate ligament on medial meniscus: A cadavaric study.

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    Jiang, Wei; Gao, Shu-Guang; Li, Kang-Hua; Luo, Ling; Li, Yu-Sheng; Luo, Wei; Lei, Guang-Hua

    2012-09-01

    The clinical relationship between medial meniscus tear and anterior cruciate ligament (ACL) rupture has been well documented. However, the mechanism of this clinical phenomenon is not exactly explained. Our aim is to investigate the biomechanical impact of partial and complete ACL rupture on different parts of medial meniscus. TWELVE FRESH HUMAN CADAVERIC KNEE SPECIMENS WERE DIVIDED INTO FOUR GROUPS: ACL intact (ACL-I), anteromedial bundle transection (AMB-T), posterolateral bundle transection (PLB-T), and ACL complete transection (ACL-T) group. Strain on the anterior horn, body part, and posterior horn of medial meniscus were measured under 200 N axial compressive tibial load at 0°, 30°, 60°, and 90° of knee flexion, respectively. Compared with the control group (ACL-I), the ACL-T group had a higher strain on whole medial meniscus at 0°, 60°, and 90° of flexion. But at 30°, it had a higher strain on posterior horn of meniscus only. As to PLB-T group, strain on whole meniscus increased at full extension, while strain increased on posterior horn at 30° and on body of meniscus at 60°. However, AMB-T only brought about higher strain at 60° of flexion on body and posterior horn of meniscus. Similar to complete rupture, partial rupture of ACL can also trigger strain concentration on medial meniscus, especially posterior horn, which may be a more critical reason for meniscus injury associated with chronic ACL deficiency.

  9. Transtibial technique versus two incisions in anterior cruciate ligament reconstruction: tunnel positioning, isometricity and functional evaluation

    Directory of Open Access Journals (Sweden)

    Ricardo Hideki Yanasse

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To compare the transtibial and two-incision techniques for anterior cruciate ligament (ACL reconstruction using a single band. METHODS: A prospective and randomized study was conducted in blocks. Patients underwent ACL reconstruction by means of two techniques: transtibial (group 1: 20 patients or two incisions (group 2: 20 patients. The radiographic positioning of the tunnel, inclination of the graft, graft isometricity and functional results (IKDC and Lysholm were evaluated. RESULTS: The positioning of the femoral tunnel on the anteroposterior radiograph, expressed as a mean percentage relative to the medial border of the tibial plateau, was 54.6% in group 1 and 60.8% in group 2 (p 0.05. Group 2 had better results from the pivot-shift maneuver (p < 0.05. CONCLUSION: The technique of two incisions allowed positioning of the femoral tunnel that was more lateralized and anteriorized, such that the graft was more inclined and there was a clinically better result from the pivot-shift maneuver. There was no difference in isometricity and no final functional result over the short follow-up time evaluated.

  10. Short term results of anterior cruciate ligament augmentation in professional and amateur athletes.

    Science.gov (United States)

    Yazdi, Hamidreza; Torkaman, Ali; Ghahramani, Morteza; Moradi, Amin; Nazarian, Ara; Ghorbanhoseini, Mohammad

    2017-06-01

    Anterior cruciate ligament (ACL) reconstruction is a widely accepted procedure; however, controversies exist about ACL augmentation. The purpose of this study was to assess the clinical outcomes of ACL augmentation in professional and amateur athletes with isolated single bundle ACL tears. A consecutive series of professional and amateur athletes with partial ACL tears who underwent selective bundle reconstruction were analyzed. Stability was assessed with the Lachman test, anterior-drawer test, pivot-shift test and KT-1000 arthrometer. Functional assessment was performed using the subjective Lysholm questionnaire. Fifty-six patients were enrolled. The mean follow-up period was 19.3 months. All patients had posterolateral bundle (PLB) tears, and no anteromedial bundle (AMB) tears were found. The Lysholm score improved significantly from 78 (SD = 2.69) preoperatively to 96 (SD = 3.41) postoperatively (P value amateur athletes, and although further studies are needed to investigate long-term results, we recommend this surgery for all symptomatic athletic patients, especially those who would like to maintain an active lifestyle. Level of evidence IV.

  11. Evaluation and comparison of clinical results of femoral fixation devices in arthroscopic anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Aydin, Deniz; Ozcan, Mert

    2016-03-01

    Several femoral fixation devices are available for hamstring tendon autograft in anterior cruciate ligament (ACL) reconstruction, but the best technique is debatable. We hypothesised that different suspensory femoral fixation techniques have no superiority over each other. The aim of this study was to evaluate and compare the clinical results of different suspensory femoral fixation devices in arthroscopic ACL reconstruction. This was a Level III, retrospective, comparative study. A total of 100 consecutive patients who underwent arthroscopic ACL reconstruction in a single institution with a mean follow-up time of 40 months (12-67 months) were divided into three groups according to femoral fixation devices as 'Endobutton' (n=34), 'Transfix' (n=35) and 'Aperfix' (n=31). The length of painful period after surgery, time to return to work and sporting activities, final range of motion, anterior drawer and Lachman tests, knee instability symptoms, International Knee Documentation Committee (IKDC) subjective knee evaluation score, Short Form 36 (SF-36) score, Lysholm knee score and Tegner point of the patients were evaluated and compared between groups. There were no significant differences between the groups. All techniques led to significant recovery in knee instability tests and symptoms. In this study, the clinical results of different suspensory femoral fixation techniques were found to be similar. We believe that different femoral fixation techniques have no effect on clinical results provided that the technique is correctly applied. The surgeon must choose a technique appropriate to his or her experience. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. Factors affecting knee laxity following anterior cruciate ligament reconstruction using a hamstring tendon.

    Science.gov (United States)

    Yanagisawa, Shinya; Kimura, Masashi; Hagiwara, Keiichi; Ogoshi, Atsuko; Nakagawa, Tomoyuki; Shiozawa, Hiroyuki; Ohsawa, Takashi

    2017-10-01

    The aim of the present study was to investigate the correlation between the pre-operative and intraoperative factors that predict postoperative knee laxity following anterior cruciate ligament (ACL) reconstruction using a hamstring tendon. The subjects included 108 patients (male, n=49; female, n=59) with ACL-deficient knees who had undergone double-bundle reconstruction. The median time between injury and surgery (TBIS) was 27.5weeks (range one to 504). The patients were divided into two groups according to the side-to-side difference (SSD) in anterior translation on a stress radiograph one year after undergoing the operation (Group A: SSD of ligament, meniscus, and articular cartilage injury. A logistic regression analysis was performed to identify the factors associated with knee laxity. The postoperative SSD values after one year were correlated with the TBIS (r=0.28; P<0.01). Eighty-one and 27 knees were classified into Groups A and B, respectively, based on the SSD at one year after surgery. The TBIS in Group B (60.2weeks) was significantly longer than that in Group A (16.6weeks; P<0.01). A logistic regression analysis showed that there was a significant association between the TBIS and postoperative knee laxity (P<0.01; odds ratio 1.013; 95% CI 1.002-1.023). Increased knee laxity was associated with the time between injury and surgery. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Does flexible tunnel drilling affect the femoral tunnel angle measurement after anterior cruciate ligament reconstruction?

    Science.gov (United States)

    Muller, Bart; Hofbauer, Marcus; Atte, Akere; van Dijk, C Niek; Fu, Freddie H

    2015-12-01

    To quantify the mean difference in femoral tunnel angle (FTA) as measured on knee radiographs between rigid and flexible tunnel drilling after anatomic anterior cruciate ligament (ACL) reconstruction. Fifty consecutive patients that underwent primary anatomic ACL reconstruction with a single femoral tunnel drilled with a flexible reamer were included in this study. The control group was comprised of 50 patients all of who underwent primary anatomic ACL reconstruction with a single femoral tunnel drilled with a rigid reamer. All femoral tunnels were drilled through a medial portal to ensure anatomic tunnel placement. The FTA was determined from post-operative anterior-to-posterior (AP) radiographs by two independent observers. A 5° difference between the two mean FTA was considered clinically significant. The average FTA, when drilled with a rigid reamer, was 42.0° ± 7.2°. Drilling with a flexible reamer resulted in a mean FTA of 44.7° ± 7.0°. The mean difference of 2.7° was not statistically significant. The intraclass correlation coefficient for inter-tester reliability was 0.895. The FTA can be reliably determined from post-operative AP radiographs and provides a useful and reproducible metric for characterizing femoral tunnel position after both rigid and flexible femoral tunnel drilling. This has implications for post-operative evaluation and preoperative treatment planning for ACL revision surgery. IV.

  14. Valgus osteotomy of the tibia with a Puddu plate combined with anterior cruciate ligament reconstruction

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    Albuquerque Roberto Freire da Mota e

    2003-01-01

    Full Text Available Anterior knee instability associated with a varus deformity is a complex condition with several treatment possibilities. Among these, anterior cruciate ligament (ACL associated to a simultaneous valgus tibial osteotomy is a increasing indication. This simultaneous procedure adds technical issues to those related to the isolated surgeries. Thus, the osteotomy plane and location of fixation hardware shouldn?t conflict with tibial tunnel and ACL graft fixation. Authors analyze the relations between a opening tibial valgus osteotomy stabilized with a Puddu plate and ACL reconstruction with a patellar tendon graft fixated with interference screws in 10 human cadaver knees. A straight oblique tibial osteotomy starting on the medial tibial cortex and oriented laterally and proximally was performed on all knees with a 10mm opening medially and stabilized with a Puddu plate on the most posterior aspect of the medial tibia, and a tibial tunnel drilled 50° to tibial plateau. With this technique there was no intersection between tibial tunnel or interference screw and the osteotomy or the plate fixation screws.

  15. Occult fracture patterns of the knee associated with anterior cruciate ligament tears: assessment with MR imaging.

    Science.gov (United States)

    Kaplan, P A; Walker, C W; Kilcoyne, R F; Brown, D E; Tusek, D; Dussault, R G

    1992-06-01

    One hundred consecutive magnetic resonance (MR) images of the knee in patients with acute complete anterior cruciate ligament (ACL) tears were reviewed to evaluate the prevalence and patterns of associated occult fractures. Eighty-nine occult fractures were identified in 56 knees. All occult fractures were in the posterior aspect of the lateral tibial plateau. Of these, occult fractures were isolated in 24 cases (43%) and were in combination with fractures in the middle aspect of the lateral femoral condyle in 26 (46%), with fractures in the posterior aspect of the medial tibial plateau in four (7%), and with fractures involving all three areas in one (2%). Disruption of the ACL under valgus stress leads to anterior translation of the tibia and relative external rotation of the femur. This allows impaction of the posterior portion of the lateral tibial plateau against the middle of the lateral femoral condyle and accounts for the unique pattern of occult fractures associated with ACL tears. An occult fracture of the posterior lateral tibial plateau with or without an associated fracture in the lateral femoral condyle ("kissing contusion") is a relatively frequent finding in acute ACL tears and, when present, is highly suggestive of such an associated tear.

  16. Thermography based diagnosis of ruptured anterior cruciate ligament (ACL) in canines

    Science.gov (United States)

    Lama, Norsang; Umbaugh, Scott E.; Mishra, Deependra; Dahal, Rohini; Marino, Dominic J.; Sackman, Joseph

    2016-09-01

    Anterior cruciate ligament (ACL) rupture in canines is a common orthopedic injury in veterinary medicine. Veterinarians use both imaging and non-imaging methods to diagnose the disease. Common imaging methods such as radiography, computed tomography (CT scan) and magnetic resonance imaging (MRI) have some disadvantages: expensive setup, high dose of radiation, and time-consuming. In this paper, we present an alternative diagnostic method based on feature extraction and pattern classification (FEPC) to diagnose abnormal patterns in ACL thermograms. The proposed method was experimented with a total of 30 thermograms for each camera view (anterior, lateral and posterior) including 14 disease and 16 non-disease cases provided from Long Island Veterinary Specialists. The normal and abnormal patterns in thermograms are analyzed in two steps: feature extraction and pattern classification. Texture features based on gray level co-occurrence matrices (GLCM), histogram features and spectral features are extracted from the color normalized thermograms and the computed feature vectors are applied to Nearest Neighbor (NN) classifier, K-Nearest Neighbor (KNN) classifier and Support Vector Machine (SVM) classifier with leave-one-out validation method. The algorithm gives the best classification success rate of 86.67% with a sensitivity of 85.71% and a specificity of 87.5% in ACL rupture detection using NN classifier for the lateral view and Norm-RGB-Lum color normalization method. Our results show that the proposed method has the potential to detect ACL rupture in canines.

  17. Three-dimensional kinematic and kinetic gait deviations in individuals with chronic anterior cruciate ligament deficient knee: A systematic review and meta-analysis.

    Science.gov (United States)

    Ismail, Shiek Abdullah; Button, Kate; Simic, Milena; Van Deursen, Robert; Pappas, Evangelos

    2016-06-01

    Altered joint motion that occurs in people with an anterior cruciate ligament deficient knee is proposed to play a role in the initiation of knee osteoarthritis, however, the exact mechanism is poorly understood. Although several studies have investigated gait deviations in individuals with chronic anterior cruciate ligament deficient knee in the frontal and transverse planes, no systematic review has summarized the kinematic and kinetic deviations in these two planes. We searched five electronic databases from inception to 14th October 2013, with key words related to anterior cruciate ligament, biomechanics and gait, and limited to human studies only. Two independent reviewers assessed eligibility based on predetermined inclusion/exclusion criteria and methodological quality was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology statement checklist. We identified 16 studies, totaling 183 subjects with anterior cruciate ligament deficient knee and 211 healthy subjects. Due to the variability in reported outcomes, we could only perform meta-analysis for 13 sagittal plane outcomes. The only significant finding from our meta-analysis showed that individuals with anterior cruciate ligament deficient knee demonstrated a significantly greater external hip flexor angular impulse compared to control (P=0.03). No consensus about what constitutes a typical walking pattern in individuals with anterior cruciate ligament deficient knee can be made, nor can conclusions be derived to explain if gait deviations in the frontal and transverse plane contributed to the development of the knee osteoarthritis among this population. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Severity of medial meniscus damage in the canine knee after anterior cruciate ligament transection.

    Science.gov (United States)

    Smith, G N; Mickler, E A; Albrecht, M E; Myers, S L; Brandt, K D

    2002-04-01

    To examine the relationship between the severity of cartilage damage and the severity of meniscus damage after transection of the anterior cruciate ligament (ACLT) in adult dogs. Data were obtained from 40 dogs which underwent ACLT and from three additional sham-operated dogs that were subjected to arthrotomy but not ligament transection. Joint pathology was analysed 12, 24 or 32 weeks after surgery. The severity of damage to the articular cartilage on the femoral condyle and tibial plateau was graded with a scoring system based on that of the Sociètè Française d'Arthroscopie and meniscus damage was graded on a 0-4 scale. No damage to the meniscus or articular cartilage was observed 12 weeks after surgery in the dogs subjected only to arthrotomy. In contrast, tears of the medial meniscus were observed in two of 10 (20%) dogs examined 12 weeks after ACLT. The incidence of severe tears increased to 86% and 84% after 24 weeks and 32 weeks, respectively. Damage to the lateral meniscus was mild, with only 7.5% of all dogs with a cruciate-deficient knee having a bucket handle or complete tear. Most of the unstable knees exhibited ulceration of the articular cartilage of the femoral condyles and tibial plateaus 12 weeks (mean chondropathy score+/-standard deviation 11.9+/-8.5, N=10), 24 weeks (7.9+/-5.0, N=7), and 32 weeks (7.1+/-5.5, N=23) after ACLT. The mean chondropathy scores for the tibial plateaus were similar to those for the femoral condyles. No correlation was apparent between the severity of cartilage damage and of meniscus damage for either joint surface. Damage to the medial meniscus is a consistent feature of the pathology which develops in the canine knee after ACLT, but the severity of cartilage damage is not correlated with the severity of meniscal damage. Copyright 2002 OsteoArthritis Research Society International.

  19. MR imaging of anterior cruciate ligament tears: is there a gender gap?

    Energy Technology Data Exchange (ETDEWEB)

    Fayad, Laura M. [Morgan Department of Radiology and Radiological Science, John Hopkins Medical Institutions, Baltimore, MD (United States); Parellada, J.Antoni; Parker, Laurence; Schweitzer, Mark E. [Department of Radiology, Thomas Jefferson University Hospital, Gibbon Building Suite 3390, 111 South 11th St., 19107-5098, Philadelphia, PA (United States)

    2003-11-01

    Clinically, females receive anterior cruciate ligament (ACL) tears more commonly than males. We explored whether gender differences exist in MR imaging patterns of ACL tears. At 1.5T, two observers evaluated MR examinations of 84 consecutive age-matched patients (42 males, 42 females, aged 16-39) with ACL tears, for mechanism of injury, extent and type of tear, the presence of secondary signs and associated osseous, meniscal and ligamentous injuries. The most common mechanism of injury for both females and males was the pivot shift mechanism (67 and 60%, respectively). Females were more commonly imaged in the acute stage of tear than males (98 and 67%, respectively, p=0.001) and more commonly possessed the typical posterolateral tibial bone contusion pattern (88 and 62%, respectively, p=0.0131). Males exhibited a deeper femoral notch sign (2.7 and 2.0 mm, p=0.007) and medial meniscal, lateral collateral ligament and posterior cruciate ligament injuries more commonly than females (48 and 24%, p=0.009, 30 and 7%, p=0.035, 17 and 0%, p=0.035). There was no significant difference between genders for the presence of other secondary signs and contusion patterns, associated lateral meniscal tears, presence of O'Donoghue's triad or associated medial collateral ligament injuries. Gender differences in MR imaging patterns of ACL tears exist: females are more commonly imaged in the acute stage and more commonly possess posterolateral tibial bone contusions; males have a more severe presentation than females, associated with more severe lateral femoral condyle and soft tissue injuries. (orig.)

  20. Anatomical study of the human anterior cruciate ligament stump's tibial insertion footprint.

    Science.gov (United States)

    Tállay, András; Lim, Mui-Hong; Bartlett, John

    2008-08-01

    The aim of this study is to define the topographical relationship of the anatomical bundles of the human anterior cruciate ligament's (ACL) stump over the tibial insertion site. Between January and April 2007, a total of 36 resected tibial plateaus were retrieved from patients who underwent total knee replacements. These samples had intact cruciate ligaments with no major osteophyte around the ACL tibial insertion footprint. The anatomical bundles of the ACL were identified and mapped, based on the topographical relationship over the tibial insertion footprint. Measurements of the dimensions of the ACL tibial footprint and tibial plateau were performed. The mean width and midsagittal depth of the tibia plateau was 78.7 +/- 6.5 and 46.4 +/- 5.0 mm, respectively. The mean width and midsagittal depth of the ACL tibial footprint was 10.3 +/- 1.9 and 19.5 +/- 2.6 mm, respectively. Out of the 36 freshly dissected ACL stumps, it was not possible to distinguish separate bundles in 14 (38.9%) cases. The average distance between the centers of the two bundles was 9.3 +/- 1.8 mm. The mean AP alignment of the tibial footprint was 89.6 degrees +/- 26.4 degrees , with a very wide range of 23 degrees -158 degrees . Of the 22 specimens with separate anatomical bundles, the alignment of the tibial footprint was AM-PL in six (27.3%), sagittal (85 degrees -95 degrees ) in five (22.7), AL-PM in nine (40.9%), and lateral-medial (L-M) in two (9.1%) cases. This study provides new information about the topographical anatomy of the ACL tibial insertion footprint. Based on gross anatomy, separate anatomical bundles of the ACL can be distinguished in 61.1% [22] of the specimens. The topographical alignment of the separate bundles is varied on a very wide range.

  1. Tears of anterior cruciate ligament and associated injury in the knee joint: MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eui Jong; Ryu, Kyung Nam; Ahn, Jin Whan; Yoon, Yup [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1994-03-15

    The objective of the study was to evaluate the characteristic findings in tears of the anterior cruciate ligament(ACL) and associated injury at MR imaging. We reviewed the findings of MR images and the corresponding arthroscopic results of 32 patients with ACL tears. We evaluated the signal intensity and contour of ACL surrounding bony structures, menisci and associated injury of the knee joint. Complete ACL tears were present in 25 patients and partial ACL tears were in 7 patients. Complete ACL tears showed heterogenously increased signal intensity with contour bulging of the ACL in 14 patients (56%) and without bulging or absence in 11 patients(44%). Most patients torn ACL with contour bulging(12/14) had bone bruise, but only one patient torn ACL without bulging contour had bone bruise. ACL with thin continuous low signal band surrounding heterogenously increased signal intensity suggests partial tear which was seen in three patients of seven proved partial ACL tears. Combined bone injury in ACL tear were in 23 patients (73%) and most of these(22/23) were at midportion of lateral notch of femur and/or posterior portion of lateral tibial plateu. Deepening of lateral notch of femur were noted in 17 patients(53%). Associated injuries of the other ligaments of knee joint were buckling of the posterior cruciate ligament(16/32, 50%) and tears of the medial collateral ligament(11/32, 34%). Posterior horns of menisci were more frequent site of combined injury within menisci in patients with ACL tear. Acute tearing of ACL in MRI is seen as heterogenously increased signal intensity with contour bulging of ACL and combined bone bruises. Patients with torn ACL frequently have various combined injury. In patient with knee injury, these associated or ancillary findings suggest that ACL tear is present.

  2. [Plastic surgery of the anterior cruciate ligament: experimental study of intra-articular aramid fibers in dogs].

    Science.gov (United States)

    Passuti, N; Daculsi, G; Gouin, F; Martin, S; Vigneron, M

    1989-01-01

    The authors explored the possibility of replacing an anterior cruciate ligament with an aramid fiber (Kevlar) implant. This study was performed in intra-articular site in 9 dogs and the average implantation period was 5 months. Studies were carried out by macroscopic, photon microscopy, and electron microscopy examination of the samples obtained at the time the animals were sacrificed. Clinical and radiographic studies of the knees were performed in order to assess functional consequences. Overall, the results showed a partial or complete rupture of 10 neoligaments out of the 17 studied ligaments; on the other hand, osseous anchorage and reintegration in the intra-articular zone appeared satisfactory. Kevlar fiber only partially meets the performance specifications for an artificial ligament intended to serve as an anterior cruciate ligament substitute. Some positive results have encouraged the authors to carry on further this experimental study.

  3. Use of platelet-rich plasma for bioplastic processes stimulation after arthroscopic reconstruction of anterior cruciate ligament (review

    Directory of Open Access Journals (Sweden)

    A. V. Rybin

    2015-01-01

    Full Text Available Based on the analysis of the scientific publications, the authors analyzed the possibilities and effectiveness of platelet- rich plasma (PRP application as a stimulator of engraftment and biological transformation of tendinous autografts and allografts after arthroscopic reconstruction of knee anterior cruciate ligament. The topic of impossibility of spontaneous recovery of torn anterior cruciate ligament of knee, and describe the staging of biological incorporation of tendinous transplant in a bone wall was discussed. The authors presented methods and techniques of accelerating engraftment of free tendinous graft into bone channels described in the literature and the difference of terms of remodeling the autografts and allografts. The effect of different techniques of sterilization and preservation of tendinous allografts on the change of their biological properties was disclosed.

  4. Isometric exercises with elements postisometric relaxation to eliminate the knee joint contracture after arthroscopic plastics of anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Pylypenko O.V.

    2014-02-01

    Full Text Available Purpose : to determine the efficiency of isometric exercises and post isometric relaxation of character for removal and prevention of contractures and recovery of motor function after arthroscopic reconstruction of the anterior cruciate ligament in the late postoperative period. Material: The study involved 22 patients aged less than 40 years. Results: The results showed that the level of pain decreased equally in patients of main and control group from 3 to 0 points, the performance difference in the amplitude of the bending of the knee joint during the goniometry in the treatment group was 70 in the control group – 30 and the extension 10 – fixed, reaching 5 hyperextension and not changed in the control group. Conclusions: The use of isometric exercises and post isometric relaxation prevent postoperative contracture of the knee joint. Methods of their application are recommended for use in the comprehensive rehabilitation of patients after arthroscopic plastics anterior cruciate ligament.

  5. Proximal Tibia Fracture After Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft: A Case Report

    OpenAIRE

    Voos, James E.; Drakos, Mark C.; Lorich, Dean G.; Fealy, Stephen

    2007-01-01

    The optimal operative management of anterior cruciate ligament (ACL) injury continues to be debated. Many complications can occur, but fracture is often not routinely discussed. We present a complex intra-articular tibia fracture in a patient who had an autologous, ipsilateral bone-patellar-bone ACL reconstruction. While still advocating early, aggressive physical therapy, this case reminds us of the inherent susceptibility to injury in the immediate post-operative period.

  6. Clinical study on the arthroscopic refreshing treatment of anterior cruciate ligament injury combined with stable medial meniscus ramp injury

    OpenAIRE

    Yang, J.; Guan, K; Wang, J. Z.

    2017-01-01

    This study sought to investigate the clinical efficacy of arthroscopic refreshing treatment of anterior cruciate ligament (ACL) injury combined with stable medial meniscus ramp injury. Sixty-eight patients treated between January 2010 and January 2014 were included, and their clinical data were retrospectively analyzed. All patients, after being treated using ACL reconstruction, were divided into 2 groups according to meniscus injury treatment method. The observation group (31 cases) was trea...

  7. Is Pre-Injury Leg Length Discrepancy A Risk Factor for Anterior Cruciate Ligament Injury in the Skeletally Immature Athlete?

    OpenAIRE

    Lazaro, Lionel E; van der List, Jelle P.; Cordasco, Frank A.; Green, Daniel W.

    2017-01-01

    Objectives: Recognition of modifiable and non-modifiable risk factors for anterior cruciate ligament (ACL) injuries in children and adolescent athletes is paramount to develop effective strategies for prevention and treatment. We hypothesize that the intrinsic risk factors leg length discrepancy (LLD) and lateral mechanical axis deviation (MAD) are not uncommon in skeletally immature athletes that suffered an acute ACL injury. Methods: We prospectively obtained full-length hip-to-ankle radiog...

  8. Primary Anterolateral Ligament Rupture in Patients Requiring Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Magnetic Resonance Imaging Review

    OpenAIRE

    Carr, James Bradley; Yildirim, Baris; Richter, Dustin L.; Etier, Brian Edward; Diduch, David R.; Anderson, Mark W.; Pierce, Jennifer

    2017-01-01

    Objectives: After anterior cruciate ligament reconstruction (ACLR), only 60% of patients are able to return to their pre-injury level of sports with nearly 15% experiencing persistent rotatory instability. Young patients returning to pivoting sports experience high rates of graft tear and subsequent need for revision ACLR. Recently, the anterolateral ligament (ALL) has gained attention as an important rotatory stabilizer about the knee in prevention of the pivot shift phenomenon. It is theori...

  9. Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature

    OpenAIRE

    Sohrab Keyhani; Arash Sharafat Vaziri; Hossein Shafiei; Mohsen Mardani-Kivi

    2015-01-01

     Background: A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture.    Case presentation: A 35-year old male soccer player with a history of ACL tear from the previous year ago, who underwent arthroscopic ACL reconstruction and functioned well until another similar injury caused ACL re-rupture. Revision of ACL reconstruction was performed and after failure of graft tension during the pumping, a fluoroscopic assessm...

  10. Effects of Closed Kinetic Chain Exercises on Proprioception and Functional Scores of the Knee after Anterior Cruciate Ligament Reconstruction

    OpenAIRE

    Cho, Sung-Hyoun; Bae, Chang-Hwan; Gak, Hwang-Bo

    2013-01-01

    [Purpose] The purpose of this study was to examine the effect of closed kinetic chain exercises performed by an unstable exercise group (UEG) and a stable exercise group (SEG) on the knee joint, proprioception, and functional scores of patients who underwent anterior cruciate ligament (ACL) reconstruction. [Subjects] Twenty-eight patients participated in this study. The exclusion criteria were fracture or neurological disease. [Methods] The subjects were randomly assigned to one of two groups...

  11. Complications associated with the techniques for anterior cruciate ligament reconstruction in patients under 18 years old: a systematic review.

    Science.gov (United States)

    Tovar-Cuellar, W; Galván-Villamarín, F; Ortiz-Morales, J

    Determine the complications related to the different techniques for anterior cruciate ligament reconstruction in patients under 18 years old. Systematic review using the databases Medline, Cochrane Database of Systematic Reviews and Embase (until July 2016), additional studies were included conducting a search of the references of previous studies. The terms included in the search were: «cruciate», «ligament», «anterior», «immature», «complications», «outcome», «acl reconstruction»,« cruciate ligament anterior reconstruction», «children», «child», «infants», «adolescent», «open physis», «growth plate» and «skeletally immature». A number of 73 studies were included; 1300 patients in total, average age 13 years, 70% were male, medial and lateral meniscal lesions in 26% and 30% respectively. Eleven cases of length discrepancy (0,8%): 4 cases were presented with physeal-sparing techniques (1,4%), 3 cases with partial physeal-sparing techniques (2.2%) and 4 cases were presented with transphyseal techniques (0.4%). There were 22 cases of axis deviation: 6 cases with physeal-sparing techniques (2%), 3 cases with partial physeal-sparing techniques and 13 cases with transphyseal techniques (1.4%). The use of allograft achilles tendon allograft and fascia lata was associated with increased length discrepancy and axis deviation (25%). There was no difference according to Tanner. The different anterior cruciate ligament reconstruction techniques in patients under 18 years old had low complications related to lower limb growth, arthrofibrosis and review. There was a higher percentage of cases of length discrepancy and axis deviation with physeal-sparing techniques than with the other surgical techniques. The evidence level studies cannot determine causality. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. MRI appearance of the distal insertion of the anterior cruciate ligament of the knee: an additional criterion for ligament ruptures

    Energy Technology Data Exchange (ETDEWEB)

    Oldrini, G.; Teixeira, P.G.; Chanson, A.; Osemont, B.; Louis, M.; Blum, A. [CHU Nancy, Service d' imagerie Guilloz, Nancy (France); Erpelding, M.L. [CHU Nancy, Hopitaux de Brabois Allee du Morvan, Service Epidemiologie et Evaluation Cliniques, Vandoeuvre-les-Nancy (France)

    2012-09-15

    Anterior cruciate ligament tears are frequent and if not diagnosed may lead to relevant patient disability. Magnetic resonance imaging is the method of choice for the non-invasive diagnosis of these tears. Despite the high performance of this method some cases are challenging and the criteria described in the literature are not sufficient to reach a diagnosis. We propose a systematic method for the evaluation of anterior cruciate ligament tears based on the aspect of its distal portion. Magnetic resonance studies of 132 knees were evaluated in correlation with arthroscopy. The performance of the proposed method was compared with that of classic imaging signs of anterior cruciate ligament tear. The impact of image quality and reader expertise on the proposed method and the classic signs of tear were taken into account. This method had a sensitivity and specificity of 91.1% and 82.9% for the detection of abnormal ACLs. The interobserver agreement (kappa) of the proposed method was significantly higher than that of the classic signs at all levels of expertise (0.89 vs 0.76). This method was not influenced by image quality. Distal ACL analysis identified more partial tears and synovialization (granulation scar tissue) than the conventional method (71% vs 58.5% for partial tears and 83.5% vs 58.5% for synovialization). The proposed classification has a high performance and reproducibility for the identification of abnormal anterior cruciate ligament. The results were influenced neither by the level of expertise of the readers nor by the image quality. (orig.)

  13. Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis?

    Energy Technology Data Exchange (ETDEWEB)

    Dyck, Pieter van; Gielen, Jan L.; Parizel, Paul M. [University Hospital Antwerp and University of Antwerp, Department of Radiology, Edegem (Belgium); Vanhoenacker, Filip M. [University Hospital Antwerp and University of Antwerp, Department of Radiology, Edegem (Belgium); AZ St-Maarten Duffel/Mechelen, Department of Radiology, Duffel (Belgium); Wouters, Kristien [University Hospital Antwerp and University of Antwerp, Department of Scientific Coordination and Biostatistics, Edegem (Belgium); Dossche, Lieven [University Hospital Antwerp and University of Antwerp, Department of Orthopedics, Edegem (Belgium)

    2012-03-15

    To determine the usefulness of magnetic resonance (MR) imaging to distinguish stable from unstable tears of the anterior cruciate ligament (ACL) of the knee. MR images of 97 patients with surgically confirmed ACL tear were retrospectively reviewed. According to arthroscopic and clinical examination, these patients had 36 stable and 61 unstable (9 partial and 52 complete) ACL tears. MR images were interpreted by two blinded reviewers and scored with respect to previously reported primary and secondary MR signs of ACL injury. Based on a comprehensive assessment of all the MR findings, ACLs were categorized as being stable or unstable. MR accuracy was calculated considering only primary MR signs and considering both primary and secondary MR signs of ACL injury, separately. Accuracy of each individual primary and secondary MR sign was calculated. Considering only primary MR signs, sensitivity, specificity, and accuracy of MR were 77, 92, and 82%, respectively. Considering both primary and secondary MR signs, sensitivity, specificity, and accuracy of MR were 59, 81, and 67%, respectively. Of all MR signs, discontinuity and abnormal orientation had highest test accuracy (79 and 87%, respectively). Anterior tibial translation, uncovering of the posterior horn of the lateral meniscus, and hyperbuckled PCL were only seen in unstable ACLs (specificity 100%), but these secondary findings had low sensitivity (23%). Bone contusion around the lateral knee compartment was seen in both unstable and stable ACLs (accuracy 64%). Previously reported MR imaging signs do not allow accurate distinction between clinically stable and unstable ACL injuries. Anterior tibial translation, uncovering of the posterior horn of the lateral meniscus, and hyperbuckled PCL, if present, are helpful signs in the diagnosis of an unstable tear. The presence of bone marrow edema around the lateral knee compartment is not predictive of ACL insufficiency. (orig.)

  14. Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft: can it restore normal knee joint kinematics?

    Science.gov (United States)

    Gadikota, Hemanth R; Wu, Jia-Lin; Seon, Jong Keun; Sutton, Karen; Gill, Thomas J; Li, Guoan

    2010-04-01

    Anatomical reconstruction techniques that can restore normal joint kinematics without increasing surgical complications could potentially improve clinical outcomes and help manage anterior cruciate ligament injuries more efficiently. Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can more closely restore normal knee anterior-posterior, medial-lateral, and internal-external kinematics than can conventional single-bundle anterior cruciate ligament reconstruction. Controlled laboratory study. Kinematic responses after single-bundle anterior cruciate ligament reconstruction and single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft were compared with the intact knee in 9 fresh-frozen human cadaveric knee specimens using a robotic testing system. Kinematics of each knee were determined under an anterior tibial load (134 N), a simulated quadriceps load (400 N), and combined torques (10 N.m valgus and 5 N.m internal tibial torques) at 0 degrees , 15 degrees , 30 degrees , 60 degrees , and 90 degrees of flexion. Anterior tibial translations were more closely restored to the intact knee level after single-tunnel double-bundle reconstruction with anatomical placement of hamstring tendon graft than with a single-bundle reconstruction under the 3 external loading conditions. Under simulated quadriceps load, the mean internal tibial rotations after both reconstructions were lower than that of the anterior cruciate ligament-intact knee with no significant differences between these 3 knee conditions at 0 degrees and 30 degrees of flexion (P > .05). The increased medial tibial shifts of the anterior cruciate ligament-deficient knees were restored to the intact level by both reconstruction techniques under the 3 external loading conditions. Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of

  15. The anterolateral complex in anterior cruciate ligament deficient knees demonstrate sonographic abnormalities on high-resolution sonography.

    Science.gov (United States)

    Yoshida, Masahito; Herbst, Elmar; Albers, Macio; Musahl, Volker; Fu, Freddie H; Onishi, Kentaro

    2017-04-01

    The presence of anterolateral ligament of the knee is still controversial, and some physicians prefer to call this structure anterolateral complex (ALC) to infer plural nature of structures involved. The purpose of this study was to describe the scanning techniques and to classify various sonographic appearances of the tibial-side ALC of the knee in subjects with anterior cruciate ligament (ACL) injury. It was hypothesized that sonographic abnormity of the ALC would be associated with ACL injury history. Patients with a history of unilateral ACL injury were prospectively recruited, and the ALC was sonographically evaluated. During the evaluation, the lateral femoral epicondyle was visualized in anatomic transverse view first. At this location, the ALC was typically most conspicuous between the short head of the biceps femoris muscle and the posterior and deep aspect of the iliotibial band superficial to the origin of the lateral collateral ligament. The ALC was followed distally to the broad insertion centralizing to the area posterior to Gerdy's tubercle. The appearance of the distal insertion of the ALC was classified based both on echogenicity and on the presence of a Segond fracture as follows: Grade 0: isoechoic to the rest of the ALC, Grade 1: hypoechoic, Grade 2: anechoic, and Grade 3: Segond fracture. The uninjured side was similarly scanned for comparison. A total of 28 patients (13 men; mean age 22.1 ± 8.1 years old with range: 12-44; mean body mass index 25.0 with range: 18.9-39.2) were included in this study. The average time from injury to sonograhpic evaluation was 4 months (range: 2 days to 1 year). Of 28 ACL-deficient knees, 19 were (68%) graded as Grade 0 in the distal insertion of the ALC, 7 (25%) as Grade 1, 1 (3.5%) as Grade 2, and 1 (3.5%) as Grade 3. Contralateral knees showed 25 knees (89%) with Grade 0 and 3 knees (11%) with Grade 1. ACL injury history was associated with a higher incidence of sonographic abnormalities within the

  16. Registration accuracy enhancement of a surgical navigation system for anterior cruciate ligament reconstruction: A phantom and cadaveric study.

    Science.gov (United States)

    Kim, Youngjun; Lee, Byung Hoon; Mekuria, Kinde; Cho, Hyunchul; Park, Sehyung; Wang, Joon Ho; Lee, Deukhee

    2017-03-01

    Recently, surgical navigation systems have been widely used to improve the results of various orthopaedic surgeries. However, surgical navigation has not been successful in anterior cruciate ligament reconstruction, owing to its inaccuracy and inconvenience. This study investigated the registration of preoperative and intraoperative data, which are the key components in improving accuracy of the navigation system. An accurate registration method was proposed using new optical tracking markers and landmark retake. A surgical planning and navigation system for anterior cruciate ligament reconstruction was developed and implemented. The accuracy of the proposed system has been evaluated using phantoms and eight cadaveric knees. The present study investigated only the registration accuracy excluding the errors of optical tracking hardware and surgeon. The target registration errors of femoral tunnelling for anterior cruciate ligament reconstruction in phantoms were found to be 0.24±0.03mm and 0.19±0.10° for the tunnel entry position and tunnel direction, respectively. The target registration errors measured using cadavers were 0.9mm and 1.94°, respectively. The preclinical experimental results showed that the proposed methods enhanced the registration accuracy of the developed system. As the system becomes more accurate, surgeons could more precisely position and orient the femoral and tibial tunnels to their original anatomical locations. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Using an accelerometer and the step-up-and-over test to evaluate the knee function of patients with anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Bailey, Christopher A; Bardana, Davide D; Costigan, Patrick A

    2016-11-01

    Evaluating the dynamic knee function of patients after anterior cruciate ligament reconstruction is a challenge. A variety of objective tests have been developed but for various reasons few are regularly used in the clinic. It may be practical to perform the step-up-and-over test with an accelerometer. A control group (N=26) and an experimental group with a reconstructed anterior cruciate ligament (N=25) completed questionnaires quantifying subjective knee function and fear of re-injury and then completed the step-up-and-over test. Results showed that the experimental group performed differently than the control group for the step-up-and-over test's Lift Symmetry and Impact Symmetry (Panterior cruciate ligament reconstruction than for those with intact anterior cruciate ligaments, and that performance is related to one's opinion of their knee's function. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Age-Related Risk Factors for Revision Anterior Cruciate Ligament Reconstruction: A Cohort Study of 21,304 Patients From the Kaiser Permanente Anterior Cruciate Ligament Registry.

    Science.gov (United States)

    Maletis, Gregory B; Chen, Jason; Inacio, Maria C S; Funahashi, Tadashi T

    2016-02-01

    It is not clear whether risk factors for revision anterior cruciate ligament reconstruction (ACLR) are the same throughout patients' lives. To assess (1) the risk of revision ACLR by age and (2) age-specific risk factors for revision ACLR. Cohort study; Level of evidence, 2. A cohort study using patients having undergone primary ACLR who were registered in the Kaiser Permanente ACLR Registry (February 2005 to June 2013) was conducted. Aseptic revision was the main endpoint. Age was evaluated as a risk factor for revision. The cohort was stratified into 4 age groups: 40 years. Graft type, sex, body mass index (BMI), and race were assessed as revision risk factors within each group. Survival analyses were conducted. Of the 21,304 patients evaluated, 7026 (33%) patients were aged 40 years. Allografts were used in 8671 (41%) patients, hamstring autografts in 6823 (32%), and bone-patellar tendon-bone (BPTB) autografts in 5260 (25%). The 5-year revision probability was highest in patients 40 years old (1.9%; 95% CI, 1.3%-2.7%). Compared with patients aged >40 years, the adjusted revision risk for patients aged 35 kg/m(2) (HR, 0.49; 95% CI, 0.34-0.70) compared with those with a BMI <30 kg/m(2), and black patients (HR, 0.55, 95% CI, 0.36-0.85) compared with white patients. Sex, BMI, and race were not associated with the risk of revision in older patients. In patients ≤40 years old, those with allografts had a higher risk of revision than those with BPTB autografts (HR, 2.69, 2.35, and 3.04 for patients aged <21, 21-30, and 31-40 years, respectively). Patients <21 years old with hamstring autografts had a 1.61 times (95% CI, 1.20-2.17) higher risk of revision than did patients with BPTB autografts; these differences were not identified in older patients. Age at the time of ACLR surgery is a strong risk factor for revision ACLR. Other risk factors for revision ACLR, such as graft type, sex, race, and BMI, may vary in strength and significance over a patient's life

  19. Ligamento Cruzado Anterior Mucoide. [Mucoid degeneration of the anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Juan Pablo Bonifacio

    2013-05-01

    Full Text Available Objetivo  Realizar una actualización del LCA mucoide y describir nuestra experiencia en el diagnóstico y tratamiento quirúrgico. Material y Métodos Se describen los aspectos clínicos, fisiopatológicos, los hallazgos de imágenes y el tratamiento quirúrgico de esta patología de acuerdo a las series publicadas.Además se incluye un estudio retrospectivo realizado entre el año 2004-2011, que incluyo 27 pacientes con un promedio de edad de 55 años (rango 34-68 años. Clínicamente fueron evaluados con la escala de dolor, rango de movilidad y estabilidad con maniobras clínicas y el artrómetro  KT-1000. Se realizaron radiografías y Resonancia magnética pre y postoperatorias. Los resultados funcionales postoperatorios fueron evaluados con la escalas de Lysholm, IKDC, y la evaluación subjetiva del dolor. Se tomaron muestras para biopsia. Resultados La escala de evaluación analógica del dolor mejoro en un promedio de 6 puntos. El rango de movilidad mejoro en un promedio de  26 °.  La estabilidad de la rodilla no fue comprometida. Las escalas de evaluación funcional  obtuvieron un IKDC de A en el 50% de los pacientes, de B en el 33 % y 17 %  de C. El Lysholm fue de 95 puntos. La escala de evaluación subjetiva fue muy buena a excelente en la mayoría. No hubo complicaciones postoperatorias. Conclusión El estudio de imágenes  para su diagnóstico preoperatorio es la Resonancia Magnética; los hallazgos son característicos, no deben ser confundidos con desgarros del LCA. El diagnóstico definitivo es histológico. El tratamiento artroscópico creemos que es efectivo, reproducible y con una baja tasa de complicaciones. Conclusiones La resonancia magnética es el estudio por imágenes para el diagnóstico preoperatorio; los hallazgos son característicos y no deben confundirse con desgarros del ligamento cruzado anterior. El diagnóstico definitivo es histológico. Creemos que el tratamiento artroscópico es eficaz

  20. Anterior cruciate ligament repair with LARS (ligament advanced reinforcement system: a systematic review

    Directory of Open Access Journals (Sweden)

    Machotka Zuzana

    2010-12-01

    Full Text Available Abstract Background Injury to the anterior cruciate ligament (ACL of the knee is common. Following complete rupture of the ACL, insufficient re-vascularization of the ligament prevents it from healing completely, creating a need for reconstruction. A variety of grafts are available for use in ACL reconstruction surgery, including synthetic grafts. Over the last two decades new types of synthetic ligaments have been developed. One of these synthetic ligaments, the Ligament Advanced Reinforcement System (LARS, has recently gained popularity. The aim of this systematic review was to assess the current best available evidence for the effectiveness of the LARS as a surgical option for symptomatic, anterior cruciate ligament rupture in terms of graft stability, rehabilitation time and return to pre-injury function. Method This systematic review included studies using subjects with symptomatic, ACL ruptures undergoing LARS reconstruction. A range of electronic databases were searched in May 2010. The methodological quality of studies was appraised with a modified version of the Law critical appraisal tool. Data relating to study characteristics, surgical times, complication rates, outcomes related to knee stability, quality of life, function, and return to sport as well as details of rehabilitation programs and timeframes were collected. Results This review identified four studies of various designs, of a moderate methodological quality. Only one case of knee synovitis was reported. Patient satisfaction with LARS was high. Graft stability outcomes were found to be inconsistent both at post operative and at follow up periods. The time frames of rehabilitation periods were poorly reported and at times omitted. Return to pre-injury function and activity was often discussed but not reported in results. Conclusions There is an emerging body of evidence for LARS with comparable complication rates to traditional surgical techniques, and high patient

  1. Serial assessments to determine normalization of gait following anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Minning, S J; Myer, G D; Mangine, R E; Eifert-Mangine, M; Colosimo, A J

    2009-08-01

    There is an increased emphasis to identify clinically applicable methods that quantify gait deficits following anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to perform serial gait assessments in a clinical setting to determine whether and when clinical gait parameters normalize in patients following ACLR. The hypothesis was that a clinically available gait treadmill would quantify gait deficits measured at 4 weeks post-reconstruction. The secondary hypothesis was that patients would demonstrate incremental improvements in these gait parameters measured at each interval up to 12 weeks post-reconstruction, and that the objectively measured improvements would correlate to the patient's subjective rating of function. Fifteen subjects, five male and 10 female, who had initial unilateral anterior cruciate ligament injury were selected for this study on the basis of operative data. All subjects were evaluated in a physical therapy clinic within 3 days following ACLR and were enrolled in a standardized rehabilitation program. The dependent gait variables of step length, stance time and gait velocity were measured at 4, 6, 8 and 12 weeks post-ACLR on a commercially available gait treadmill. A 2 x 4 multivariate analysis of variance (2 within factors) with measures for limb involvement (uninvolved and involved) and repeated measures for time (4, 6, 8 and 12 weeks) was used to assess the interactions and the main effects on the gait variables of stance time and step length. The results of this study supported the hypothesis that gait deficits and serial improvements can be objectively quantified in a clinical setting (P<0.001). Specifically, stance time, step length and gait velocity deficits evaluated at 4 weeks showed significant improvements at the measured intervals. Step length normalized at week 8. Stance time and gait velocity reached normal levels at the 12-week time interval. Subjective activity of daily living scores (ADLS) also

  2. Low Prevalence of Anterior and Posterior Cruciate Ligament Injuries in Patients With Achondroplasia.

    Science.gov (United States)

    Brooks, Jaysson T; Ramji, Alim F; Lyapustina, Tatyana A; Yost, Mary T; Ain, Michael C

    2017-01-01

    Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries and their subsequent reconstructions are common in the general population, but there has been no research regarding ACL or PCL injuries in patients with achondroplasia, the most common skeletal dysplasia. Our goals were to (1) evaluate the prevalence of ACL and PCL injuries in adolescents and adults with achondroplasia, (2) compare this prevalence with that reported for the general population, (3) determine how many patients with ACL or PCL injuries underwent ligament reconstruction as treatment, and (4) determine patient activity levels as they relate to the rate of ACL/PCL injuries and reconstructions. We reviewed medical records of 430 patients with achondroplasia seen in the senior author's clinic from 2002 through 2014. Demographic data were reviewed, as well as any documentation of ACL or PCL injury or reconstruction. We called all 430 patients by telephone, and 148 agreed to participate in our survey, whereas 1 declined. We asked these patients about their history of ACL or PCL injury or reconstruction, as well as current and past physical activity levels. No ACL or PCL injuries were found on chart review. One patient reached by telephone reported an ACL injury that did not require reconstruction. This yielded a theoretical prevalence of 3/430 (0.7%). Of the 148 patients surveyed, 43 (29%) reported low physical activity, 75 (51%) reported moderate physical activity, and 26 (17%) reported high physical activity. There was no significant difference in the rate of ACL injury when stratified by physical activity level (P=0.102). ACL and PCL injuries and reconstructions are extremely rare in patients with achondroplasia, which cannot be completely ascribed to a low level of physical activity. One possible explanation is that patients with achondroplasia, on an average, have a more anterior tibial slope compared with those without achondroplasia, which decreases the force generated

  3. Evaluation of the walking pattern in two types of patients with anterior cruciate ligament deficiency: copers and non-copers

    DEFF Research Database (Denmark)

    Alkjaer, T; Simonsen, Erik B; Jørgensen, Uffe

    2003-01-01

    The purpose of the present study was to investigate whether different walking patterns in healthy subjects and in coper and non-coper subjects with deficient anterior cruciate ligaments could be quantified. An inverse dynamics approach was used to calculate joint kinematics and kinetics for flexion....... It is suggested that the copers stabilized their knee joint by co-contraction of the hamstrings and quadriceps muscles, while the non-copers lacked this ability. Instead, the non-copers reduced the knee extensor moment in order to decrease anterior displacement of the tibia. The walking pattern differences...

  4. Magnetic resonance imaging of cyclops lesion as a cause of persistent morbidity after anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Amit Kharat

    2015-01-01

    Full Text Available Localized anterior arthrofibrosis (cyclops lesion is having around 1-9.8% frequency rate after anterior cruciate ligament (ACL reconstruction. It has been reported to be a significant cause of loss of knee extension after reconstruction of the ACL of the knee. We present a case report of a patient with prior ACL reconstruction who presented with pain and loss of extension following surgery. MR imaging revealed the typical features of cyclops lesion. Repeat arthroscopy excision of the lesion is the only treatment to reduce the morbidity of the patient.

  5. Are Muscle Strength and Function of the Uninjured Lower Limb Weakened After Anterior Cruciate Ligament Injury? Two-Year Follow-up After Reconstruction.

    Science.gov (United States)

    Chung, Kyu Sung; Ha, Jeong Ku; Yeom, Cheol Hyun; Ra, Ho Jong; Lim, Jin Woo; Kwon, Min Soo; Kim, Jin Goo

    2015-12-01

    After an anterior cruciate ligament (ACL) injury, the uninjured contralateral lower limb may become weakened because of neuromuscular changes, proprioceptive deficits, and disuse of the limb; this weakness predisposes the limb to ACL injury. However, no results have been reported regarding weakness in the contralateral limb after ACL injury. Muscle strength and functional status of the contralateral lower limb are reduced after unilateral ACL injury. Cohort study; Level of evidence, 3. The ACL group consisted of 75 patients who underwent primary unilateral ACL reconstruction and were followed at 3, 6, 12, and 24 months postoperatively. A group of 75 healthy individuals (controls) were matched one-to-one with the ACL group for age, sex, body mass index, and initial Tegner activity level. The side that was evaluated in each control subject corresponded to the injured limb in the matched ACL subject. Isokinetic muscle strength, including extension peak torque per body weight (EPT) and flexion peak torque per body weight (FPT), was evaluated at angular velocities of 60 and 180 deg/s. Patients were also evaluated by single-legged hop test. Compared with the EPT at 60 deg/s in the control group (290.9 ± 40.1 N · m/kg), the value in the ACL group 24-month follow-up (276.6 ± 42.8 N · m/kg) as well as other follow-up times was significantly lower (P follow-up but were restored to normal levels at final follow-up. Results from the single-legged hop test demonstrated that the ACL group performed at a significantly lower level than the control group at 24-month follow-up (158.4 ± 25.3 vs 176.3 ± 24.7 cm; P follow-up times. However, both measurements improved significantly as the follow-up time progressed. After ACL injury, isokinetic extensor muscle strength and functional status of the contralateral limb were reduced, even at 24 months after ACL reconstruction. However, both measurements improved significantly as the follow-up time progressed. In contrast, flexion

  6. What I have learned about the ACL: utilizing a progressive rehabilitation scheme to achieve total knee symmetry after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Shelbourne, K Donald; Klotz, Christine

    2006-05-01

    Anterior cruciate ligament surgery and rehabilitation have changed drastically during the past 30 years. The patellar tendon autograft fixed with buttons provides tight bone-to-bone placement of the graft and quick bony healing, which allows accelerated rehabilitation to obtain full range of motion and strength. Although surgical stability is easily reproducible, long-term patient satisfaction is difficult to guarantee. Full knee range of motion should be compared to that of the contralateral normal knee, including full hyperextension. We followed the progress of all patients to gauge the utility of our rehabilitation program. In order of importance, the lack of normal knee range of motion (within 2 degrees extension and 5 degrees of flexion compared with that of the normal knee), partial or total medial meniscectomy, partial or total lateral meniscectomy, and articular cartilage damage were related to lower subjective scores. Rehabilitation after ACL reconstruction must first strive to achieve full symmetrical knee range of motion before aggressive strengthening can begin. Our current perioperative rehabilitation starts at the time of injury and preoperatively includes aggressive swelling reduction, hyperextension exercises, gait training, and mental preparation. Goals after surgery are to control swelling while regaining full knee range of motion. After quadriceps strengthening goals are reached, patients can shift to sport-specific exercises. When using a graft from the contralateral knee, the conflicting goals of strengthening the donor site and achieving full knee range of motion are divided between the knees. Thus, normal range of motion and strength can be achieved more easily and more quickly than when using an ipsilateral graft. Regardless of the graft source, a systematic rehabilitation program that emphasizes the return to symmetrical knee motion, including hyperextension, is necessary to achieve the optimum result.

  7. Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial.

    Science.gov (United States)

    Barenius, Björn; Ponzer, Sari; Shalabi, Adel; Bujak, Robert; Norlén, Louise; Eriksson, Karl

    2014-05-01

    The reported prevalence of radiological osteoarthritis (OA) after anterior cruciate ligament (ACL) reconstruction varies from 10% to 90%. Purpose/ To report the prevalence of OA after ACL reconstruction and to compare the OA prevalence between quadrupled semitendinosus tendon (ST) and bone-patellar tendon-bone (BPTB) grafts. The hypothesis was that there would be no difference in OA prevalence between the graft types. The secondary aim was to study whether patient characteristics and additional injuries were associated with long-term outcomes. Randomized controlled trial; Level of evidence, 1. Radiological examination results, Tegner activity levels, and Knee injury and Osteoarthritis Outcome Score (KOOS) values were determined in 135 (82%) of 164 patients at a mean of 14 years after ACL reconstruction randomized to an ST or a BPTB graft. Osteoarthritis was defined according to a consensus by at least 2 of 3 radiologists of Kellgren-Lawrence grade ≥2. Using regression analysis, graft type, sex, age, overweight, time between injury and reconstruction, additional meniscus injury, and a number of other variables were assessed as risk factors for OA 14 years after ACL reconstruction. Osteoarthritis of the medial compartment was most frequent, with 57% of OA cases in the ACL-reconstructed knee and 18% of OA cases in the contralateral knee (P risk factor for OA of the medial compartment (odds ratio, 3.6; 95% CI, 1.4-9.3) in the multivariable logistic regression analysis. A 3-fold increased prevalence of OA was found after an ACL injury treated with reconstruction compared with the contralateral healthy knee. No differences in the prevalence of OA between the BPTB and quadrupled ST reconstructions were found. An initial meniscus resection was a strong risk factor for OA; the time between injury and reconstruction was not.

  8. Combined reconstruction of the anterior cruciate ligament associated with anterolateral tenodesis effectively controls the acceleration of the tibia during the pivot shift.

    Science.gov (United States)

    Hardy, Alexandre; Casabianca, Laurent; Hardy, Edouard; Grimaud, Olivier; Meyer, Alain

    2017-04-01

    The pivot shift test is quantified subjectively during assessment of patients presenting with suspected Anterior Cruciate Ligament (ACL) tears and has a low interobserver reproducibility. The Kinematic Rapid Assessment (KiRA) is a triaxial accelerometer that makes it possible to non-invasively quantify tibial acceleration during the pivot shift test. Abolishing pivot shift is considered to be a key element in surgical reconstruction but is incomplete in 25-38% of patients. Patients were included prospectively. Inclusion criteria were patients requiring ACL reconstruction associated with at least one of the following factors corresponding to the patient who have a high risk of rupture either by their sports activity, a failure case, or the notion of important rotational laxity: the patient practiced a competitive pivot-contact sport, revision ACL reconstruction (besides STG (semitendinosus-gracilis graft) repair), subjective explosive rotational laxity, Segond fracture, and TELOS value of >10 mm. Standardized pre- and postoperative pivot shift tests were immediately performed under anesthesia in both knees. Forty-three patients were included. Mean preoperative variations in tibial acceleration in the healthy and injured knees were 1.2 ± 0.1 and 2.7 ± 0.3 m/s(2), respectively, p difference between postoperative contralateral healthy knees and operated knees (n.s). Combined ACL reconstruction associated with anterolateral tenodesis suppress acute pathologic tibial acceleration in the pivot shift. III.

  9. Acute Management of Anterior Cruciate Ligament Injuries Using Novel Canine Models.

    Science.gov (United States)

    Bozynski, Chantelle C; Stannard, James P; Smith, Pat; Hanypsiak, Bryan T; Kuroki, Keiichi; Stoker, Aaron; Cook, Cristi; Cook, James L

    2016-10-01

    The objective of this study was to compare treatment options for acute management of anterior cruciate ligament (ACL) injuries using preclinical models. Twenty-seven adult purpose-bred research hounds underwent knee surgery (sham control, exposed ACL, or partial-tear ACL) and were assessed over the following 8 weeks. Dogs were randomized into three treatment groups: standard of care (i.e., rest and nonsteroidal anti-inflammatory drugs [NSAIDs]), washout, or leukoreduced platelet-rich plasma (PRP) so that a total of nine dogs received each treatment. Data from the two ACL-injury groups were pooled for each treatment ( n  = 6 per treatment group) and analyzed for treatment effects. The washout and PRP groups experienced less lameness, pain, and effusion, and greater function and comfortable range of motion compared with the NSAID group, with the PRP group showing most benefits. PRP was associated with the lowest severity of ACL pathology based on arthroscopic assessment. Measurable levels of inflammatory and degradative biomarkers were present in synovial fluid with significant differences noted over time. Based on these findings, washout had positive clinical effects compared with the standard-of-care group especially within the first week of treatment, but became less beneficial over time. A single injection of leukoreduced PRP was associated with favorable clinical results. However, no treatment was significantly "protective" against progression toward osteoarthritis after ACL injury. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  10. Experiences of professional rugby union players returning to competition following anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Carson, Fraser; Polman, Remco

    2012-02-01

    The purpose of this study was to gain a greater understanding of the emotions and coping strategies utilized when returning to competition following anterior cruciate ligament (ACL) reconstruction. A qualitative approach, consisting of five semi-structured interviews and a pre-designed diary, was conducted concurrent with each 'player's return to competition, allowing each to record emotional responses experienced and identify coping strategies employed. Five professional male rugby union players, who had suffered an ACL injury that required surgical reconstruction, participated in the study. Each had spent between six to twelve months in rehabilitation. Content analysis was conducted on both pre- and post- return data, identifying 12 higher order themes. Confidence building; anticipation; anxiety; physical preparation; psychological preparation; and social support were prevalent pre-return to competition. Post-return higher order themes consisted of confidence building; positive performance emotions; performance anxieties; problem focused coping; social support; and dealing with fears. For the players in this study, gaining confidence in the injured knee joint appears to be influential, with increases in confidence provided by completing clinical and sport specific tests, and by performance accomplishments. Successful return can be enhanced further by the use of a specific goal setting program aimed at reintroducing the player to competition. Copyright © 2010 Elsevier Ltd. All rights reserved.

  11. Quadriceps strength and weight acceptance strategies continue to improve two years after anterior cruciate ligament reconstruction

    Science.gov (United States)

    Roewer, Ben D.; Di Stasi, Stephanie L.; Snyder-Mackler, Lynn

    2011-01-01

    The anterior cruciate ligament (ACL) is the most commonly-injured knee ligament during sporting activities. After injury, most individuals experience episodes of the knee giving way during daily activities (non-copers). Non-copers demonstrate asymmetrical quadriceps strength and movement patterns which could have long-term deleterious effects on the integrity of the knee joint. The purpose of this study was to determine if non-copers resolve their strength and movement asymmetries within two years after surgery. 26 non-copers were recruited to undergo pre-operative quadriceps strength testing and 3-dimensional gait analysis. Subjects underwent surgery to reconstruct the ligament followed by physical therapy focused on restoring normal range of motion, quadriceps strength, and function. Subjects returned for quadriceps strength testing and gait analysis six months and two years after surgery. Acutely after injury, quadriceps strength was asymmetric between limbs, but resolved six months after surgery. Asymmetric knee angles, knee moments, and knee and hip power profiles were also observed acutely after injury and persisted six months after surgery despite subjects achieving symmetrical quadriceps strength. Two years after surgery, quadriceps strength in the involved limb continued to improve and most kinematic and kinetic asymmetries resolved. These findings suggest that adequate quadriceps strength does not immediately resolve gait asymmetries in non-copers. They also suggest that non-copers have the capacity to improve their quadriceps strength and gait symmetry long after ACL reconstruction. PMID:21592482

  12. Mechanisms of anterior cruciate ligament injuries in elite women's netball: a systematic video analysis.

    Science.gov (United States)

    Stuelcken, Max C; Mellifont, Daniel B; Gorman, Adam D; Sayers, Mark G L

    2016-08-01

    This study involved a systematic video analysis of 16 anterior cruciate ligament (ACL) injuries sustained by elite-level netball players during televised games in order to describe the game situation, the movement patterns involved, the player's behaviour, and a potential injury mechanism. Eight of the ACL injuries were classified as "indirect contact" and eight as "non-contact". Two common scenarios were identified. In Scenario A the player was jumping to receive or intercept a pass and whilst competing for the ball experienced a perturbation in the air. As a result the player's landing was unbalanced with loading occurring predominantly on the knee of the injured side. In Scenario B the player was generally in a good position at ground contact, but then noticeably altered the alignment of the trunk before the landing was completed. This involved rotating and laterally flexing the trunk without altering the alignment of the feet. Apparent knee valgus collapse on the knee of the injured side was observed in 3/6 Scenario A cases and 5/6 Scenario B cases. Players may benefit from landing training programmes that incorporate tasks that use a ball and include decision-making components or require players to learn to cope with being unbalanced.

  13. The phenomenon of "ligamentization": anterior cruciate ligament reconstruction with autogenous patellar tendon.

    Science.gov (United States)

    Amiel, D; Kleiner, J B; Roux, R D; Harwood, F L; Akeson, W H

    1986-01-01

    Reconstruction of the anterior cruciate ligament (ACL) with patellar tendon (PT) is a common procedure for the symptomatic ACL-deficient knee. Questions regarding graft incorporation, viability, and nutrition of the transplanted tissue are of concern. This relates to the graft's response to its new intrasynovial milieu and new physical forces. These factors were studied in a rabbit model of ACL reconstruction using PT and were evaluated with histological and biochemical parameters with respect to time. A histological and biochemical metamorphosis of the grafted PT occurred in this study. Autografts demonstrated a gradual assumption of the microscopic properties of normal ACL; by 30 weeks postoperatively, cell morphology was ligamentous in appearance. Normally, type III collagen is not observed in PT, however, a gradual increase in its concentration was seen in the grafts; by 30 weeks its concentration (10%) was the same as in normal ACL. Similarly, glycosaminoglycans content increased from its normally low level in PT to that found in native ACL. Collagen-reducible crosslink analysis demonstrated that grafted tissue changed from the normal PT pattern of low dihydroxylysinonorleucine (DHLNL) and high histidinohydroxymerodesmosine (HHMD) to the pattern seen in normal ACL (high DHLNL and low HHMD) by 30 weeks. These data suggest that when PT is placed in the anatomic and environmental milieu of the ACL, a "ligamentization" of the grafted tissue results; also the autograft initially depends on synovial fluid nutrition, as revascularization occurs after 6 weeks.

  14. Short-term effects of radiofrequency shrinkage treatment for anterior cruciate ligament relaxation on proprioception.

    Science.gov (United States)

    Wei, Min; Liu, Yujie; Li, Zhongli; Wang, Zhigang

    2013-10-01

    Radiofrequency (RF) shrinkage is used in anterior cruciate ligament (ACL) reconstruction. The present study investigated the therapeutic effects of RF on ACL relaxation and the probable influencing factors. Patients with ACL relaxation were included. Participants were randomly divided into two groups: a treatment group, in which patients were treated with RF shrinkage (RF group); a control group, in which patients received conventional surgical treatment. Thermal shrinkage was performed on ACL using an ArthroCare® CAPSure® wand. Lysholm scores, proprioceptive testing and Tegner activity scores were evaluated before and after treatment (at 6 and 12 months). A total of 38 patients were included. The mean ± SD Lysholm score of those in the RF group at 12 months' post-treatment was significantly higher than in controls. The angle of deviation of the knee joint in RF group was significantly larger than in the control group at 6 months' post-treatment. RF shrinkage treatment for ACL laxity could improve knee scores, and may affect proprioception and recovery of activity after surgery.

  15. The effect of proprioception exercises on functional status in patients with anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Ordahan, Banu; Küçükşen, Sami; Tuncay, İbrahim; Salli, Ali; Uǧurlu, Hatice

    2015-01-01

    To evaluate knee proprioception in patients with anterior cruciate ligament (ACL) injuries and to assess the effectiveness of an exercise program consisting mainly of proprioception exercises addressing pain, proprioception, and functional status following ACL reconstruction. Twenty male patients, diagnosed with unilateral ACL injury and scheduled for reconstruction, participated in the study along with 16 age- and sex-matched healthy volunteers. Arthroscopic reconstruction of the ACL using autologous hamstring tendon was performed in every case by the same surgeon. After the operation, a six-month rehabilitation program was initiated. Knee proprioception, pain, and functional status were evaluated before and six months after the reconstruction. An isokinetic dynamometer was used to evaluate proprioception and a visual analog scale (VAS) and the Tegner Lysholm Knee Scoring Scale were used to evaluate pain and functional status respectively. Preoperative proprioception loss was detected on the patients' injured side when compared to the uninjured side and to healthy volunteers (p = 0.00). A significant improvement was found in pain severity, proprioception, and functional capacity after the postoperative six-month rehabilitation program (p = 0.00). Preoperative proprioception loss was detected in ACL-injured patients. The rehabilitation program predominantly consisting of proprioception exercises provided considerable improvement on knee proprioception and functional status.

  16. Effects of an anterior cruciate ligament injury prevention program on performance in adolescent female soccer players.

    Science.gov (United States)

    Vescovi, J D; VanHeest, J L

    2010-06-01

    Female soccer players are three times more likely to suffer a non-contact anterior cruciate ligament (ACL) tear compared with male soccer players. Several ACL injury prevention programs have been developed and are used to reduce injury risk. However, to date there is limited information on how such programs affect physical performance. The aim of this randomized controlled study was to investigate the effects of the Prevent Injury Enhance Performance (PEP) program in adolescent female soccer players. Four soccer teams were randomly assigned to an intervention (PEP) or control (CON) group and assessed at baseline, 6 weeks, and 12 weeks on linear sprinting, countermovement jump (CMJ), and two agility tests. A mixed model factorial ANOVA with repeated measures was used to assess for treatment effects on the dependent variables. Improvements in 27.3 and 36.6 m sprint times (ACL injury prevention programs designed as a structured warm-up routine seem to lack the necessary stimulus to enhance athletic performance.

  17. Sparing the anterior cruciate ligament remnant: is it worth the hassle?

    Science.gov (United States)

    Papalia, Rocco; Franceschi, Francesco; Vasta, Sebastiano; Di Martino, Alberto; Maffulli, Nicola; Denaro, Vincenzo

    2012-01-01

    Anterior cruciate ligament (ACL) rupture is the most common surgically treated ligament injury. Many efforts have been taken to reconstruct it as anatomically as possible to restore knee stability and, possibly, prevent knee osteoarthritis. A literature search was performed using the isolated or combined keywords 'ACL augmentation remnant', 'ACL reconstruction and remnant and stump', 'ACL reconstruction and remnant and stump preserving and stability' and 'ACL remnant complete tear' with no limit regarding the year of publication. We identified seven published studies. The ACL remnant might accelerate the vascularization and the ligamentization of the graft and contribute to faster graft innervation leading to a better proprioception. The role of the ACL remnant is debated, because, although it may increase the risk of impingement and the formation of cyclops lesion, its preservation can improve proprioception, biomechanical functions and vascularity. However, the current assessment methods to assess proprioception, vascularization and the ligamentization do not lead to hard evidence that preservation of the remnant confers clinically relevant advantages over its excision. The ACL remnant has been demonstrated in experimental studies to have a role in improving revascularization, ligamentization and reinnervation of the graft, but these findings are still not supported by clinical findings. A more direct way to assess proprioceptive function after ACL reconstruction and appropriately conducted powered and rigorously prospective randomized double-blind studies comparing the clinical outcomes of excising the remnant to leaving it in situ are necessary.

  18. Anterior cruciate ligament injuries in elite and high school rugby players: a 11-year review.

    Science.gov (United States)

    Takazawa, Yuji; Nagayama, Masataka; Ikeda, Hiroshi; Kawasaki, Takayuki; Ishijima, Muneaki; Saita, Yoshitomo; Kaneko, Haruka; Kobayashi, Yohei; Hada, Shinnosuke; Kaneko, Kazuo

    2016-01-01

    Over a 11-year period, we investigated the incidence of anterior cruciate ligament (ACL) injuries and the clinical outcomes after ACL reconstruction with hamstring autografts in two homogenous cohorts of rugby players. Two teams, including those in elite (94 players) and high school (290 players) clubs, were followed. Isolated ACL injuries occurred in 28 players (12 elite, 16 high school). The incidence during match play was 1.26 per 1000 player-hours (95% confidence interval [95% CI]: 0.48-2.05) among elite players and 0.97 per 1000 player-hours (95% CI: 0.30-1.64) among high school players. After ACL reconstruction, 26 players (12 elite, 14 high school) were successfully contacted for follow-up at a mean of 71.9 months. None (0%) of the elite and 4 (29%) of the high school players experienced graft ruptures. Seven (58%) elite and 10 (91%) high school players were fearful of reinjury; the mean time to overcome this fear was 6.1 ± 4.9 months among elite players and 17.5 ± 26.0 months among high school players. In conclusion, young rugby players experienced inferior outcomes after ACL reconstruction with hamstring autografts compared with their older counterparts.

  19. Factors associated with playing football after anterior cruciate ligament reconstruction in female football players.

    Science.gov (United States)

    Fältström, A; Hägglund, M; Kvist, J

    2016-11-01

    This study investigated whether player-related factors (demographic, personality, or psychological factors) or the characteristics of the anterior cruciate ligament (ACL) injury were associated with the return to playing football in females after ACL reconstruction (ACLR). We also compared current knee function, knee related quality of life and readiness to return to sport between females who returned to football and those who had not returned. Females who sustained a primary ACL rupture while playing football and underwent ACLR 6-36 months ago were eligible. Of the 460 contacted, 274 (60%) completed a battery of questionnaires, and 182 were included a median of 18 months (IQR 13) after ACLR. Of these, 94 (52%) returned to football and were currently playing, and 88 (48%) had not returned. Multiple logistic regression analysis identified two factors associated with returning to football: short time between injury and ACLR (0-3 months, OR 5.6; 3-12 months OR 4.7 vs reference group > 12 months) and high motivation. Current players showed higher ratings for current knee function, knee-related quality of life, and psychological readiness to return to sport (P football after ACLR. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Knee functions and a return to sports activity in competitive athletes following anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Nakayama, Y; Shirai, Y; Narita, T; Mori, A; Kobayashi, K

    2000-06-01

    We investigated knee functions and a return to sports in 50 competitive athlete patients treated with arthroscopic anterior cruciate ligament reconstruction using double-looped STG augmented by woven polyester at a 1-year follow-up. There were 25 males and 25 females with a mean age of 24.3 years (range: 19-39 years). The majority of preinjury sports were basketball, volleyball and soccer. Athletic rehabilitation including agility training and sports-specific training was started at 12 weeks. Fourty patients (80%) was rated as normal or nearly normal on the assessment of International Knee Documentation Commitee postoperatively. Fourty-eight patients (96%) obtained full range of motion, and the mean quadriceps muscle strength of the injured side was 91.3%of that of the uninjured side. As for a return to sports, 46 patients (92%) were able to do fully competitive sports at a mean of 8.1 postoperative months. These results suggest that arthroscopic reconstruction using augmented double-looped STG allows early athletic rehabilitation, and lead satisfactory outcome as well as a reliable and early return to preinjury level of sport activity for the majority of the competitive athlete patients.

  1. Effects of knee bracing on postural control after anterior cruciate ligament rupture.

    Science.gov (United States)

    Palm, Hans-Georg; Brattinger, Florian; Stegmueller, Bernd; Achatz, Gerhard; Riesner, Hans-Joachim; Friemert, Benedikt

    2012-10-01

    Randomized clinical trial. To investigate the effects of functional knee braces on postural control in patients with anterior cruciate ligament (ACL) rupture. ACL rupture leads to both mechanical knee instability and deficits in proprioception. Although elastic knee braces do not increase mechanical stability, patients report improved stability when wearing a brace. Elastic braces were found to reduce the loss of proprioception. It is, however, still unclear whether they also improve postural control, which involves the processing of proprioceptive input at a higher level. We studied 58 patients with isolated unilateral ACL rupture using computerized dynamic posturography and compared overall stability index (OSI) scores for injured and uninjured legs with and without a knee brace. In addition, patients were classified as copers and non-copers depending on knee function. Within subjects, OSI scores were 3.0 ± 1.1° for uninjured legs when unbraced, 2.8±1.3° for uninjured legs when braced (p=0.17), 3.7 ± 1.5° for unbraced injured legs, and 2.9 ± 1.3° for braced injured legs (pbraced condition (p=0.26). Elastic knee braces increase postural stability by approximately 22% in patients with ACL rupture. There was no difference in postural stability between uninjured and injured legs in the braced condition. One possible explanation is that bracing improves both proprioception and postural control. Copyright © 2011 Elsevier B.V. All rights reserved.

  2. Surgical management of anterior cruciate ligament injuries in Belgium anno 2013.

    Science.gov (United States)

    Van der Bracht, Hans; Goubau, Laurent; Stuyts, Bart; Schepens, Alexander; Verdonk, Peter; Victor, Jan

    2015-12-01

    Anatomic ACL surgery, including double bundle ACL reconstruction, has been investigated widely. The purpose of this study was to gain insight in the currently used surgical management of anterior cruciate ligament injuries amongst Belgian orthopaedic surgeons. A survey consisting of epidemiological questions, ACL surgery related questions and questions concerning rehabilitation was submitted to all members of the Belgian Knee Society. Anatomic single bundle ACL repair with transportal femoral tunnel drilling, using an autologous hamstring graft fixed with a cortical suspension system proximal and an interference screw distal is currently the most common technique. The surgery is usually performed under general anesthesia with a one-night stay in the hospital. Postoperatively a hinge brace is mostly used. Although much research concerning double bundle ACL surgery is performed, only few surgeons perform this technique. Most surgeons perform an anatomic single bundle repair. This is in accordance with the current knowledge regarding cost effective care. Performing this procedure in day care with the aid of loco-regional anesthesia and avoidance of a hinged brace can help to reduce the cost for the healthcare system without compromising the outcome.

  3. The effect of bracing on proprioception of knees with anterior cruciate ligament injury.

    Science.gov (United States)

    Beynnon, Bruce D; Good, Lars; Risberg, May Arna

    2002-01-01

    This paper is a comprehensive review on the effect of bandaging, bracing, and neoprene sleeves on knee proprioception following anterior cruciate ligament (ACL) injury and reconstruction with a focus on studies that have measured joint position sense and threshold to detection of passive knee motion. Disruption of the ACL does not appear to alter joint position sense soon after injury, although there is evidence that in some subjects deterioration may occur over time. An ACL tear creates a deficit in the threshold to detection of passive knee motion soon after injury and in those with chronic tears. The magnitude of worsening is less then 1.0 degree of movement in flexion-extension and of questionable concern from a clinical and functional perspective. Application of a functional brace or neoprene sleeve to the ACL-deficient limb does not improve the threshold to detection of passive knee motion; however, application of an elastic bandage to a knee with an ACL tear improves joint position sense. Reconstruction of a torn ACL is associated with a deficit in the threshold to detection of passive knee motion, and during the first year of healing the use of a neoprene sleeve provides improvement. Two years following ACL reconstruction there is no deficit in the threshold to detection of passive knee motion and the use of a brace has no effect on this outcome.

  4. [Peculiarities of early rehabilitation of mountain ski athletes after plastic reconstruction of anterior cruciate ligament].

    Science.gov (United States)

    Sidorenko, E V; Preobrazhenskiĭ, V Iu; Vnukov, D V; Preobrazhenskaia, M V

    2013-01-01

    The primary objective of the present study was to estimate the effectiveness of the new methods of physical rehabilitation for mountain ski athletes designed to optimize and accelerate restoration of their professional capabilities after arthroscopic plastic reconstruction of anterior cruciate ligament (ACL). This open controlled prospective study involved 26 alpine skiers aged from 18 to 25 who were recruited into the regular follow up program based at our Centre during the last 3 years. The athletes proved able to start balance training on the Biodex platform 4 weeks earlier than with the use of the conventional approach. These exercises were supplemented by the training of speed endurance on the Speed Courte tensor platform and Sky Teck ski simulators. Control studies were carried out on the 16th and 24th weeks of the rehabilitation period. Their results were compared with the results shown by the same athletes before injury. It was found that the early introduction of exercises designed to normalize proprioception into the rehabilitative treatment allowed the injured mountain ski athletes to restore the strength of femoral muscles and specific professional skills by the 4th month of the rehabilitation period. It is concluded that the combination of classical rehabilitative techniques with balance training, Speed Court training, and training on the alpine ski simulator makes it possible to begin special of alpine ski training on the snow 2 months earlier than with the use of conventkional methods.

  5. The correlation between anterior cruciate ligament injury in elite alpine skiers and their parents.

    Science.gov (United States)

    Westin, Maria; Reeds-Lundqvist, Sandra; Werner, Suzanne

    2016-03-01

    The aim of this study was to investigate whether a familiar correlation with anterior cruciate ligament (ACL) injury exists between competitive alpine skiers and their parents. All 593 (293 males, 300 females) elite alpine skiers who have studied at a Swedish alpine Ski High School during 2006 and 2012 answered a questionnaire whether they or their parents had suffered an ACL injury. A total of 418 skiers (70%) answered the questionnaire. Twenty-nine per cent (n = 19) out of the 65 ACL-injured skiers reported that they had a parent (mother or father) who have had an ACL injury. In skiers without an ACL injury (n = 353), the result was 18% (n = 64). An odds ratio of 1.95 (95% confidence interval 1.04-3.65) was found to suffer an ACL injury if you have a parent who has had an ACL injury compared with if you have a parent without any ACL injury. The findings of the current study demonstrated a family history to tear the ACL between alpine skiers who had studied at a Swedish Ski High School and ACL injuries of their parents. III.

  6. Current practice variations in the management of anterior cruciate ligament injuries in Delhi.

    Science.gov (United States)

    Vaishya, Raju; Agarwal, Amit Kumar; Ingole, Sachin; Vijay, Vipul

    2016-01-01

    The aim of this study was to determine the current practices and preferences of the arthroscopic surgeons of Delhi in the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament (ACL) injury. It was a cross-sectional descriptive study conducted among arthroscopic surgeons of Delhi. A survey was conducted using a questionnaire that was sent either by e-mail or by direct contact to all sixty arthroscopic surgeons of Delhi. Forty-eight (80%) surgeons responded to our questionnaire. Maximum participants (83.3%) used semitendinosus/gracilis tendon autograft for ACL reconstruction (ACLR) and only 2.1% were using bone-patellar-tendon-bone (BPTB) autograft. Most preferred method of graft fixation was an 'interference screw' on the tibial side and an 'endobutton' on the femoral side, which was preferred by 95.83% and 93.75% surgeons, respectively. Almost all respondents (97%) used a bio-absorbable interference screw for tibial side graft fixation. Postoperative bracing was advised for timing of surgery, rehab after surgery, pain management, etc.

  7. An Ambulatory Method of Identifying Anterior Cruciate Ligament Reconstructed Gait Patterns

    Directory of Open Access Journals (Sweden)

    Matthew R. Patterson

    2014-01-01

    Full Text Available The use of inertial sensors to characterize pathological gait has traditionally been based on the calculation of temporal and spatial gait variables from inertial sensor data. This approach has proved successful in the identification of gait deviations in populations where substantial differences from normal gait patterns exist; such as in Parkinsonian gait. However, it is not currently clear if this approach could identify more subtle gait deviations, such as those associated with musculoskeletal injury. This study investigates whether additional analysis of inertial sensor data, based on quantification of gyroscope features of interest, would provide further discriminant capability in this regard. The tested cohort consisted of a group of anterior cruciate ligament reconstructed (ACL-R females and a group of non-injured female controls, each performed ten walking trials. Gait performance was measured simultaneously using inertial sensors and an optoelectronic marker based system. The ACL-R group displayed kinematic and kinetic deviations from the control group, but no temporal or spatial deviations. This study demonstrates that quantification of gyroscope features can successfully identify changes associated with ACL-R gait, which was not possible using spatial or temporal variables. This finding may also have a role in other clinical applications where small gait deviations exist.

  8. deal Rehabilitation Programme after Anterior Cruciate Ligament Injury: Review of Evidence

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    Adeel Nazir AHMAD

    2016-03-01

    Full Text Available Knee injuries are the second most common musculoskeletal injuries in primary care, with anterior cruciate the most commonly injured ligament. It is caused by contact / non - contact and accelerating/decelerating twisting injury of the knee. Typical presentation includes trauma with pain and swellin g, with laxity of the knee joint. Management includes rehabilitation alone or surgery combined with rehabilitation. Pre - surgery rehabilitation with graded physiotherapy programme results in improved postoperative recovery, reduced pain, swelling, better s tability and improved range of movement. No consensus exists on an ideal rehabilitation programme, as various factors, including injury to other knee structures, choice of graft, type of surgery performed and patient preference exist. Rehabilitation includ es accelerated vs. conservative, closed vs. open kinetic chain and techniques involving bracing, neuromuscular training and cryotherapy. Ideal personalised rehabilitation plan should include educating athletes to improve adherence, providing realistic stra tegies and approximate time frame for a return to sport. Studies support accelerated rehabilitation before and after surgery, in a clinic and home setting, with combined kinetic exercises. Accelerated rehabilitation protocol involving exercises to increas e muscle strength, knee ROM and proprioception along with reducing pain, inflammation and swelling can lead to better knee stability and a less complicated rehabilitation course.

  9. Can the hamstring muscles protect the anterior cruciate ligament during a side-cutting maneuver?

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    Simonsen, E B; Magnusson, S P; Bencke, J; Naesborg, H; Havkrog, M; Ebstrup, J F; Sørensen, H

    2000-04-01

    Because anterior cruciate ligament (ACL) injuries are common in European handball the present study assessed knee joint shear forces to estimate ACL loading in six elite female handball players during a side-cutting maneuver. A pilot investigation in three dimensions showed that peak moments occurred in the sagittal plane at a high velocity. Therefore, analysis of the movement was performed in two dimensions using high-speed cinematography, ground reaction forces, and electromyography (EMG). Film and force plate data allowed for calculation of net joint moments (inverse dynamics), estimates of instantaneous muscle-tendon lengths, contraction velocities, and peak loading of the ACL. During the breaking phase of the maneuver the peak knee joint moment was 239 Nm (99-309), which yielded an ACL-load of 520 N (215-673). The corresponding peak EMG amplitudes for the hamstring muscles were 34-39% of maximum EMG. During the breaking phase the quadriceps muscle contracted eccentrically with a velocity of 216-253% fiber length/s. In contrast, the hamstring muscles contracted concentrically with a velocity of 222-427% fiber length/s. These results suggest that a side-cutting maneuver produces loads that are insufficient to rupture the ACL. Furthermore, the rapid concentric hamstring contraction suggests that even during maximal activation, the ability of the hamstrings to reduce the ACL load is marginal.

  10. Relationship between patellar mobility and patellofemoral joint cartilage degeneration after anterior cruciate ligament reconstruction.

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    Ota, Susumu; Kurokouchi, Kazutoshi; Takahashi, Shigeo; Yoda, Masaki; Yamamoto, Ryuichiro; Sakai, Tadahiro

    2017-11-01

    Patellofemoral cartilage degeneration is a potential complication of anterior cruciate ligament reconstruction (ACLR) surgery. Hypomobility of the patella in the coronal plane is often observed after ACLR. Few studies, however, have examined the relationship between cartilage degeneration in the patellofemoral joint and mobility after ACLR. The present study investigated 1) the coronal mobility of the patella after ACLR, 2) the relationship between patellar mobility and cartilage degeneration of the patellofemoral joint, and 3) the relationship between patellar mobility and knee joint function after ACLR. Forty patients who underwent medial hamstring-based ACLR participated in the study. Lateral and medial patellar displacements were assessed with a modified patellofemoral arthrometer, and the absolute values of the displacements were normalized to patient height. The International Cartilage Repair Society (ICRS) cartilage injury classification of the patellar and femoral (trochlear) surfaces, and the Lysholm Knee Scoring Scale were used to evaluate knee function. Lateral and medial patellar displacements were reduced compared with the non-operated knee at the second-look arthroscopy and bone staple extraction operation (second operation; 24.4 ± 7.9 months after ACLR, Pmobility, however, were significantly correlated with the ICRS grade or the Lysholm score. Although patellar mobility at approximately 2 years after ACLR was decreased compared to the non-operated knee, small displacement of the patella was not related to cartilage degeneration or knee joint function at the time of the second operation.

  11. Functional result relating to the positioning of the graft in anterior cruciate ligament reconstruction

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    Otávio de Melo Silva Júnior

    2015-02-01

    Full Text Available OBJECTIVE: To ascertain the coronal angles for the femoral and tibial tunnels that provide the best postoperative result from anterior cruciate ligament (ACL reconstruction surgery, through assessing the variables of the IKDC and Lysholm-Tegner questionnaires and the hop test.METHODS: Sixteen patients with a single unilateral ACL injury who underwent this surgery between 24 and 36 months earlier were evaluated. They were divided into four groups in which the tibial and femoral tunnel angles were greater than or less than 65° in the coronal plane.RESULTS: The results demonstrated that a more vertical angle for the tibial tunnel (72° and a more horizontal angle for the femoral tunnel (60°, with valgus alignment of 12° correlated with the best values for the variables studied. This may indicate that the long-term results from this surgery are excellent.CONCLUSION: A more horizontal femoral angle and a more vertical tibial angle produced better assessments in the tests that were applied and in the functional results evaluated.

  12. Revascularisation pattern of ruptured flexor tendon grafts in anterior cruciate ligament reconstruction: A histological study.

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    Figueroa, D; Martínez, R; Calvo, R; Scheu, M; Gallegos, M; Vaisman, A; Martínez, C; González, A

    For successful anterior cruciate ligament (ACL) reconstruction, revascularisation and histological maturation are necessary, as their failure can cause graft rupture. The purpose of this study was to describe differences in the histological maturation of early failed plasty (less than 12 months after surgery) and late failed plasty (more than 12 months after surgery) in patients with re-rupture after ACL reconstruction with hamstring tendons. A descriptive observational study was conducted on a consecutive series of 20 patients whose ACL reconstruction had failed. Graft biopsy samples were obtained during the revision surgery from the proximal, medial, and distal graft remnants. The samples were evaluated by light microscopy, and the vascularity and maturation of the samples were established by histological scoring. The most common aetiology of reconstruction failure (86.6%) was a specific event with non-contact mechanism. The patients with re-rupture of their ACL plasty less than 12 months after surgery had substance vessels that were less deep. The distal segment of the graft in those patients showed a delay in histological maturation with fewer collagen fibres. In patients whose ACL grafts failed less than 12 months after surgery, a lower distribution of blood vessels and collagen fibres was found that were less ordered in the distal graft. These results indicate a delay in maturation, which leads to a higher risk of graft failure. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. EPIDEMIOLOGY OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN BRAZIL'S PUBLIC HEALTH SYSTEM

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    Thiago Jambo Alves Lopes

    Full Text Available ABSTRACT Introduction: Several studies have reported on the epidemiology of Anterior Cruciate Ligament Reconstruction (ACLR in Europe and North America; however, there is currently no data relating to Brazil. Objective: To describe the incidence of ACLR in Brazil and investigate temporal trends and differences between age and sex groups. Methods: All reported ACLR cases in the public hospital system between January 2008 and December 2014 were extracted from the Information Technology Department of the Brazilian Ministry of Health. Linear regression analysis was used to assess changes in ACLR incidence in the overall population and among sex and age groups, hospitalization time, and health care costs. Results: A total of 48,241 ACLR were reported from 2008-2014 with an overall incidence of 3.49 per 100,000 persons/year. Males accounted for 82% of the procedures. The incidence of ACLR increased by 56% among males (p=0.01 and by 112% among females (p=0.001. The mean hospitalization time decreased from 2.4 days in 2008 to 1.8 day in 2014 (R2 = 0.883, p= 0.002. The total cost across all years was US$56 million, with a mean of US$1,145 per ACLR. Conclusion: Although the total incidence of ACLR in Brazil is lower compared to other countries, it has increased over the years, especially in females. The creation of an ACLR registry is necessary in the future, for more accurate control and new investigations.

  14. Motor coordination during gait after anterior cruciate ligament injury: a systematic review of the literature

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    Gustavo Leporace

    2013-08-01

    Full Text Available To investigate the state of art about motor coordination during gait in patients with anterior cruciate ligament (ACL injury. Searches were carried out, limited from 1980 to 2010, in various databases with keywords related to motor coordination, gait and ACL injury. From the analysis of titles and applying the inclusion/exclusion criteria 24 studies were initially selected and, after reading the abstract, eight studies remained in the final analysis. ACL deficient patients tend to have a more rigid and less variable gait, while injured patients with ACL reconstruction have less rigid and more variable gait with respect to healthy individuals. The overall results suggest the existence of differences in motor coordination between the segments with intact and those with injured knee, regardless of ligament reconstruction. ACL injured patients present aspects related to the impairment of the capability to adapt the gait pattern to different environmental conditions, possibly leading to premature knee degeneration. However, the techniques used for biomechanical gait data processing are limited with respect to obtaining information that leads to the development of intervention strategies aimed at the rehabilitation of that injury, since it is not possible to identify the location within the gait cycle where the differences could be explained.

  15. Reconstruction of the anterior cruciate ligament in skeletally immature patients: an individualized approach,

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    Osmar Valadão Lopes Júnior

    2014-06-01

    Full Text Available OBJECTIVE: to evaluate a series of skeletally immature patients who underwent three surgical techniques for anterior cruciate ligament (ACL reconstruction according to each patient's growth potential.METHODS: a series of 23 skeletally immature patients who underwent ACL reconstruction surgery at ages ranging from 7 to 15 years was evaluated prospectively. The surgical technique was individualized according to the Tanner sexual maturity score. The surgical techniques used were transphyseal reconstruction, partial transphyseal reconstruction and extraphyseal reconstruction. Four patients underwent the extraphyseal technique, seven the partial transphyseal technique and twelve the full transphyseal technique, on the ACL. The postoperative evaluation was based on the Lysholm score, clinical analysis on the knee and the presence of angular deformity or dysmetria of the lower limb.RESULTS: the mean Lysholm score was 96.34 (±2.53. None of the patients presented differences in length and/or clinical or radiographic misalignment abnormality of the lower limbs.CONCLUSION: ACL reconstruction using flexor tendon grafts in skeletally immature patients provided satisfactory functional results. Use of individualized surgical techniques according to growth potential did not give rise to physeal lesions capable of causing length discrepancies or misalignments of the lower limbs, even in patients with high growth potential.

  16. Biomechanical analysis on transverse tibial fixation in anterior cruciate ligament reconstructions

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    Edmar Stieven Filho

    2015-04-01

    Full Text Available OBJECTIVE: To verify whether the combination of tibial cross pin fixation and femoral screw fixation presents biomechanical advantages when compared to femoral cross pin fixation and tibial screw fixation for the reconstruction of the anterior cruciate ligament (ACL.METHODS: Thirty-eight porcine knees and bovine extensor digitorum tendons were used as the graft materials. The tests were performed in three groups: (1 standard, used fourteen knees, and the grafts were fixated with the combination of femoral cross pin and a tibial screw; (2 inverted, used fourteen knees with an inverted combination of tibial cross pin and a femoral screw; (3 control, ten control tests performed with intact ACL. After the grafts fixation, all the knees were subjected to tensile testing to determine yield strength and ultimate strength.RESULTS: There was no statistically significant difference in survival techniques in regard to strength, yield load and tension. There was a higher survival compared in the standard curves of yield stress (p < 0.05.CONCLUSION: There is no biomechanical advantage, observed in animal models testing, in the combination of tibial cross pin fixation and femoral screw when compared to femoral cross pin fixation and tibial screw.

  17. Magnetic Resonance Imaging of Anterior Cruciate Ligament Tears: Evaluation of Standard Orthogonal and Tailored Paracoronal Images

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    Duc, S.R.; Zanetti, M.; Kramer, J.; Kaech, K.P.; Zollikofer, C.L.; Wentz, K.U. [Cantonal Hospital, Inst. of Radiology, Winterthur (Switzerland). MR Research Group

    2005-11-01

    Purpose: To evaluate the three standard orthogonal imaging planes and a paracoronal imaging plane for anterior cruciate ligament (ACL) tears. Material and Methods: Ninety patients (91 knees; 29 F and 61 M) aged between 15 and 84 years (mean 36.9{+-}16.4 years) underwent magnetic resonance imaging (MRI) of the knee prior to arthroscopy. At surgery, 32 knees had an intact ACL, 4 a partial tear, and 55 a complete ACL tear. In all patients, axial, sagittal, coronal, and paracoronal T2-weighted turbo-SE images were acquired. The ACL was classified as intact, partially, or completely torn. Partial and complete tears were combined for statistical evaluation. Results: Partial ACL tears (four cases) were not correctly diagnosed at MRI except in one knee by one observer on coronal images. Sensitivity in detecting ACL tears was 95%/63% (reader1/reader2) in the axial, 93%/95% in the sagittal, 93%/86% in the coronal, and 100%/93% in the paracoronal plane. Specificity was 75%/81% in the axial, 72%/81% in the sagittal, 78%/94% in the coronal, and 78%/88% in the paracoronal plane. Conclusion: ACL tears can be diagnosed accurately with each of the standard orthogonal planes. Based on reader confidence and interobserver agreement paracoronal images may be useful in equivocal cases.

  18. Does the tibial remnant of the anterior cruciate ligament promote ligamentization?

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    Lee, Byung Ill; Kim, Byoung Min; Kho, Duk Hwan; Kwon, Sai Won; Kim, Hyeung June; Hwang, Hyun Ryong

    2016-12-01

    The purpose of this study was to clarify the difference in ligamentization between the remnant-preserving (RP) and remnant-sacrificing (RS) techniques in anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI). A retrospective comparative study was carried out on 98 patients undergoing ACL reconstruction using either an RP (n=56) or RS (n=42) technique. MRI was performed at one of four time points postoperatively, and the signal intensity of the ACL graft was analyzed using the signal to noise quotient (SNQ) ratio and inter-bundle high signal intensity, along with an analysis of the survival rate of remnant tissue. The mean SNQ ratio of grafted tendons in the RP group was significantly higher than that seen in the RS group in the proximal and middle regions two to four months after surgery (Pligamentization of grafts in the RP group proceeded more quickly. Preserving the remnant in ACL reconstruction appears to have a positive effect on ligamentization. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Finite Element Modelling of a Novel Anterior Cruciate Ligament Repairing Device

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    A.Vairis

    2014-07-01

    Full Text Available The knee anterior cruciate ligament which connects the femur to the tibia is often torn during sudden twisting motions resulting in knee instability with surgery being an effective treatment where the torn ligament is replaced with a graft. This study provides qualitative stress information on a restored knee which has been repaired using a novel device. This device has been designed to reduce graft damage and to minimize post-surgery complications. The device as well as the intact knee have been modelled in 3D and studied using finite elements to assess the mechanical behaviour of the device under different loads. Results are evaluated and compared to equivalent published works. They showed that high stresses appear where tendons wrap around objects like the securing pin of the knee ligament repair device, while the highest stresses are away from the repair device components indicating that the device design does not affect the graft. Developed stresses were within the tendon elastic range, and load case direction does not affect significantly the developed stresses on the circumference of tendons in the most stressed region.

  20. Sports-specific differences in postsurgical infections after arthroscopically assisted anterior cruciate ligament reconstruction.

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

    2017-12-01

    Post-operative infection after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a rare but severe complication, particularly for young and active patients. It is unclear whether the prevalence of knee infection is correlated with the type of sports or the level of performance. From 2008 to 2012, the internal single-centre ACL registry of the FIFA Medical Centre of Excellence Regensburg was retrospectively screened for sex, age, time between isolated primary ACL rupture and surgery, surgical technique, rate of infection after ACL reconstruction and the type of sports practised. In total, 4801 ACL reconstructions had been conducted over 5 years, 4579 in amateur and 221 in professional athletes. After application of the exclusion criteria, 1809 athletes with ACL reconstruction were analysed regarding postsurgical infection and the type of sports practised. Professionals and amateurs did not significantly differ with regard to infection rates (n.s.) but in the timing of ACL repair (p amateur athletes. Relevant prevention strategies for postsurgical ACL infections should consider influencing patient factors such as the type of sports activity and attendant circumstances. III.

  1. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction.

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    Kvist, Joanna; Ek, Anna; Sporrstedt, Katja; Good, Lars

    2005-07-01

    Unrestricted participation in sports activities and return to the pre-injury level is often reported as an indicator of the success of ACL reconstruction. The athletes' choice not to return to their pre-injury level may depend on the knee function, but some times, social reasons or psychological hindrances such as fear of re-injury may influence their return to sports. The aim of this study was to investigate whether fear of re-injury due to movement is of significance for returning to previous level of activity in patients who have undergone anterior cruciate ligament reconstruction. The Tampa Scale of Kinesiophobia (TSK), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and some general questions were mailed to 87 patients who underwent ACL reconstruction 3-4 years before the study was conducted. Sixty-two patients (74%) answered the questionnaires (34 men and 28 women). Fifty-three percent of the patients returned to their pre-injury activity level. The patients who did not return to their pre-injury activity level had more fear of re-injury, which was reflected in the TSK. In addition, high fear of re-injury was correlated with low knee-related quality of life. Fear of re-injury must be considered in the rehabilitation and evaluation of the effects of an ACL reconstruction.

  2. Psychosocial factors influencing the recovery of athletes with anterior cruciate ligament injury: a systematic review.

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    te Wierike, S C M; van der Sluis, A; van den Akker-Scheek, I; Elferink-Gemser, M T; Visscher, C

    2013-10-01

    This review describes the psychosocial factors that affect recovery following anterior cruciate ligament (ACL) injury and reconstructive surgery in athletes. A systematic search in literature with inclusion and exclusion criteria on PubMed, PsycINFO, and Embase was performed. Articles used in this review were divided in five different parts according to the biopsychosocial model of Wiese-Bjornstal, with the addition of intervention studies. The results showed that a high internal Health Locus of Control and a high self-efficacy were useful cognitive factors to facilitate the recovery. Athletes with a low level of fear of reinjury had the best knee outcome after the injury followed by a reconstruction. In addition, athletes who returned to sport had less fear of reinjury and were more experienced and established athletes compared with athletes who did not return to sport. Furthermore, researchers showed that there was a positive relation between goal setting and adherence, which in turn yielded a positive relation with the outcome of the rehabilitation of an ACL injury. There were several psychosocial interventions that appeared to be facilitating the rehabilitation process. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Double-bundle depiction of the anterior cruciate ligament at 3 Tesla

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    Adriaensen, M.E.A.P.M. [Atrium Medical Center Parkstad, Department of Radiology, Heerlen (Netherlands); Hogan, B. [Sports Surgery Clinic, Department of Radiology, Dublin (Ireland); Al-Bulushi, H.I.J. [Armed Forces Hospital, Department of Radiology, Muscat (Oman); Kavanagh, E.C. [Mater Misericordiae Hospital, Department of Radiology, Dublin (Ireland)

    2012-07-15

    Magnetic resonance imaging on 3 Tesla (3T MRI) with arthroscopic correlation has proven to adequately identify the anteromedial bundle (AMB) and posterolateral bundle (PLB) in cadaver knees. The purpose of this study was to describe the depiction of ACL bundle anatomy on 3T MRI in daily practice. In a retrospective cohort study, we included 50 consecutive patients who underwent standard 3T MRI of the knee and had an intact ACL. Two musculoskeletal radiologists independently reviewed all scans for depiction of ACL bundle anatomy using standardized forms. Descriptive statistics were used. Twenty-three right knees (46%) and 27 left knees (54%) were included in the study. Mean age of the patients was 35 years (range 12 to 68 years); 37 patients were male (74%). ACL bundle anatomy was best depicted in the axial plane in 44 knees (88%) and in the coronal plane in six knees (12%). Two bundles were seen in 47 knees (94%). The AMB was completely seen in 45 knees (90%). The PLB was completely seen in 40 knees (80%). Both bundles were completely seen in 37 knees (76%). The double-bundle anatomy of the ACL is visualized in 94% of patients on 3T MRI. Because of potentially associated clinical benefits, we advocate to report separately on the anteromedial bundle and posterolateral bundle in case of anterior cruciate ligament injury of the knee. (orig.)

  4. Gender differences in the restoration of knee joint biomechanics during gait after anterior cruciate ligament reconstruction.

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    Asaeda, Makoto; Deie, Masataka; Fujita, Naoto; Kono, Yoshifumi; Terai, Chiaki; Kuwahara, Wataru; Watanabe, Hodaka; Kimura, Hiroaki; Adachi, Nobuo; Sunagawa, Toru; Ochi, Mitsuo

    2017-03-01

    The aim of our study was to evaluate the effects of gender on recovery of knee joint biomechanics over the stance phase of gait after reconstruction of the anterior cruciate ligament (ACL). Gait parameters and knee joint kinematics and kinetics were compared in 32 patients (16 male and 16 female) who underwent ACL reconstruction for a unilateral ACL deficiency, with comparison to an age-, height-, and weight-matched Control group. Knee flexion, adduction and tibial rotation angles were measured and knee extension and abduction moment was calculated by inverse dynamics methods. Females exhibited more tibial external rotation, in both the Control and ACL groups (P<0.05), which was not changed after ACL reconstruction. Prior to reconstruction, sagittal plane biomechanics were changed, in both males and females, compared to the Control groups (P<0.05). These abnormal sagittal plane mechanics were recovered at 12months, but not six months post-reconstruction. We identified gender-based differences in tibial rotation that influenced the kinematics and kinetics of the knee over the stance phase of gait, both pre-operatively and post-ACL reconstruction. Evaluation of biomechanical effects of ACL injury, before and after reconstruction, should be separately evaluated for females and males. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Differences in the microstructural properties of the anteromedial and posterolateral bundles of the anterior cruciate ligament.

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    Skelley, Nathan W; Castile, Ryan M; York, Timothy E; Gruev, Viktor; Lake, Spencer P; Brophy, Robert H

    2015-04-01

    Tissue properties of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) have not been previously characterized with real-time dynamic testing. The current study used a novel polarized light technique to measure the material and microstructural properties of the ACL. The AM and PL bundles of the ACL have similar material and microstructural properties. Controlled laboratory study. The AM and PL bundles were isolated from 16 human cadaveric ACLs (11 male, 5 female; average age, 41 years [range, 24-53 years]). Three samples from each bundle were loaded in uniaxial tension, and a custom-built polarized light imaging camera was used to quantify collagen fiber alignment in real time. A bilinear curve fit was applied to the stress-strain data of a quasistatic ramp-to-failure to quantify the moduli in the toe and linear regions. Fiber alignment was quantified at zero strain, the transition point of the bilinear fit, and in the linear portion of the stress-strain curve by computing the degree of linear polarization (DoLP) and angle of polarization (AoP), which are measures of the strength and direction of collagen alignment, respectively. Data were compared using t tests. The AM bundle exhibited significantly larger toe-region (AM 7.2 MPa vs. PL 4.2 MPa; P ligament microstructure can be used to assess graft options for ACL reconstruction and optimize surgical reconstruction techniques. © 2015 The Author(s).

  6. Review of evolution of tunnel position in anterior cruciate ligament reconstruction

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    Rayan, Faizal; Nanjayan, Shashi Kumar; Quah, Conal; Ramoutar, Darryl; Konan, Sujith; Haddad, Fares S

    2015-01-01

    Anterior cruciate ligament (ACL) rupture is one of the commonest knee sport injuries. The annual incidence of the ACL injury is between 100000-200000 in the United States. Worldwide around 400000 ACL reconstructions are performed in a year. The goal of ACL reconstruction is to restore the normal knee anatomy and kinesiology. The tibial and femoral tunnel placements are of primordial importance in achieving this outcome. Other factors that influence successful reconstruction are types of grafts, surgical techniques and rehabilitation programmes. A comprehensive understanding of ACL anatomy has led to the develop