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Sample records for crucial ligament reconstruction

  1. Is correctional osteotomy crucial in primary varus knees undergoing anterior cruciate ligament reconstruction?

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    Kim, Sung-Jae; Moon, Hong-Kyo; Chun, Yong-Min; Chang, Woo-Hyuk; Kim, Sul-Gee

    2011-05-01

    Valgus high tibial osteotomy (HTO) has been recommended for ligament stability and enhanced function after anterior cruciate ligament (ACL) reconstruction in varus-angulated knees. However, it is not clear whether HTO should be performed in patients undergoing ACL reconstruction who have primary varus knees without medial compartment arthrosis. We therefore asked whether stability and function differed in patients having ACL reconstruction with differing degrees of preoperative alignment. We retrospectively reviewed 201 patients who had primary, single-bundle ACL reconstructions with primary varus knees based on the preoperative mechanical axis deviation (MAD) on preoperative standing hip-knee-ankle radiographs. Patients were categorized into four groups according to the MAD: Group 1: 0 mm to 4 mm, Group 2: 5 mm to 9 mm, Group 3: 10 mm to 14 mm, and Group 4: greater than 15 mm. A total of 201 patients, 67 in Group 1, 53 in Group 2, 38 in Group 3, and 43 in Group 4, were assessed. Ligament stability was determined with the Lachman test, pivot shift test, and KT 2000™ arthrometer. Functional scores were assessed using the Lysholm score and the International Knee Documentation Committee (IKDC) score. The minimum followup was 24 months (mean, 45 months; range, 24-96 months). We observed no differences in the side-to-side KT 2000™ measurements, Lysholm score, or IKDC functional scores based on the preoperative MAD. The stability and functional scores after ACL reconstruction were not adversely altered by primary varus alignment. Thus, if there is no medial compartment arthritis or varus thrust, we do not believe a correctional tibial osteotomy is crucial in primary varus knees undergoing ACL reconstruction.

  2. Telomere length of anterior crucial ligament after rupture

    DEFF Research Database (Denmark)

    Ponsot, Elodie; Langberg, Henning; Krogsgaard, Michael R

    2011-01-01

    The regeneration of ligaments following injury is a slow process compared to the healing of many other tissues and the underlying mechanisms remain unknown. The purpose of the study was to evaluate the proliferative potential of ligaments by assessing telomere length within three distinct parts...... of human anterior cruciate ligament (ACL) obtained during ACL reconstruction: the macroscopically injured proximal part and macroscopically noninjured mid- and distal portions in eight subjects (age 28 ± 8 years). The mean telomere length in ACL was within normal range of values usually reported for other...... tissues indicating that the endogenous machinery responsible for the proliferative potential of ligament is not implicated in its poor healing capacity. The three ACL parts showed similar mean TRF lengths (distal part: 11.5 ± 0.8 kbp, mid-portion: 11.8 ± 1.2 kbp, proximal part: 11.9 ± 1.6 kbp...

  3. Revision Anterior Cruciate Ligament Reconstruction

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    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

  4. CRUCIATE LIGAMENT RECONSTRUCTION

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    A. V. Korolev

    2016-01-01

    Full Text Available Purpose: To evaluate long-term results of meniscal repair during arthroscopic ACL reconstruction.Materials and methods: 45 patients who underwent meniscal repair during arthroscopic ACL reconstruction between 2007 and 2013 by the same surgeon were included in the study. In total, fifty meniscus were repaired (26 medial and 24 lateral. Procedures included use of one up to four Fast-Fix implants (Smith & Nephew. In five cases both medial and lateral meniscus were repaired. Cincinnati, IKDC and Lysholm scales were used for long-term outcome analysis.Results: 19 male and 26 female patients were included in the study aging from 15 to 59 years (mean age 33,2±1,5. Median time from injury to surgical procedure was zero months (ranging zero to one. Mean time from surgery to scale analysis was 55,9±3 months (ranged 20-102. Median Cincinnati score was 97 (ranged 90-100, with excellent results in 93% of cases (43 patients and good results in 7% (3 patients. Median IKDC score was 90,8 (ranged 86,2-95,4, with excellent outcomes in 51% of cases (23 patients, good in 33% (15 patients and satisfactory in 16% (7 patients. Median Lysholm score was 95 (ranged 90-100, with excellent outcomes in 76% of cases (34 patients and good in 24% (11 patients. Authors identified no statistical differences when comparing survey results in age, sex and time from trauma to surgery.Conclusions: Results of the present study match the data from orthopedic literature that prove meniscal repair as a safe and efficient procedure with good and excellent outcomes. All-inside meniscal repair can be used irrespectively of patients' age and is efficient even in case of delayed procedures.

  5. The Danish Knee Ligament Reconstruction Registry

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    Rahr-Wagner L

    2016-10-01

    Full Text Available Lene Rahr-Wagner, Martin Lind Department of Orthopaedic Surgery, Division of Sports Surgery, Aarhus University Hospital, Aarhus, Denmark Abstract: The Danish Knee Ligament Reconstruction Registry was established in 2005 as a web-based nationwide clinical database with the purpose of improving the monitoring and quality of both primary and revision knee ligament reconstructions in Denmark. All primary and revision anterior and posterior cruciate ligament reconstructions as well as collateral ligament and multiligament reconstructions are recorded. Main variables include sex, age, cause of injury, objective ligament instability, and surgical data, such as affected ligament, graft- and implant choice, operation technique among other things. The operating surgeon prospectively collects the data. Hence, detailed preoperative, intraoperative, and 1-year follow-up data are recorded by the operating surgeon using a standardized form and a secured Internet portal. The number of procedures registered in the database each year is ~2,500 and the first 9 years, in total, 22,775 procedures have been registered. Since the beginning of the database multiple papers have been published in international peer-reviewed journals, improving the knowledge of patients treated with knee ligament reconstruction surgery. This paper reviews the content, organization, and published research from the Danish Knee Ligament Reconstruction Registry. Keywords: ligament reconstruction, anterior cruciate ligament, operation technique, database, graft choice, femoral tunnel drilling, patient-reported outcome measure

  6. Graft fixation in cruciate ligament reconstruction.

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    Brand, J; Weiler, A; Caborn, D N; Brown, C H; Johnson, D L

    2000-01-01

    Cruciate ligament reconstruction has progressed dramatically in the last 20 years. Anatomic placement of ligament substitutes has fostered rehabilitation efforts that stress immediate and full range of motion, immediate weightbearing, neuromuscular strength and coordination, and early return to athletic competition (3 months). This has placed extreme importance on secure graft fixation at the time of ligament reconstruction. Current ligament substitutes require a bony or soft tissue component to be fixed within a bone tunnel or on the periosteum at a distance from the normal ligament attachment site. Fixation devices have progressed from metal to biodegradable and from far to near-normal native ligament attachment sites. Ideally, the biomechanical properties of the entire graft construct would approach those of the native ligament and facilitate biologic incorporation of the graft. Fixation should be done at the normal anatomic attachment site of the native ligament (aperture fixation) and, over time, allow the biologic return of the histologic transition zone from ligament to fibrocartilage, to calcified fibrocartilage, to bone. The purpose of this article is to review current fixation devices and techniques in cruciate ligament surgery.

  7. Anterior Cruciate Ligament Reconstruction Rehabilitation

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    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

  8. LARS Artificial Ligament Versus ABC Purely Polyester Ligament for Anterior Cruciate Ligament Reconstruction

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    Iliadis, Dimitrios Ph.; Bourlos, Dimitrios N.; Mastrokalos, Dimitrios S.; Chronopoulos, Efstathios; Babis, George C.

    2016-01-01

    Background: Graft choice for anterior cruciate ligament (ACL) reconstruction is of critical importance. Various grafts have been used so far, with autografts long considered the optimal solution for the treatment of ACL-deficient knees. Limited data are available on the long-term survivorship of synthetic grafts. Purpose: To compare the functional outcome and survivorship of ACL reconstructions performed using the LARS (ligament augmentation and reconstruction system) ligament and the ABC (active biosynthetic composite) purely polyester ligament. Study Design: Case series; Level of evidence, 4. Methods: The results of 72 patients who underwent primary arthroscopic ACL reconstruction with the LARS ligament and 31 cases with an ABC purely polyester ligament were reviewed. The mean follow-up periods for the LARS and ABC groups were 9.5 and 5.1 years, respectively. A survivorship analysis of the 2 synthetic grafts was performed using the Kaplan-Meier method with a log-rank test (Mantel-Cox, 95% CI). Lysholm, Tegner activity, Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) scores as well as laxity measurements obtained using a KT-1000 arthrometer were recorded for all intact grafts, and a Mann-Whitney U test was used for comparison reasons. Results: The rupture rates for LARS and ABC grafts were 31% (95% CI, 20%-42%) and 42% (95% CI, 25%-59%), respectively. For intact grafts, the mean Lysholm score was good for both groups (90 for the LARS group and 89 for the ABC group), with the majority of patients returning to their preinjury level of activities, and the mean IKDC score was 90 for the LARS group and 86 for the ABC group. Conclusion: The rupture rates of both LARS and ABC grafts were both high. However, the LARS ligament provided significantly better survivorship compared with the ABC ligament at short- to midterm follow-up (95% CI). PMID:27453894

  9. Bollen's jig and anterior cruciate ligament reconstruction.

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    Ng, A B; Bollen, S R

    2000-10-01

    We report the design of a surgical instrument that facilitates the harvest of the autologous patellar tendon in anterior cruciate ligament (ACL) reconstruction. The advantage of this jig is that it is a simple, self-centring device resulting in a reproducible and consistent autograft. Its use also minimises the potential risks of donor site morbidity such as patellar fracture and tendon rupture. We briefly describe our technique and discuss its advantages.

  10. Lateral reinforcement in anterior cruciate ligament reconstruction

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    Timothy D. Lording

    2014-01-01

    Full Text Available Lateral extra-articular procedures were popular in the treatment of anterior cruciate ligament injury in the nineteen seventies and eighties, but fell from favor due to poor results, concerns regarding biomechanics, and concurrent advances in intra-articular reconstruction. Persistent problems with rotational control in modern reconstructive techniques have lead to a resurgence of interest in the concept of lateral reinforcement. In this article, we examine the history of lateral extra-articular procedures, the reasons for renewed interest in the technique, recent research that lends support to lateral procedures and possible indications for selective use.

  11. Anterior cruciate ligament reconstruction: principles of treatment

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    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

  12. Outcomes in Anterior Cruciate Ligament Reconstruction Surgery

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    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.

  13. Reconstruction of the Anterior Cruciate Ligament : Alternative Strategies

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    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

  14. Neuroplasticity Associated With Anterior Cruciate Ligament Reconstruction.

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    Grooms, Dustin R; Page, Stephen J; Nichols-Larsen, Deborah S; Chaudhari, Ajit M W; White, Susan E; Onate, James A

    2017-03-01

    Study Design Controlled laboratory study. Background Anterior cruciate ligament (ACL) injury may result in neuroplastic changes due to lost mechanoreceptors of the ACL and compensations in neuromuscular control. These alterations are not completely understood. Assessing brain function after ACL injury and anterior cruciate ligament reconstruction (ACLR) with functional magnetic resonance imaging provides a means to address this gap in knowledge. Objective To compare differences in brain activation during knee flexion/extension in persons who have undergone ACLR and in matched controls. Methods Fifteen participants who had undergone left ACLR (38.13 ± 27.16 months postsurgery) and 15 healthy controls matched on age, sex, height, mass, extremity dominance, education level, sport participation, and physical activity level participated. Functional magnetic resonance imaging data were obtained during a unilateral knee motor task consisting of repeated cycles of knee flexion and extension. Results Participants who had undergone ACLR had increased activation in the contralateral motor cortex, lingual gyrus, and ipsilateral secondary somatosensory area and diminished activation in the ipsilateral motor cortex and cerebellum when compared to healthy matched controls. Conclusion Brain activation for knee flexion/extension motion may be altered following ACLR. The ACLR brain activation profile may indicate a shift toward a visual-motor strategy as opposed to a sensory-motor strategy to engage in knee movement. Level of Evidence Cohort, level 3. J Orthop Sports Phys Ther 2017;47(3):180-189. Epub 5 Nov 2016. doi:10.2519/jospt.2017.7003.

  15. 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 e...

  16. Oblique reconstruction of the cruciate ligaments on computed tomography

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    Ihara, Hidetoshi; Nishino, Koshi; Koga, Masayuki; Kitakata, Akira; Deya, Keizo; Nakagawa, Hiroto

    1984-12-01

    Optimal positioning where the entire longitudinal axis of the cruciate ligaments could be demonstrated on computed tomography was discovered by using an amputated knee and was applied clinically. To demonstrate the anterior cruciate ligament, the patient was positioned on the table with the hip flexed, abducted, externally rotated and knee flexed at a 110-140 degrees angle. For the posterior cruciate ligament, the patient was placed in a prone position on the table with the knee flexed at a 50 degrees angle. These positions, especially the one for the anterior cruciate ligament, were difficult for some patients with gonalgia or limited range of motion. Reconstruction in the oblique planes was studied for those patients by using an amputated knee and quasi-ligament made of gum. Clinically, an axial image was obtained by the simple position of the patient lying prone on the table with knee extended. Oblique reconstruction was made from the axial images and this reconstructed image also demonstrated the entire longitudinal axis of the ligament. The rupture of the cruciate ligaments could be assessed by the reconstructed image in the oblique plane. (author).

  17. Failure of Anterior Cruciate Ligament Reconstruction

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    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

  18. Anatomic anterior cruciate ligament reconstruction using an individualized approach

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    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.

  19. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

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    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

  20. 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

  1. 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

    -constructions were stimulated. The sensory threshold was 3.4 times higher in the ACL than in the PCL. Stimulus amplitudes were increased to 1.5-2.0 times the sensory threshold, and a typical inhibitory reflex could be elicited in 9 patients. The latency was the same as for the reflex from the PCL. The stimulus......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...

  2. Psychological Aspects of Recovery Following Anterior Cruciate Ligament Reconstruction.

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    Christino, Melissa A; Fantry, Amanda J; Vopat, Bryan G

    2015-08-01

    Recovery following anterior cruciate ligament reconstruction is an arduous process that requires a significant mental and physical commitment to rehabilitation. Orthopaedic research in recent years has focused on optimizing anterior cruciate ligament surgical techniques; however, despite stable anterior cruciate ligament reconstructions, many athletes still never achieve their preinjury ability or even return to sport. Psychological factors associated with patient perceptions and functional outcomes following anterior cruciate ligament reconstruction are important to acknowledge and understand. Issues related to emotional disturbance, motivation, self-esteem, locus of control, and self-efficacy can have profound effects on patients' compliance, athletic identity, and readiness to return to sport. The psychological aspects of recovery play a critical role in functional outcomes, and a better understanding of these concepts is essential to optimize the treatment of patients undergoing anterior cruciate ligament reconstruction, particularly those who plan to return to sport. Identifying at-risk patients, encouraging a multidisciplinary approach to patient care, and providing early referral to a sports psychologist may improve patient outcomes and increase return-to-play rates among athletes. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

  3. Bone tunnel enlargement on anterior cruciate ligament reconstruction.

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    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.

  4. Characteristics of bone tunnel changes after anterior cruciate ligament reconstruction using Ligament Advanced Reinforcement System artificial ligament.

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    Huang, Jian-ming; Liu, Hao-yuan; Chen, Feng-rong; Jian, Guo-jian; Chen, Qi; Wang, Zi-min; Kang, Yi-fan

    2012-11-01

    There are different materials used for anterior cruciate ligament (ACL) reconstruction. It has been reported that both autologous grafts and allografts used in ACL reconstruction can cause bone tunnel enlargement. This study aimed to observe the characteristics of bone tunnel changes and possible causative factors following ACL reconstruction using Ligament Advanced Reinforcement System (LARS) artificial ligament. Forty-three patients underwent ACL reconstruction using LARS artificial ligament and were followed up for 3 years. X-ray and CT examinations were performed at 1, 3, 6, 12, 24, and 36 months after surgery, to measure the width of tibial and femoral tunnels. Knee function was evaluated according to the Lysholm scoring system. The anterior and posterior stability of the knee was measured using the KT-1000 arthrometer. According to the Peyrache grading method, grade 1 femoral bone tunnel enlargement was observed in three cases six months after surgery. No grade 2 or grade 3 bone tunnel enlargement was found. The bone tunnel enlargement in the three cases was close to the articular surface with an average tunnel enlargement of (2.5 ± 0.3) mm. Forty cases were evaluated as grade 0. The average tibial and femoral tunnel enlargements at the last follow-up were (0.8 ± 0.3) and (1.1 ± 0.3) mm, respectively. There was no statistically significant difference in bone tunnel width changes at different time points (P > 0.05). X-ray and CT measurements were consistent. There was no marked bone tunnel enlargement immediately following ACL reconstruction using LARS artificial ligament. Such enlargement may, however, result from varying grafting factors involving the LARS artificial ligament or from different fixation methods.

  5. 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.

  6. Anterior Cruciate Ligament Reconstruction in Ehlers-Danlos Syndrome

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    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.

  7. Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee.

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    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.

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

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    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.

  9. Magnetic resonance imaging evaluation of cruciate ligaments after arthroscopic reconstruction

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    Amit Kharat

    2017-01-01

    Full Text Available Background: Due to increase in road traffic and sports injuries, tears of anterior cruciate ligament (ACL and the posterior cruciate ligament (PCL of the knee are common. Magnetic resonance imaging (MRI is emerging as an important tool of diagnosis and evaluation of these injuries. Methods: We carried out a prospective study on role of MRI on ten patients who had undergone ACL or PCL repair over a period of six months. In this report we present three illustrative cases to capture the spectrum of findings in our series to underline the role of MRI in management of such injuries and discuss the modalities of the procedure. Results: In our series, as demonstrated by the cases, MRI had an important role in diagnosis and evaluation of injuries to the cruciate ligaments. Conclusion: MRI can play an important role, particularly in tertiary centres, in diagnosis and evaluation of reconstructed ACL and PCL ligaments of the knee joint.

  10. Clinical and radiographic outcome of cranial cruciate ligament reconstruction in dogs using frozen pattelar ligament allograft

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    Biasi, F. de; Rahal, S.C.; Volpi, R.S.; Mamprim, M.I.; Bergamo, F.M.M.; Ishiy, H.M.

    2002-01-01

    The purpose of the study was to evaluate the clinical and radiographic outcome of cranial cruciate ligament reconstruction using frozen pattelar ligament allograft at –20 ºC, fixed with interference screw and blount clamp. Ten crossbred dogs, between one and three years old, weightening 18 to 25 Kg, were submitted to left cranial cruciate desmotomy, based on the Pond & Nuki model. After 30 days, they were divided in two groups. In the group B, it was performed ligament reconstruction, and the group A received no treatment (control). The follow-up period was 90 days. Group B showed better limb function, less muscle hipotrophy and lower severity of the radiographic lesions in the knee when compared to control group (p value [pt

  11. An In Vitro Robotic Assessment of the Anterolateral Ligament, Part 2: Anterolateral Ligament Reconstruction Combined With Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Nitri, Marco; Rasmussen, Matthew T; Williams, Brady T; Moulton, Samuel G; Cruz, Raphael Serra; Dornan, Grant J; Goldsmith, Mary T; LaPrade, Robert F

    2016-03-01

    Recent biomechanical studies have demonstrated that an extra-articular lateral knee structure, most recently referred to as the anterolateral ligament (ALL), contributes to overall rotational stability of the knee. However, the effect of anatomic ALL reconstruction (ALLR) in the setting of anterior cruciate ligament (ACL) reconstruction (ACLR) has not been biomechanically investigated or validated. The purpose of this study was to investigate the biomechanical function of anatomic ALLR in the setting of a combined ACL and ALL injury. More specifically, this investigation focused on the effect of ALLR on resultant rotatory stability when performed in combination with concomitant ACLR. It was hypothesized that ALLR would significantly reduce internal rotation and axial plane translation laxity during a simulated pivot-shift test compared with isolated ACLR. Controlled laboratory study. Ten fresh-frozen cadaveric knees were evaluated with a 6 degrees of freedom robotic system. Knee kinematics were evaluated with simulated clinical examinations including a simulated pivot-shift test consisting of coupled 10-N·m valgus and 5-N·m internal rotation torques, a 5-N·m internal rotation torque, and an 88-N anterior tibial load. Kinematic differences between ACLR with an intact ALL, ACLR with ALLR, and ACLR with a deficient ALL were compared with the intact state. Single-bundle ACLR tunnels and ALLR tunnels were placed anatomically according to previous quantitative anatomic attachment descriptions. Combined anatomic ALLR and ACLR significantly improved the rotatory stability of the knee compared with isolated ACLR in the face of a concurrent ALL deficiency. During a simulated pivot-shift test, ALLR significantly reduced internal rotation and axial plane tibial translation when compared with ACLR with an ALL deficiency. Isolated ACLR for the treatment of a combined ACL and ALL injury was not able to restore stability of the knee, resulting in a significant increase in

  12. 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.

  13. Combined Anatomic Anterior Cruciate Ligament and Double Bundle Anterolateral Ligament Reconstruction

    OpenAIRE

    Zein, Assem Mohamed Noureldin; Elshafie, Mohamed; Elsaid, Ahmed Nady Saleh; Elrefai, Mohamed Ahmed Elsaid

    2017-01-01

    The results of arthroscopic anterior cruciate ligament (ACL) reconstruction are so far satisfactory and improving over time as a result of the improved understanding of the anatomy and biomechanics of the ACL. Rotational instability confirmed by a positive pivot shift is present in more than 15% of cases who underwent successful ACL reconstruction. Persistent rotational instability interferes with performing pivoting sports, and also may lead to meniscal and chondral injuries, or re-rupture o...

  14. Anterior cruciate ligament injury, reconstruction, and the optimization of outcome

    Directory of Open Access Journals (Sweden)

    James Philip Bliss

    2017-01-01

    Full Text Available 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.

  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. 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.

  17. Biomechanical comparison of rotational activities between anterior cruciate ligament- and posterior cruciate ligament-reconstructed patients.

    Science.gov (United States)

    Lim, Bee Oh; Shin, Han Sol; Lee, Yong Seuk

    2015-04-01

    The purpose of this study was to compare the early functional recovery using biomechanical properties between anterior cruciate ligament (ACL)- and posterior cruciate ligament (PCL)-reconstructed patients and to determine the biomechanical deficit of PCL-reconstructed patients compared to ACL-reconstructed patients. A motion analysis system was used to measure and calculate kinematic and kinetic data for 10 patients who underwent PCL-reconstructed patients [experimental group (group 1)], 10 ACL-reconstructed patients (group 2), and 10 healthy subjects (group 3) during 45°, 90°, 135°, and 180° cutting and turn running tasks. Groups 1 and 2 were assessed at 3 (return to daily activity) and 6 months (return to light sports) postoperatively. At 3 months postoperatively, compared to groups 2 and 3, group 1 showed a decrease in knee flexion angle, extension moment, valgus moment, external rotational moment, ground reaction force, and increased hamstring-quadriceps ratio. At 6 months postoperatively, results from group 1 resembled those of groups 2 and 3 over time. Patients who underwent PCL reconstruction showed some biomechanical deficits in performance of activities requiring rotation, compared to those who underwent ACL reconstruction. Therefore, the modification of a rehabilitation programme for patients who underwent PCL reconstruction would be necessary for improvement of the biomechanical properties during performance of dynamic activities. Case-control study, Level III.

  18. 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.

  19. 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...... in the degree of tunnel widening between the two groups. The mean increase in femoral tunnel area in the hamstring group was 100.4% compared with a decrease of 25% in the patella tendon group (P = hamstring group was 73.9% compared with a decrease of 2.......1% in the patella tendon group (P = hamstring group. Tunnel widening does not correlate with instability...

  20. Patellofemoral ligament reconstruction in a patient with Rubinstein-Taybi syndrome.

    Directory of Open Access Journals (Sweden)

    Fardin Mirzatolooei

    2014-03-01

    Full Text Available Recurrent dislocation of patella may occur in patients with ligament laxity. Method of treatment in this condition is controversial but patellofemoral ligament reconstruction is the most accepted method. We present a patient with Rubinstein-Taybi syndrome and recurrent patellar dislocation who managed successfully by patellofemoral ligament reconstruction.

  1. Reconstruction of chronic acromioclavicular joint disruption with artificial ligament prosthesis

    Directory of Open Access Journals (Sweden)

    Chouhan Devendra Kumar

    2013-08-01

    Full Text Available 【Abstract】Objective: Management of Rockwood type 3 acromioclavicular disruptions is a matter of debate. Should we adopt conservative or operative measures at first presentation? It is not clear but most of the evidences are in favour of conservative management. We present our expe-rience in managing these patients surgically. Methods: We present a prospective series of eight cases of chronic Rockwood type 3 acromioclavicular joint disruptions treated surgically. Anatomical reconstruction of the coracoclavicular ligament was done by artificial braided polyester ligament prosthesis. Results: All the patients were able to perform daily activities from an average of the 14th postoperative day. All patients felt an improvement in pain, with decrease in ave-rage visual analogue scale from preoperative 6.5 points (range 3-9 points to 2.0 points (range 0-5 points, Constant score from 59% to 91% and American Shoulder and Elbow Surgeons shoulder score from 65 to 93 points postoperatively. These results improved or at least remained stationary on midterm follow-up, and no deterioration was recorded at an average follow-up of 46 months. Conclusion: This midterm outcome analysis of the artificial ligament prosthesis is the first such follow-up study with prosthesis. Our results are encouraging and justify the further use and evaluation of this relatively new and easily reproducible technique. Key words: Acromioclavicular joint; Prostheses and implants; Reconstructive surgical procedures; Ligaments

  2. Return to play following anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Ellman, Michael B; Sherman, Seth L; Forsythe, Brian; LaPrade, Robert F; Cole, Brian J; Bach, Bernard R

    2015-05-01

    In athletes, significant advances in anterior cruciate ligament reconstruction techniques and rehabilitation have led to improved surgical outcomes and increased expectations for return to play. Although an expeditious return to sport has become an achievable and often realistic goal, the factors that most influence safe, timely, and successful return to play remain unknown. The literature offers mainly anecdotal evidence to guide the team physician in the decision-making process, with a paucity of criteria and consensus guidelines available to help determine return to sport. Attempts have been made to introduce criteria-based progression in the rehabilitation process, but validation of subjective and objective criteria has been difficult. Nevertheless, several pertinent factors in the preoperative, intraoperative, and postoperative periods may affect return to play following anterior cruciate ligament reconstruction. Further research is warranted to validate reliable, consensus guidelines with objective criteria to facilitate the return to play process. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

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

    OpenAIRE

    Demet Pepele

    2014-01-01

    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 ...

  4. Popliteal artery injury during posterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Marcos Henrique Frauendorf Cenni

    2015-06-01

    Full Text Available This study reports a case of popliteal artery injury during arthroscopic reconstruction of the posterior cruciate ligament. The evolution of the injury is described and comments are made regarding the anatomy of this artery and potential risks of this surgical technique. This study had the aims of alerting the medical community, especially knee surgeons, regarding a severe surgical complication and discussing the ways of preventing it.

  5. Reconstruction of the anterior cruciate ligament of the knee

    Directory of Open Access Journals (Sweden)

    Nikolić Dragan

    2006-01-01

    Full Text Available Background/Aim. Numerous papers on reconstruction of the anterior cruciate ligament of the knee (ACL contribute to the significance of this method. The aim of this study was to analyze the outcome of the use of this surgical treatment method regardless the type of surgical intervention, graft, and the choice of the material for fixing. Methods. The study included 324 patients treated within the period from April 1997 to April 2004. Arthroscopically assisted ACL reconstruction was typically performed using the central one-third of the patellar ligament, as a graft, with bone blocks. Fixing was performed using screws (spongy or interferential, Mitek type. In the cases who required revision of the surgery, we used a graft m. semitendinosus and m. gracilise (STG or a graft of the patellar ligament (B-Pt-B. Fixation in these cases was performed using absorptive wedges according to the Rigidfix technique or metallic implants. Results. The analysis included the results of the reconstruction of the anterior cruciate ligament of the knee (B-Pt-B or STG graft in 139 of the knees. Chronic injuries were revealed in 132 (94.9% of the knees. According to the anamnesis and clinical findings, the feeling of instability prevailed in 132 (94.9% of the knees, pain in 72 (51.7%, effluents in 24 (17.2%, and blockages in 13 (9.3%. Early and late postoperative complications were noticeable in 3.5% each. Hypotrophy of the upper knee musculature up to 2 cm was present in 53.9% of the operated knees, while minor contractions in 13.6% of them. The final result of the reconstruction graded begusing the Lysholm Scale was 85.2, simultaneous reconstructions of other ligaments 75.3, and revision surgery 68.0. First-grade degenerative postoperative changes according to the K/L Scale were found in 55.0% of the surgically treated knees, while the worst, four-grade one in 2.5%. Conclusion. On the basis of these findings, we can conclude that this method is the method of choice in

  6. 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.

  7. 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.

  8. Graft selection in anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Miller, Suzanne L; Gladstone, James N

    2002-10-01

    Selecting the appropriate graft for ACL reconstruction depends on numerous factors including surgeon philosophy and experience, tissue availability (affected by anatomical anomalies or prior injury or surgery), and patient activity level and desires. Although the patella tendon autograft has the widest experience in the literature, and is probably the most commonly used graft source, this must be tempered with the higher reported incidences of potential morbidity and pitfalls associated with its use. The hamstring tendons are gaining increasing popularity, mostly due to reduced harvest morbidity and improved soft tissue fixation techniques, and many recent studies in the literature report equal results to BTB ACL reconstruction with respect to functional outcome and patient satisfaction. On the other hand, many of these studies report higher degrees of instrument (KT-100) tested laxity for hamstring reconstruction, and some have reported lower returns to preinjury levels of activity. One question that remains to be addressed is how closely objectively measured laxity tests correlate with subjectively assessed outcomes and ability to return to high levels of competitive sports. Allograft use, which decreased in popularity during the 1990s, appears to be undergoing a resurgence, with better sterilization processes and new graft sources (tibialis tendons), leading to increased availability and improved fixation techniques. The benefits of decreased surgical morbidity and easier rehabilitation must be weighed against the potential for greater failure of biologic incorporation, infection, and possibly slower return to activities. In our practice, for high-demand individuals (those playing cutting, pivoting, or jumping sports and skiing) BTB tends to be the graft of choice. For lower demand or older individuals, hamstring reconstructions will be performed. Allograft tissue will be used in older individuals (generally over 45 years old), those with signs of arthritis (and

  9. Septic arthritis of the knee following anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Matjaz Sajovic

    2009-04-01

    Full Text Available Septic arthritis of the knee is a rare complication after arthroscopic anterior cruciate ligament reconstruction, and the most appropriate treatment is unclear. All case series reported so far have been retrospective, and case numbers of septic arthritis have ranged from 4 to 11. From a consecutive case series of 1,283 patients who underwent arthroscopic anterior cruciate ligament reconstruction between January 1997 and May 2008, we report on 3 patients (0.23% with post-operative septic arthritis. All patients had acute infection (≤ 2 weeks, bacterial cultures showed Staphylococcus species in 2 patients, while the bacterial culture was negative in the third. All of them underwent immediate arthroscopic debridement and lavage with continuous irrigation, as well as antibiotic treatment. The results were evaluated with physical and radiographic examination, functional testing, KT-2000, Lysholm and Tegner scales. The infection was successfully eradicated without further surgical treatment and the ligament graft was retained in all patients. Follow-up, at an average of 33 months, revealed that the patients had full symmetric knee range of motion and no effusion. The average Lysholm score was 91 points. In the patient with a lower subjective score, radiographs demonstrated patellofemoral joint-space narrowing, which is most probably in correlation with his anterior knee pain problems and lower activity level. The 134 N KT-2000 arthrometer side-to-side differences averaged 13 mm. Their performance in the single-legged hop test gave excellent results. The goals of treatment for septic arthritis after anterior cruciate ligament reconstruction are, primarily, to protect the articular cartilage and, secondly, to protect the graft. Through early diagnosis and prompt treatment, the infection can be successfully eradicated, with stability of the knee and full range of motion achieved.

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

    Science.gov (United States)

    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.

  11. Surgical Indications and Technique for Anterior Cruciate Ligament Reconstruction Combined with Lateral Extra-articular Tenodesis or Anterolateral Ligament Reconstruction.

    Science.gov (United States)

    Vundelinckx, Bart; Herman, Benjamin; Getgood, Alan; Litchfield, Robert

    2017-01-01

    After anterior cruciate ligament (ACL) rupture, anteroposterior and rotational laxity in the knee causes instability, functional symptoms, and damage to other intra-articular structures. Surgical reconstruction aims to restore the stability in the knee, and to improve function and ability to participate in sports. It also protects cartilage and menisci from secondary injuries. Because of persistent rotational instability after ACL reconstruction, combined intra-articular and extra-articular procedures are more commonly performed. In this article, an overview of anatomy, biomechanical studies, current gold standard procedures, techniques, and research topics are summarized. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. 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.

  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. Medial patellofemoral ligament and medial patellotibial ligament reconstruction in children: preliminary results

    Directory of Open Access Journals (Sweden)

    David Sadigursky

    Full Text Available ABSTRACT OBJECTIVE: The aim of this study was to evaluate the reconstruction of the medial patellofemoral ligament associated with the medial patellotibial ligament in skeletally immature patients. METHOD: This is a case series study in patients with patellar instability with open physis. In total, seven patients were evaluated: four males and three females were operated using the proposed technique. Patients with open physis who had more than two episodes of recurring patellar dislocation were included. No patients underwent additional procedures. The distance from the anterior tibial tuberosity to the trochlea grove (TT-TG was measured in all patients. On physical examination, the inverted J-sign, the apprehension sign, and the knee range of motion parameters were used in the pre- and post-operative period. In addition, the Kujala and Lysholm scores were applied before and 12 months after surgery. The results were analyzed with the Wilcoxon test. RESULTS: The mean age of the patients was 11.28 in both genders. Comparing the data of the pre- and post-operative period, the inverted J-sign was present in six patients (85.7% vs. absent in one (14.3%. The apprehension sign was absent in cases in the postoperative period; the range of motion was 117.85 ± 8.09 vs. 148.57 ± 3.77. The Kujala score was 42.57 ± 8.9 vs. 88.57 ± 5.09 and the Lysholm scores were classified as excellent or good in 28.6% and 71.4%, respectively. CONCLUSION: The combined reconstruction of the medial patellofemoral ligament combined with the medial patellotibial ligament in skeletally immature patients with predisposing factors, presents satisfactory results without episodes of recurrence or residual subluxation; according to these preliminary results, it should be considered as a treatment option.

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

    Directory of Open Access Journals (Sweden)

    Tahmasebi MN

    2009-04-01

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

  16. Comparison of the Source and Quality of Information on the Internet Between Anterolateral Ligament Reconstruction and Anterior Cruciate Ligament Reconstruction: An Australian Experience.

    Science.gov (United States)

    Devitt, Brian M; Hartwig, Taylor; Klemm, Haydn; Cosic, Filip T; Green, James; Webster, Kate E; Feller, Julian A; Baker, Joseph F

    2017-12-01

    The internet is a valuable tool, but concerns exist regarding the quality and accuracy of medical information available online. To evaluate the source and quality of information on the internet relating to anterolateral ligament reconstruction (ALLR) compared with anterior cruciate ligament reconstruction (ACLR). Cross-sectional study. A questionnaire was administered to 50 ACLR patients in Australia to determine their use of the internet to research their operation and their familiarity with the anterolateral ligament (ALL) of the knee. The most common search terms were determined, and the first 70 websites returned by the 5 most popular search engines were used to assess the quality of information about ACLR and ALLR. Each site was categorized by type and was assessed for quality and validity using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and a novel specific content score for each procedure. The presence of the Health on the Net Code (HONcode) seal was also recorded. The majority (84%) of ACLR patients used the internet to research their operation. The quality of information available for ALLR was significantly inferior to that for ACLR according to the DISCERN score (37.3 ± 3.4 vs 54.4 ± 4.6; P quality of information on the internet relating to ALLR was significantly inferior to information about ACLR. Most ALLR websites failed to include crucial information about the indication or options for treatment, prognosis, and potential complications. Surgeons should be aware of the information to which their patients are exposed through the internet and should be proactive in directing patients to appropriate websites.

  17. 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

  18. 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 ...

  19. 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.

  20. Medial patellofemoral ligament reconstruction: patient selection and perspectives

    Directory of Open Access Journals (Sweden)

    Baer MR

    2017-09-01

    Full Text Available Michael R. Baer, Jeffrey A. Macalena Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA Abstract: Patellofemoral instability is a painful and often recurring disorder with many negative long-term consequences. After a period of failed nonoperative management, surgical intervention has been used to reduce the incidence of patellar subluxation and dislocations. Medial patellofemoral ligament (MPFL reconstruction successfully addresses patellofemoral instability by restoring the deficient primary medial patellar soft tissue restraint. When planning MPFL reconstruction for instability, it is imperative to consider the patient’s unique anatomy including the tibial tuberosity–trochlear groove (TT–TG distance, trochlear dysplasia, and patella alta. Additionally, it is important to individualize surgical treatment in the skeletally immature, hypermobile, and athletic populations. Keywords: MPFL, indications, considerations, contraindications

  1. 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 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).

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

    Science.gov (United States)

    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.

  3. Anterior cruciate ligament reconstruction failure after tibial shaft malunion.

    Science.gov (United States)

    LaFrance, Russell M; Gorczyca, John T; Maloney, Michael D

    2012-02-17

    Anterior cruciate ligament (ACL) reconstruction is common, with >100,000 procedures performed each year in the United States. Several factors are associated with failure, including poor surgical technique, graft incorporation failure, overly aggressive rehabilitation, and trauma. Tibial shaft fracture is also common and frequently requires operative intervention. Failure to reestablish the anatomic alignment of the tibia may cause abnormal forces across adjacent joints, which can cause degenerative joint disease or attritional failure of the surrounding soft tissues. This article describes a case of ACL reconstruction failure after a tibial fracture that resulted in malunion. Excessive force across the graft from lower-extremity malalignment and improper tunnel placement likely contributed to the attritional failure of the graft. This patient required a staged procedure for corrective tibial osteotomy followed by revision ACL reconstruction. This article describes ACL reconstruction failure, tibial shaft malunions, their respective treatments, the technical details of each procedure, and the technical aspects that must be considered when these procedures are done in a staged manner by 2 surgeons. Copyright 2012, SLACK Incorporated.

  4. An osteogenesis/angiogenesis-stimulation artificial ligament for anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Li, Hong; Li, Jinyan; Jiang, Jia; Lv, Fang; Chang, Jiang; Chen, Shiyi; Wu, Chengtie

    2017-05-01

    To solve the poor healing of polyethylene terephthalate (PET) artificial ligament in bone tunnel, copper-containing bioactive glass (Cu-BG) nanocoatings on PET artificial ligaments were successfully prepared by pulsed laser deposition (PLD). It was hypothesized that Cu-BG coated PET (Cu-BG/PET) grafts could enhance the in vitro osteogenic and angiogenic differentiation of rat bone marrow mesenchymal stem cells (rBMSCs) and in vivo graft-bone healing after anterior cruciate ligament (ACL) reconstruction in a goat model. Scanning electron microscope and EDS mapping analysis revealed that the prepared nanocoatings had uniform element distribution (Cu, Ca, Si and P) and nanostructure. The surface hydrophilicity of PET grafts was significantly improved after depositing Cu-BG nanocoatings. The in vitro study displayed that the Cu-BG/PET grafts supported the attachment and proliferation of rBMSCs, and significantly promoted the expression of HIF-1α gene, which up-regulated the osteogenesis-related genes (S100A10, BMP2, OCN) and angiogenesis-related genes (VEGF) in comparison with PET or BG coated PET (BG/PET) grafts which do not contain Cu element. Meanwhile, Cu-BG/PET grafts promoted the bone regeneration at the graft-host bone interface and decreased graft-bone interface width, thus enhancing the bonding strength as well as angiogenesis (as indicated by CD31 expression) in the goat model as compared with BG/PET and pure PET grafts. The study demonstrates that the Cu-containing biomaterials significantly promote osteogenesis and angiogenesis in the repair of bone defects of large animals and thus offering a promising method for ACL reconstruction by using Cu-containing nanobioglass modified PET grafts. It remains a significant challenge to develop an artificial graft with distinct osteogenetic/angiogenetic activity to enhance graft-bone healing for ligament reconstruction. To solve these problems, copper-containing bioactive glass (Cu-BG) nanocoatings on PET artificial

  5. A New Reconstructive Technique of the Anterolateral Ligament with Iliotibial Band-Strip

    OpenAIRE

    Stuyts, Bart; Van den Eeden, Elke; Victor, Jan

    2017-01-01

    Background: Anterior cruciate ligament (ACL) reconstruction is a well-established surgical procedure for the correction of ACL ruptures. However, the incidence of instability following ACL reconstruction is substantial. Recent studies have led to greater insight into the anatomy and the radiographic characteristics of the native anterolateral ligament (ALL), along with its possible role in residual instability after ACL reconstruction. Method: The current paper describes a lateral extra-artic...

  6. Meniscal survival rate after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Rochcongar, G; Cucurulo, T; Ameline, T; Potel, J F; Dalmay, F; Pujol, N; Sallé de Chou, É; Lutz, C; Ehkirch, F P; Le Henaff, G; Laporte, C; Seil, R; Gunepin, F X; Sonnery-Cottet, B

    2015-12-01

    Meniscal suture provides well-documented benefits. Integrity of the cruciate ligaments of the knee is a prerequisite for meniscal healing. Nevertheless, reconstruction of the anterior cruciate ligament (ACL) does not consistently prevent recurrent tearing of a sutured meniscus. We evaluated meniscal survival rates, 5 and 10 years after meniscal suture concomitant with an ACL reconstruction. We compared the outcomes of these repaired menisci to those in which no menisci tears were detected during ACL reconstruction. In this multi-centric retrospective study, we included two groups. One group consists of patients who underwent a meniscal repair. This group was further divided into two subgroups based on whether follow-up was 5 years (n=76) or 10 years (n=39). The control group included 120 patients with normal menisci observed during surgery. We studied meniscal survival rates in each group, and we analyzed risk factors associated with the recurrence of meniscal lesions. The 5-year meniscal survival rate was significantly higher in the control group than in the meniscal-repair group (95% vs. 80%, respectively; P=0.0029). The controls group also had a higher meniscal survival rate after 10 years, although the difference was not statistically significant (88% vs. 77%, P=0.07). A difference in knee laxity greater than 4mm was associated with a 5-fold increase in the risk of recurrent meniscal tears (P=0.0057). After 5 years, the risk of recurrence was higher for the medial than for the lateral meniscus, whereas after 10 years the difference was no longer statistically significant. Although insufficient healing after meniscal suturing contributes to the risk of further meniscal tears, new lesions can develop in menisci that were undamaged at the time of ACL reconstruction. The risk of a new meniscal lesion is strongly associated with inadequate control of antero-posterior and rotational laxity. Some apparently "new menisci lesions" seems to have been missed during ACL

  7. Isokinetic dynamometry in anterior cruciate ligament injury and reconstruction.

    Science.gov (United States)

    Pua, Yong Hao; Bryant, Adam L; Steele, Julie R; Newton, Robert U; Wrigley, Tim V

    2008-04-01

    The use of isokinetic dynamometry has often been criticised based on the face-validity argument that isokinetic movements poorly resemble the everyday multi-segmented, dynamic activities of human movements. In the anterior cruciate ligament (ACL) reconstruction or deficiency population where muscle deficits are ubiquitous, this review paper has made a case for using isokinetic dynamometry to isolate and quantify these deficits in a safe and controlled manner. More importantly, the usefulness of isokinetic dynamometry, as applied in individuals with ACL reconstruction or deficiency, is attested by its established known-group and convergent validity. Known-group validity is demonstrated by the extent to which a given isokinetic measure is able to identify individuals who could and could not resume pre-morbid athletic or strenuous activities with minimal functional limitations following an ACL injury. Convergent validity is demonstrated by the extent to which a given isokinetic measure closely associates with self-report measures of knee function in individuals with ACL reconstruction. A basic understanding of the measurement properties of isokinetic dynamometry will guide the clinicians in providing reasoned interventions and advancing the clinical care of their clients.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. 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.

  10. 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.

  11. Crucial role of Notch signaling in osteogenic differentiation of periodontal ligament stem cells in osteoporotic rats.

    Science.gov (United States)

    Li, Ying; Li, S Q; Gao, Y M; Li, Jin; Zhang, Bin

    2014-06-01

    Estrogen deficiency-induced osteoporosis typically occurs in postmenopausal women and has been strongly associated with periodontal diseases. Periodontal ligament stem cells (PDLSCs) isolated from the periodontal ligament can differentiate into many types of specialized cells, including osteoblast-like cells that contribute to periodontal tissue repair. The Notch signaling pathway is highly conserved and associated with self-renewal potential and cell-fate determination. Recently, several studies have focused on the relationship between Notch signaling and osteogenic differentiation. However, the precise mechanisms underlying this relationship are largely unknown. We have successfully isolated PDLSCs from both ovariectomized (OVX) and sham-operated rats. Both the mRNA and protein levels of Notch1 and Jagged1 were upregulated when PDLSCs were cultured in osteogenic induction media. Mineralization assays showed decreased calcium deposits in OVX-PDLSCs treated with a γ-secretase inhibitor compared with control cells. Thus Notch signaling is important in maintaining the osteogenic differentiation of PDLSCs in osteoporotic rats, which help in the development of a potential therapeutic strategy for periodontal disease in postmenopausal women. © 2014 International Federation for Cell Biology.

  12. Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction.

    Science.gov (United States)

    Dong, Jiangtao; Wang, Xiao Feng; Men, Xiaoqian; Zhu, Junjun; Walker, Garth N; Zheng, Xiao Zuo; Gao, Jin Bao; Chen, Baicheng; Wang, Fei; Zhang, Yingze; Gao, Shi Jun

    2015-06-01

    The purpose of this study was to evaluate the clinical results of medial collateral ligament (MCL) anatomic ligament repair (ALR) and triangular ligament reconstruction (TLR) in treating acute grade III MCL injury with respect to imaging and functional results. Between January 2009 and October 2011, a total of 69 patients with an acute grade III MCL tear combined with an anterior cruciate ligament tear were divided into 2 groups: those who underwent ALR and those who underwent TLR. Single-bundle anterior cruciate ligament reconstruction was also performed in all patients. A radiographic stress-position imaging test was performed to evaluate excessive medial opening of the knee. In addition, the Slocum test was carried out to assess anteromedial rotatory instability before surgery and at follow-up. The subjective symptoms and functional outcomes were evaluated preoperatively and postoperatively with International Knee Documentation Committee (IKDC) assessment. Sixty-four patients with a mean follow-up period of 34 months were included in the final analysis. The measurement results for medial opening at the last follow-up appointment decreased significantly from the pretreatment measurements and fell within the normal range, without a statistically significant difference between the 2 groups (P > .05). The overall incidence of anteromedial rotatory instability was reduced to 21.9% compared with 62.5% preoperatively. However, the incidence of anteromedial rotatory instability in the TLR group (9.4%) decreased significantly compared with that in the ALR group (34.4%) (P .05). The comparison of IKDC extension and flexion deficit scores between the 2 groups showed no significant differences. Eleven patients in the ALR group and 4 in the TLR group complained of medial knee pain. The comparison between the 2 groups showed no significant difference (P > .05). The clinical outcomes of this study showed that no major difference existed in the ALR and TLR groups based on IKDC

  13. Collateral ligament reconstruction of the chronic thumb injury with bio-tenodesis screw fixation

    DEFF Research Database (Denmark)

    Gvozdenovic, Robert; Boeckstyns, Michel

    2014-01-01

    We describe a new technique for the reconstruction of chronic lesions of the collateral ligaments of the metacarpophalangeal ligaments of the thumb, using a Bio-Tenodesis screw for the fixation of a tendon graft in a triangular manner with proximal apex and allowing early mobilization, starting 2...

  14. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  16. An Isolated Medial Patellofemoral Ligament Reconstruction with Patellar Tendon Autograft

    Directory of Open Access Journals (Sweden)

    Dariusz Witoński

    2013-01-01

    Full Text Available The aim of the study was to evaluate the results of the medial patellofemoral ligament reconstruction with a medial strip of patellar tendon autograft after a minimum 2-year followup. Ten patients (10 knees were operated on by one surgeon, according to the modified technique, described by Camanho, without any bone plug at free graft end. The mean age of the patients was 27.2 years (ranging from 18 to 42 years. The mean follow-up period was 3 years and 7 months. All patients were reviewed prospectively. At the last follow-up visit, all the patients demonstrated a significant improvement in terms of patellofemoral joint stability, all aspects of the KOOS questionnaire, and Kujala et al.’s score (59.7 points preoperatively and 84.4 points at the last followup. No patient revealed recurrent dislocation. The SF-36 score revealed a significant improvement in bodily pain, general health, physical role functioning, social role functioning, and physical functioning domains. The described MPFL reconstruction with the use of the medial 1/3rd of patella tendon is an effective procedure that gives satisfactorily patellofemoral joint functions, improves the quality of life, and provides much pain relief. It is relatively simple, surgically not extensive, and economically cost-effective procedure.

  17. Qualitative and Quantitative Anatomic Investigation of the Lateral Ankle Ligaments for Surgical Reconstruction Procedures.

    Science.gov (United States)

    Clanton, Thomas O; Campbell, Kevin J; Wilson, Katharine J; Michalski, Max P; Goldsmith, Mary T; Wijdicks, Coen A; LaPrade, Robert F

    2014-06-18

    Lateral ankle sprains are common sports injuries that may require surgery for chronic lateral ankle instability. Anatomic repair or reconstruction is desired, yet there is a scarcity of quantitative information regarding the origins and insertions of the lateral ligaments related to surgically pertinent osseous landmarks. Fourteen ankle specimens were dissected to isolate the anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament, and cervical ligament. A three-dimensional coordinate measurement device was used to determine the origins, insertions, footprint areas, orientations, and distances from osseous landmarks. A single-banded anterior talofibular ligament was identified in seven of the fourteen specimens, and a double-banded anterior talofibular ligament was identified in the remaining seven. The single-banded anterior talofibular ligament originated an average of 13.8 mm (95% confidence interval [CI], 12.3 to 15.3) from the inferior tip of the lateral malleolus at the anterior fibular border and inserted an average of 17.8 mm (95% CI, 16.3 to 19.3) superior to the apex of the lateral talar process along the anterior border of the talar lateral articular facet. The calcaneofibular ligament originated an average of 5.3 mm (95% CI, 4.2 to 6.5) from the inferior tip of the lateral malleolus at the anterior fibular border and inserted an average of 16.3 mm (95% CI, 14.5 to 18.1) from the posterior point of the peroneal tubercle. The posterior talofibular ligament was the largest ligament and originated an average of 4.8 mm (95% CI, 3.7 to 5.9) superior to the inferior tip of the lateral malleolus in the digital fossa to insert an average of 13.2 mm (95% CI, 11.5 to 14.9) from the talar posterolateral tubercle. The cervical ligament originated on the superior part of the calcaneus and inserted at a point that was approximately 50% of the talar neck anteroposterior distance. Consistent distances from the anterior talofibular

  18. Septic arthritis after arthroscopic posterior cruciate ligament and multi-ligament reconstructions is rare and can be successfully treated with arthroscopic irrigation and debridement: analysis of 866 reconstructions.

    Science.gov (United States)

    Schuster, Philipp; Geßlein, Markus; Mayer, Philipp; Schlumberger, Michael; Mayr, Raul; Richter, Jörg

    2018-03-20

    The purpose of this study was to determine the incidence of septic arthritis following arthroscopic posterior cruciate ligament (PCL) and multi-ligament reconstructions, and to evaluate a treatment regime with sequential arthroscopic irrigation and debridement procedures combined with antibiotic therapy that is focused on retention of the graft. Between 2004 and 2016 a total of 866 PCL reconstructions and multi-ligament reconstructions were performed at our institution (408 isolated PCL reconstructions, 458 combined reconstructions). Medical charts of all cases were retrospectively reviewed with regard to the occurrence of septic complications. These cases were analysed with special focus on clinical management, number of reoperations and if the grafts were retained. Further, microbiological findings, postoperative clinical course and available clinical outcome data were evaluated. Four cases of septic arthritis (0.5%) were identified (follow-up rate 96.5%): two following isolated PCL reconstruction (0.5%), and two following multi-ligament reconstruction (0.4%), respectively. Septic arthritis was successfully treated in all cases with a mean of 2.5 ± 2.4 irrigation and debridement procedures (1-6). In one case of isolated PCL reconstruction, the graft was resected within the fifth irrigation and debridement due to septic loosing of the femoral fixation. All other grafts were retained. With regard to the outcome, all patients were subjectively satisfied with good stability (stress radiographs) in cases of retained grafts. Postoperative septic arthritis after arthroscopic PCL and complex knee ligament reconstructions is a rare but serious complication. Arthroscopic graft-retaining treatment is recommended, as it is established in ACL surgery. Graft retention can be expected in the majority of the cases. Case series, Level 4.

  19. Three-Dimensional Anatomic Evaluation of the Anterior Cruciate Ligament for Planning Reconstruction

    Directory of Open Access Journals (Sweden)

    Yuichi Hoshino

    2012-01-01

    Full Text Available Anatomic study related to the anterior cruciate ligament (ACL reconstruction surgery has been developed in accordance with the progress of imaging technology. Advances in imaging techniques, especially the move from two-dimensional (2D to three-dimensional (3D image analysis, substantially contribute to anatomic understanding and its application to advanced ACL reconstruction surgery. This paper introduces previous research about image analysis of the ACL anatomy and its application to ACL reconstruction surgery. Crucial bony landmarks for the accurate placement of the ACL graft can be identified by 3D imaging technique. Additionally, 3D-CT analysis of the ACL insertion site anatomy provides better and more consistent evaluation than conventional “clock-face” reference and roentgenologic quadrant method. Since the human anatomy has a complex three-dimensional structure, further anatomic research using three-dimensional imaging analysis and its clinical application by navigation system or other technologies is warranted for the improvement of the ACL reconstruction.

  20. [Reconstruction of the inguinal ligament with fascia lata sling. First reported case in Hungary].

    Science.gov (United States)

    Bognár, Gábor; Barabás, Loránd; Tóth, Enikő; Schöller, Andrea; István, Gábor

    2017-06-01

    A technique of reconstructing the inguinal ligament using pedicled fascia lata flap is described. A 66-year-old woman was referred with massive incarcerated left inguinal hernia, following acute surgery on a femoral vein leasion and numerous attempts at repair and subsequent recurrences. There was complete absence of the left inguinal ligament. The inguinal ligament was reconstructed using a strip of fascia lata, pedicled on the anterior superior iliac spine. This was transposed to cover the external iliac vessels, and sutured to the pubic tubercle. The musculoaponeurotic abdominal wall was reconstructed with 15×13 cm sheet of polypropylene mesh, placed preperitoneal and sutured to the remaining abdominal wall muscles and to the neo-Pouoart ligament. Complete destruction of the inguinal ligament is rare but can occur following multiple operative procedures or trauma. Published reports of inguinal ligament reconstruction have been performed using synthetic mesh. The use of autologous tissue should reduce the risk of erosion into the neurovascular bundle, seroma formation, and enhance integration into surrounding tissues. This new technique for autologous reconstruction of the inguinal ligament provides a safe alternative to the use of synthetic mesh in the operative armamentarium of plastic and general surgeons. This is the first reported case in Hungary.

  1. Effect of preoperative education on patient‘s after cruciate ligament reconstruction functional status

    OpenAIRE

    Vainiūtė, Aistė

    2016-01-01

    Effect of Preoperative Education on Patient‘s After Cruciate Ligament Reconstruction Functional Status Goal of the research: Evaluation of the effect of preoperative education on patients’ functional state after anterior cruciate ligament reconstruction. Research objectives: 1. Evaluate and compare different preoperative training programs’ effects on participants’ subjective knee functional status and manifestation of motion of fear. 2. Evaluate and compare different preoperative training pro...

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

    OpenAIRE

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

    2012-01-01

    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 g...

  3. An Ecological Study of Anterior Cruciate Ligament Reconstruction, Part 2

    Science.gov (United States)

    McGrath, Timothy M.; Waddington, Gordon; Scarvell, Jennie M.; Ball, Nick; Creer, Rob; Woods, Kevin; Smith, Damian; Adams, Roger

    2017-01-01

    Background: Additional high-quality prospective studies are needed to better define the objective criteria used in relation to return-to-sport decisions after anterior cruciate ligament (ACL) reconstruction in active populations. Purpose: To investigate prospectively the relationship between functional performance test results at 24 weeks postoperative and return-to-sport activity (Tegner activity score) at 12 and 24 months, respectively, after synthetic (ligament advanced reinforcement system [LARS]) and autograft (doubled semitendinosus/gracilis [2ST/2GR]) ACL reconstructions. Study Design: Case series; Level of evidence, 4. Methods: A total of 64 patients who underwent ACL reconstruction (32 LARS, 32 2ST/2GR autograft; mean age, 27.9 years; body mass index [BMI], 24.9 kg/m2) were assessed preoperatively and at staged intervals postoperatively up to 24 weeks for isokinetic testing of quadriceps and hamstring average power per repetition at 60 deg/s and 180 deg/s, a battery of hop tests, peak vertical ground-reaction force (vGRF), and time to peak vGRF (in seconds) during a step- and jump-down task onto a force platform and peak speed (m/s) using a global positioning system (GPS unit) during a running task. A cohort of 32 healthy matched participants (mean age, 26.31 years; BMI, 25.7 kg/m2) were also tested to act as reference. Pearson correlation was calculated to assess correlation of each performance measure at 24 weeks postoperative with activity outcomes (Tegner score) at 12 and 24 months. Results: The strongest correlation between physical performance tests and return-to-sport outcomes was observed with peak speed during running. Large correlations were also observed for hamstring isokinetic power and hop test for distance. Moderate correlations were observed for timed hop, peak vGRF during a jump-down task, and quadriceps isokinetic power. No statistical correlations were observed for time to peak vGRF during a step-down and jump-down task as well as peak v

  4. Psychological Factors Associated With Anterior Cruciate Ligament Reconstruction Recovery

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

    2016-01-01

    Background: 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. Purpose: 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. Study Design: Cross-sectional study; Level of evidence, 3. Methods: 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. Results: 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 < .05), KOOS-QOL scores (r = 0

  5. 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 Self-esteem levels and locus of control had significant relationships with functional

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

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    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. Anterior cruciate ligament anatomy and function relating to anatomical reconstruction.

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    Zantop, Thore; Petersen, Wolf; Sekiya, Jon K; Musahl, Volker; Fu, Freddie H

    2006-10-01

    Recently, the interest in surgical techniques that reconstruct the anteromedial (AM) and the posterolateral (PL) bundles of the anterior cruciate ligament (ACL) has risen. This review focuses on the structural as well as the mechanical properties of the ACL and the anatomical details of the femoral origin, midsubstance, and tibial insertion of AM and PL bundles of the ACL. The terminology of AM and PL bundles is chosen according to the tibial insertion and determined by their functional tensioning pattern throughout knee flexion. Close to extension the AM is moderately loose and the PL is tight. As the knee is flexed, the femoral attachment of the ACL becomes more horizontally oriented, causing the AM bundle to tighten and the PM bundle to loosen up. The ACL has been described to be restraint to anterior tibial displacement and internal tibial rotation. The rotational component might be represented by the PL bundle. The femoral origin has an oval shape with the center of the AM close to over-the-top position and the center of the PL close to the anterior and inferior cartilage margin. Tibial and femoral insertions of the ACL are over 3.5 times larger when compared to the midsubstance and tunnel placement is more challenging because of the limited size of potential grafts selection of tunnel site placement. For reconstruction, both bone-patellar tendon-bone (BPTB) and quadrupled hamstring grafts are used. Structural properties of a 10 mm wide BPTB or quadrupled hamstring graft have been reported to be comparable with those of the native ACL.

  8. Preoperative cryotherapy use in anterior cruciate ligament reconstruction.

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    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.

  9. Radiodense ligament markers for radiographic evaluation of anterior cruciate ligament reconstruction.

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    Borbas, Paul; Wieser, Karl; Rahm, Stefan; Fucentese, Sandro F; Koch, Peter P; Meyer, Dominik C

    2014-12-01

    Early clinical and radiographic diagnosis of failed or loosened anterior cruciate ligament (ACL) reconstructions can be challenging. The aim of the present study is to retrospectively evaluate the use of radiologically visible markers in the ACL graft, serving as a potential diagnostic tool in ACL graft rupture and insufficiency. Twenty patients were included in the study. ACL reconstruction was performed with use of a hamstring autograft in hybrid fixation technique. The graft was marked with two radiodense suture knots, one at the tibial and femoral tunnel openings. Radiographs were performed postoperatively, after 6 weeks and 12 months. Four distances between markers and landmarks were measured in anteroposterior and three in lateral radiographic views and the positional change between the timepoints of measurement was calculated. Measurements of the marker distances on radiographs showed an excellent interobserver reliability (κ=0.97). In two measured distal anteroposterior distances statistically significant changes could be detected between 6 weeks and 12 months postoperatively in one patient with MRI-documented ACL rerupture and in five patients with ACL elongation defined as anteroposterior-translation with side-to-side difference of ≥3 mm measured with a Rolimeter device. On lateral radiographs, marker distances were highly variable and did not correlate with clinical ACL elongation. The application of radiodense ACL graft markers is a straight-forward, non-expensive and potentially useful diagnostic tool to identify the position of the transplant and for diagnosis of graft elongation or failure. However, the method is sensitive to the radiological projection, which should be further studied and optimized. Copyright © 2014 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

    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. 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

  12. Simulation of Anterior Cruciate Ligament Reconstruction in a Dry Model.

    Science.gov (United States)

    Dwyer, Tim; Slade Shantz, Jesse; Chahal, Jaskarndip; Wasserstein, David; Schachar, Rachel; Kulasegaram, K Mahan; Theodoropoulos, John; Greben, Rachel; Ogilvie-Harris, Darrell

    2015-12-01

    As the demand increases for demonstration of competence in surgical skill, the need for validated assessment tools also increases. The purpose of this study was to validate a dry knee model for the assessment of performance of anterior cruciate ligament reconstruction (ACLR). The hypothesis was that the combination of a checklist and a previously validated global rating scale would be a valid and reliable means of assessing ACLR when performed by residents in a dry model. Controlled laboratory study. All residents, sports medicine staff, and fellows were invited to perform a hamstring ACLR using anteromedial drilling and Endobutton fixation on a dry model of an anterior cruciate ligament. Previous exposure to knee arthroscopy and ACLR was recorded. A detailed surgical manuscript and technique video were sent to all participants before the study. Residents were evaluated by staff surgeons with task-specific checklists created by use of a modified Delphi procedure and the Arthroscopic Surgical Skill Evaluation Tool (ASSET). Each procedure (hand movements and arthroscopic video) was recorded and scored by a fellow blinded to the year of training of each participant. A total of 29 residents, 5 fellows, and 6 staff surgeons (40 participants total) performed an ACLR on the dry model. The internal reliability (Cronbach alpha) of the test when using the total ASSET score was very high (>0.9). One-way analysis of variance for the total ASSET score and the total checklist score demonstrated a difference between participants based on year of training (P .05). A good correlation was seen between the total ASSET score and prior exposure to knee arthroscopy (0.73) and ACLR (0.65). The interrater reliability (intraclass correlation coefficient) between the examiner ratings and the blinded assessor ratings for the total ASSET score was very high (>0.8). The results of this study provide evidence that the performance of an ACLR in a dry model is a reliable method of assessing a

  13. Acromioclavicular joint reconstruction with coracoacromial ligament transfer using the docking technique

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    Gobezie Reuben

    2009-01-01

    Full Text Available Abstract Background Symptomatic Acromioclavicular (AC dislocations have historically been surgically treated with Coracoclavicular (CC ligament reconstruction with transfer of the Coracoacromial (CA ligament. Tensioning the CA ligament is the key to success. Methods Seventeen patients with chronic, symptomatic Type III AC joint or acute Type IV and V injuries were treated surgically. The distal clavicle was resected and stabilized with CC ligament reconstruction using the CA ligament. The CA ligament was passed into the medullary canal and tensioned, using a modified 'docking' technique. Average follow-up was 29 months (range 12–57. Results Postoperative ASES and pain significantly improved in all patients (p = 0.001. Radiographically, 16 (94% maintained reduction, and only 1 (6% had a recurrent dislocation when he returned to karate 3 months postoperatively. His ultimate clinical outcome was excellent. Conclusion The docking procedure allows for tensioning of the transferred CA ligament and healing of the ligament in an intramedullary bone tunnel. Excellent clinical results were achieved, decreasing the risk of recurrent distal clavicle instability.

  14. Does additional reconstruction of the anterolateral ligament during a primary anterior cruciate ligament reconstruction affect tibial rotational laxity – A case series

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    Rohi Shah

    2017-07-01

    Conclusion: Our findings are based primarily in anaesthetized patients, with kinematic values at time-zero postoperatively. Patients presenting with significant rotational instability following a primary ACL injury and assessed to have a grade-3 pivot-shift may benefit from dual-ligament reconstruction. Further research is required to assess long-term patient-centered clinical outcomes.

  15. Development of a Tissue-Engineered Artificial Ligament: Reconstruction of Injured Rabbit Medial Collateral Ligament With Elastin-Collagen and Ligament Cell Composite Artificial Ligament.

    Science.gov (United States)

    Hirukawa, Masaki; Katayama, Shingo; Sato, Tatsuya; Inoue, Kota; Niwa, Kosuke; Ito, Naoya; Hattori, Tetsuya; Hosoi, Takashi; Unno, Hironori; Suzuki, Yoshiaki; Hasegawa, Masahiro; Miyamoto, Keiichi; Horiuchi, Takashi

    2018-04-16

    Ligament reconstruction using a tissue-engineered artificial ligament (TEAL) requires regeneration of the ligament-bone junction such that fixation devices such as screws and end buttons do not have to be used. The objective of this study was to develop a TEAL consisting of elastin-coated polydioxanone (PDS) sutures covered with elastin and collagen fibers preseeded with ligament cells. In a pilot study, a ring-type PDS suture with a 2.5 mm (width) bone insertion was constructed with/without elastin coating (Ela-coat and Non-coat) and implanted into two bone tunnels, diameter 2.4 mm, in the rabbit tibia (6 cases each) to access the effect of elastin on the bond strength. PDS specimens taken together with the tibia at 6 weeks after implantation indicated growth of bone-like hard tissues around bone tunnels accompanied with narrowing of the tunnels in the Ela-coat group and not in the Non-coat group. The drawout load of the Ela-coat group was significantly higher (28.0 ± 15.1 N, n = 4) than that of the Non-coat group (7.6 ± 4.6 N, n = 5). These data can improve the mechanical bulk property of TEAL through extracellular matrix formation. To achieve this TEAL model, 4.5 × 10 6 ligament cells were seeded on elastin and collagen fibers (2.5 cm × 2.5 cm × 80 µm) prior to coil formation around the elastin-coated PDS core sutures having ball-shape ends with a diameter of 2.5 mm. Cell-seeded and cell-free TEALs were implanted across the femur and the tibia through bone tunnels with a diameter of 2.4 mm (6 cases each). There was no incidence of TEAL being pulled in 6 weeks. Regardless of the remarkable degradation of PDS observed in the cell-seeded group, both the elastic modulus and breaking load of the cell-seeded group (n = 3) were comparable to those of the sham-operation group (n = 8) (elastic modulus: 15.4 ± 1.3 MPa and 18.5 ± 5.7 MPa; breaking load: 73.0 ± 23.4 N and 104.8 ± 21.8 N, respectively) and higher than those

  16. Reconstruction of the scapholunate ligament in a cadaver model using a bone-ligament-bone autograft from the foot.

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    Davis, C A; Culp, R W; Hume, E L; Osterman, A L

    1998-09-01

    This study is an investigation of a new procedure in which the scapholunate interosseous ligament (SLIL) is reconstructed using a bone-ligament-bone autograft from the foot. After investigation, the dorsal medial portion of the navicular-first cuneiform ligament (NFCL) was chosen for testing as a potential donor since it is similar in length and thickness to the SLIL and it is easily harvested with minimal potential donor site morbidity. Eight SLILs and NFCLs were harvested from fresh-frozen cadavers. Biomechanical extensometry testing was performed using an Instron 1000 machine. A 5-mm-wide central portion of the NFCL was tested since this width was compatible with the technical aspects of reconstructing the SLIL. Both ligaments were tested for elastic properties, including stiffness, load to failure, and deformation to failure. Mean length of the NFCL was 7.6 mm (range, 5.5-8.5 mm). Stiffness of the NFCL was 10.6 x 10(5) Nm (range, 8.0-13.0 Nm) compared with 14.4 x 10(5) Nm for the SLIL (range, 10.0-19.5 Nm). Peak load to failure for the NFCL was 1,980 N (range, 1,530-2,940 N) compared with 2,940 N for the SLIL (range, 1,780-4,050 N). Total elongation to failure for the NFCL was 2.50 mm (range, 1.7-3.2 mm) compared with 3.2 mm for the SLIL (range, 2.1-5.2 mm). Thus, the biomechanical characteristics of the NFCL were found to be very similar to those of the SLIL. Having established the biomechanical similarities of the 2 ligaments, we are currently using the NFCL to reconstruct the sectioned SLIL in a fresh-frozen cadaver model. Early results suggest that this procedure is feasible for restoration of normal kinematics of the wrist.

  17. Mechanical Analysis of Extra-Articular Knee Ligaments. Part two: Tendon grafts used for knee ligament reconstruction.

    Science.gov (United States)

    Smeets, Kristof; Bellemans, Johan; Scheys, Lennart; Eijnde, Bert O; Slane, Joshua; Claes, Steven

    2017-10-01

    The aim of this study was to provide information about the mechanical properties of grafts used for knee ligament reconstructions and to compare those results with the mechanical properties of native knee ligaments. Eleven cadaveric knees were dissected for the semitendinosus, gracilis, iliotibial band (ITB), quadriceps and patellar tendon. Uniaxial testing to failure was performed using a standardized method and mechanical properties (elastic modulus, ultimate stress, ultimate strain, strain energy density) were determined. The elastic modulus of the gracilis tendon (1458±476MPa) (Ptendon (1036±312MPa) (Ptendon (568±194MPa), and patellar tendon (417±107MPa). In addition, the ultimate stress of the hamstring tendons (gracilis 155.0±30.7MPa and semitendinosus 120.1±30.0MPa) was significantly higher (Ptendon (81.0±27.6MPa), and patellar tendon (76.2±25.1MPa). A significant difference (Ptendon (24.6±5.9%) and the hamstrings (gracilis 14.5±3.1% and semitendinosus 17.0±4.0%). No significant difference in strain energy density between the grafts was observed. Material properties of common grafts used for knee ligament reconstructions often differ significantly from the original knee ligament which the graft is supposed to emulate. Copyright © 2017 Elsevier B.V. All rights reserved.

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

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    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.

  19. 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

  20. Anatomic Reconstruction of the Anterior Cruciate Ligament of the Knee With or Without Reconstruction of the Anterolateral Ligament: A Randomized Clinical Trial.

    Science.gov (United States)

    Ibrahim, Samir Abdulrazik; Shohdy, Emad Mureed; Marwan, Yousef; Ramadan, Sami Abdulghaffar; Almisfer, Abdulrahman Khalid; Mohammad, Mohammad Wagdy; Abdulsattar, Wael Shoabe; Khirat, Shiref

    2017-06-01

    Rotational instability of the knee remains an issue after anterior cruciate ligament (ACL) reconstruction. Hypothesis/Purpose: The purpose was to evaluate the subjective and objective outcomes of combined reconstruction of the ACL and anterolateral ligament (ALL) of the knee. The hypothesis was that favorable outcomes can be achieved with this surgical procedure compared with isolated anatomic reconstruction of the ACL. Randomized controlled trial; Level of evidence, 2. One hundred ten patients with a unilateral ACL injury and high-grade pivot shift were randomly assigned to undergo either combined ACL and ALL reconstruction (group A) or isolated ACL reconstruction (group B). Preoperative and postoperative evaluations of the patients were conducted by obtaining history details, recording physical examination findings, measuring knee laxity using the KT-1000 arthrometer, and using validated outcome scores for the knee. P reconstruction was 1.3 mm, while the median result for isolated ACL reconstruction was 1.8 mm ( P reconstruction had anterior translation of greater than 5 mm at maximum pulling strength compared with their normal knees at final follow-up. On the other hand, 3 (6.0%) patients who underwent isolated ACL reconstruction had anterior translation of more than 5 mm. No serious complications were found in both groups. Combined ACL and ALL reconstruction was found to be effective in improving subjective and objective outcomes. Nevertheless, these findings were not significantly superior to isolated ACL reconstruction except for the instrumented knee laxity testing results. This might indicate that ALL reconstruction should not be performed routinely for patients undergoing ACL reconstruction.

  1. 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.

  2. Simultaneous Reconstruction of the Medial and Lateral Collateral Ligaments for Chronic Combined Ligament Injuries of the Ankle.

    Science.gov (United States)

    Yasuda, Toshito; Shima, Hiroaki; Mori, Katsunori; Tsujinaka, Seiya; Neo, Masashi

    2017-07-01

    Objective data on chronic injuries of the medial collateral ligament (MCL) of the ankle are scarce. Chronic MCL injuries are frequently associated with lateral collateral ligament (LCL) injuries. For patients with chronic combined MCL and LCL injuries, the authors have performed simultaneous surgery of the 2 ligaments. Simultaneous surgery of the 2 ligaments may be effectively used to treat chronic combined MCL and LCL injuries. Case series; Level of evidence, 4. Surgical outcomes were evaluated in 29 consecutive patients presenting with chronic MCL and LCL injuries (30 ankles; 15 men and 14 women; mean age, 31 years; 13 competitive and 10 recreational athletes). Preoperative and postoperative clinical outcomes were measured with the Karlsson score and the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale score. The patients underwent preoperative and postoperative functional measurements and a radiological examination. In addition, preoperative magnetic resonance imaging (MRI) results, arthroscopic findings, and histology of the MCL were evaluated. Preoperatively, the deep fibers of the MCL did not appear striated in 29 ankles, and high-intensity signal changes were observed in 23 ankles on T2-weighted or gradient echo MRI. MCL ruptures were confirmed with arthroscopic surgery. Medial impingement lesions and focal chondral lesions were confirmed in 10 and 21 ankles, respectively. Histology of the reconstructed MCL showed dense collagen fibers with vessels. The mean postoperative follow-up period was 30 months (range, 24-52 months). There was a significant change between preoperative and postoperative Karlsson scores (69.0 vs 96.1 points, respectively; P ankle instability and medial impingement lesions. Outcomes in the patients indicated that MCL reconstruction or resection of medial impingement lesions, performed in addition to LCL reconstruction, is effective for treating chronic combined MCL and LCL injuries of the ankle.

  3. 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.

  4. [ARTHROSCOPIC STUDY OF REMNANT-PRESERVED RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT].

    Science.gov (United States)

    Lu, Daifeng; Xiao, Mochao; Zhang, Yunpeng; Yan, Shi; Dong, Feng; Lian, Yongyun

    2015-08-01

    To investigate the value of ligament remnant preservation during anterior cruciate ligament (ACL) reconstruction by observing the integrity, the tension, the synovial membrane covering, and the color of the reconstructed ligament under arthroscopy. Between January 2011 and December 2013, 122 patients who underwent ACL reconstruction and arthroscopic internal fixation removal at 1 year after reconstruction were included in this study. Of these cases, 61 cases underwent ACL reconstruction using the remnant-preserved technique (preservation group); the other 61 cases underwent ACL reconstruction using non remnant-preserved technique (non preservation group). There was no significant difference in gender, age, injury side, body mass index, type of injury, the time from injury to reconstruction, and the result of KT-2000 examination between 2 groups (P > 0.05). The reconstructed ACL were observed under arthroscopy when internal fixation was removed, and the effectiveness was evaluated according to the criteria of AO Yingfang. In preservation group, the results were excellent in 34 cases, good in 22 cases, fair in 4 cases, and poor in 1 case; and in non preservation group, the results were excellent in 29 cases, good in 20 cases, fair in 10 cases, and poor in 2 cases; and there was no significant difference between 2 groups (Z= -1.320, P=0.187). In ACL reconstruction, the remnant-preserved technique is not obviously better than non remnant-preserved technique in the integrity, tension, membrane covering, and color.

  5. 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.

  6. 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

  7. Physiotherapy treatment after combined cruciate ligament reconstruction of the knee: a review

    Directory of Open Access Journals (Sweden)

    Anderson Delano

    2007-01-01

    Full Text Available The purpose of this paper was to describe the physiotherapy treatment after combined reconstruction of the cruciate ligaments of the knee. In order to do so a literature review was made and the articles from Medline and Lilacs databases were selected, published between 1997 and 2006, in English and Portuguese. The articles that featured any of the following keywords were chosen: “rehabilitation”, “anterior cruciate ligament (ACL”, “posterior cruciate ligament (PCL”, “combined reconstruction”, “multiple-ligament injuried”, “knee dislocations” as well as its correlates in Portuguese. From 11 selected articles, 6 had been excludedby being descriptive studies, not having application of the protocol considered in groups of patients. Five articles were included in this study that descrived a protocol of physiotherapy treatment of combined reconstruction of the cruciate ligaments. It was observed that, despite the divergences related in the progression of the treatment, the protocols gave priority to protection of reconstruction tissues, given a bigger emphasis in the PCL graft.

  8. Segond Fractures Are Not a Risk Factor for Anterior Cruciate Ligament Reconstruction Failure.

    Science.gov (United States)

    Gaunder, Christopher L; Bastrom, Tracey; Pennock, Andrew T

    2017-12-01

    Segond fractures may be identified when an anterior cruciate ligament (ACL) tear is diagnosed and likely represent an avulsion of the anterolateral ligament. It is currently unclear whether these fractures can be ignored at the time of ACL reconstruction or if they should be addressed surgically. To compare the incidence of Segond fractures in patients undergoing primary ACL reconstruction compared with those undergoing revision ACL reconstruction in an attempt to determine if the presence of a Segond fracture predisposes to ACL reconstruction failure. Cross-sectional study; Level of evidence, 3. A retrospective review of all patients undergoing primary or revision ACL reconstruction between 2007 and 2014 was performed. Demographic data (age, sex, body mass index), injury variables (acuity, mechanism of injury), and radiographic features (concomitant ligamentous injuries, growth plate status) were documented. Each Segond fracture was analyzed for its specific location, size, displacement, and healing using both radiographs and magnetic resonance imaging. Statistical analysis was performed using a P value of ligament a mean 20.6 mm posterior to the Gerdy tubercle in nearly all patients. After ACL reconstruction, the Segond fracture healed in 90% of patients. The incidence of Segond fractures was 3 times as common in male patients ( P = .02); otherwise, its presence was not associated with any other demographic data, injury variables, or radiographic features ( P > .05). No patients undergoing revision surgery had a Segond fracture, and no patient with a Segond fracture had graft failure. Patients with a Segond fracture are at no higher risk to require revision ACL reconstruction compared with patients without a Segond fracture. This may be attributable to its high union rate. At the time of primary ACL reconstruction, if a Segond fracture is identified, it can be ignored (not repaired or reconstructed), and this approach does not appear to predispose to early ACL

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

    African Journals Online (AJOL)

    A few complications occurred with one infection and calcification of ligament in two patients, arthrofibrosis in two patients. Conclusion: This study is of clinical relevance as it shows alleviation of pain after surgical treatment of the torn ACL which has been described as the stabiliser of the knee and guardian of the Meniscus.

  10. 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.

  11. Functional results from reconstruction of the anterior cruciate ligament using the central third of the patellar ligament and flexor tendons

    Directory of Open Access Journals (Sweden)

    Marcos George de Souza Leao

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVES: To evaluate knee function in patients undergoing reconstruction of the anterior cruciate ligament (ACL using the central third of the patellar ligament or the medial flexor tendons of the knee, i.e. quadruple ligaments from the semitendinosus and gracilis (ST-G, by means of the Knee Society Score (KSS and the Lysholm scale. METHODS: This was a randomized prospective longitudinal study on 40 patients who underwent arthroscopic ACL reconstruction between September 2013 and August 2014. They comprised 37 males and three females, with ages ranging from 16 to 52 years. The patients were numbered randomly from 1 to 40: the even numbers underwent surgical correction using the ST-G tendons and the odd numbers, using the patellar tendon. Functional evaluations were made using the KSS and Lysholm scale, applied in the evening before the surgical procedure and six months after the operation. RESULTS: From the statistical analysis, it could be seen that the patients' functional capacity was significantly greater after the operation than before the operation. There was strong evidence that the two forms of therapy had similar results ( p= >0.05, in all the comparisons. CONCLUSIONS: The results from the ACL reconstructions were similar with regard to functional recovery of the knee and improvement of quality of life, independent of the type of graft. It was not possible to identify the best method of surgical treatment. The surgeon's clinical and technical experience and the patient are the factors that determine the choice of graft type for use in ACL surgery.

  12. Anterior cruciate ligament reconstruction: a look at prosthetics - past, present and possible future

    Science.gov (United States)

    Mascarenhas, Randy; MacDonald, Peter B.

    2008-01-01

    Biological tissue autograft reconstruction using the patellar tendon or quadrupled semitendinosus/gracilis tendons has become the most popular procedure in surgical treatment of a ruptured ACL. This article provides a review of the history of the use of prosthetics with respect to ACL reconstruction grafts including Carbon Fibre, Gore-Tex and Dacron prosthetics as well as the Leeds-Keio Artificial Ligament and the Kennedy Ligament Augmentation Device (LAD). Emphasis is placed on the Ligament Advanced Reinforcement System (LARS) as preliminary investigations of its use have been encouraging. Significant progress has been made recently with respect to the understanding of ACL anatomy, composition, biomechanics, and healing processes, leading to innovative techniques using approaches based in tissue engineering principles and computer – assisted surgery. While research into improved ACL treatment options continues, the synthesis of recent advancements provides a new optimism towards the regeneration of an ACL mirroring its original stability, function, and longevity. PMID:18523530

  13. 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.

  14. 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.

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

    OpenAIRE

    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...

  16. Double bundle arthroscopic Anterior Cruciate Ligament reconstruction with remnant preserving technique using a hamstring autograft

    OpenAIRE

    Ochi, Mitsuo; Abouheif, Mohamed M; Kongcharoensombat, Wirat; Nakamae, Atsuo; Adachi, Nobuo; Deie, Masataka

    2011-01-01

    Abstract Background Preservation of the Anterior Cruciate Ligament (ACL) remnant is important from the biological point of view as it enhances revascularization, and preserves the proprioceptive function of the graft construct. Additionally, it may have a useful biomechanical function. Double bundle ACL reconstruction has been shown to better replicate the native ACL anatomy and results in better restoration of the rotational stability than single bundle reconstruction. Methods We used the fa...

  17. 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

  18. 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

  19. 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…

  20. 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

  1. 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...

  2. 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.

  3. Sex Differences in Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: Data From the Swedish Knee Ligament Register

    DEFF Research Database (Denmark)

    Ageberg, Eva; Forssblad, Magnus; Herbertsson, Pär

    2010-01-01

    BACKGROUND: Female gender is a risk factor for sustaining anterior cruciate ligament (ACL) injury. However, little is known about possible sex differences in patients with ACL injury/reconstruction. PURPOSE: To study sex differences in patient-reported outcomes before and at 1 and 2 years after ACL...... in KOOS and EQ-5D preoperatively, 1 and 2 years postoperatively, and over time. RESULTS: Preoperatively, female patients reported worse scores than male patients in 4 KOOS subscales (pain, symptoms, sport/recreation, quality of life) and EQ-5D, with the largest difference seen in KOOS sport......, this difference was also clinically relevant. There were no clinically relevant sex differences in improvements over time. We suggest that possible sex differences be analyzed in future studies on evaluation after ACL injury/reconstruction....

  4. PHYSIOTHERAPY TREATMENT AFTER COMBINED CRUCIATE LIGAMENT RECONSTRUCTION OF THE KNEE: A REVIEW

    Directory of Open Access Journals (Sweden)

    Aline Mendonça de Andrade

    2007-08-01

    Full Text Available The purpose of this paper was to describe the physiotherapy treatment after combined reconstruction of the cruciate ligaments of the knee. In order to do so a literature review was made and the articles from Medline and Lilacs databases were selected, published between 1997 and 2006, in English and Portuguese. The articles that featured any of the following keywords were chosen: “rehabilitation”, “anterior cruciate ligament (ACL”, “posterior cruciate ligament (PCL”, “combined reconstruction”, “multipleligament injuried”, “knee dislocations” as well as its correlates in Portuguese. From 11 selected articles, 6 had been excludedby being descriptive studies, not having application of the protocol considered in groups of patients. Five articles were included in this study that descrived a protocol of physiotherapy treatment of combined reconstruction of the cruciate ligaments. It was observed that, despite the divergences related in the progression of the treatment, the protocols gave priority to protection of reconstruction tissues, given a bigger emphasis in the PCL graft.

  5. 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.

  6. MR imaging of the knee following cruciate ligament reconstruction and meniscal surgery

    International Nuclear Information System (INIS)

    Woertler, K.

    2009-01-01

    Due to the increasing number of surgical procedures performed on the knee, MR imaging of the postoperative knee has gained more and more importance. For the evaluation of anterior cruciate ligament grafts and postoperative menisci, basic knowledge of surgical techniques is essential in order to differentiate normal postoperative findings from transplant failure, retears, and complications. This article reviews technical aspects of MR imaging following knee surgery, basic principles of operative techniques for anterior cruciate ligament reconstruction and therapy of meniscal tears, normal postoperative findings, MR imaging criteria for recurrent lesions, and findings with typical complications. (orig.)

  7. Anchor proximal migration in the medial patellofemoral ligament reconstruction in skeletally immature patients

    Directory of Open Access Journals (Sweden)

    Fabiano Kupczik

    2013-09-01

    Full Text Available The medial patellofemoral ligament (MPFL injury has been considered instrumental in lateral patellar instability after patellar dislocation. Consequently, the focus on the study of this ligament reconstruction has increased in recent years. The MPFL femoral anatomical origin point has great importance at the moment of reconstruction surgery, because a graft fixation in a non anatomical position may result in medial overload, medial subluxation of the patella or excessive tensioning of the graft with subsequent failure. In the pediatric population, the location of this point is highlighted by the presence of femoral physis. The literature is still controversial regarding the best placement of the graft. We describe two cases of skeletally immature patients in whom LPFM reconstruction was performed. The femoral fixation was through anchors that were placed above the physis. With the growth and development of the patients, the femoral origin point of the graft moved proximally, resulting in failure in these two cases.

  8. Comparison of outcomes of two femoral fixation devices in hamstring anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Miguel Angel Sanchez-Carrasco

    2017-01-01

    Full Text Available Background: Tear of the anterior cruciate ligament (ACL is a common ligamentous injury of the knee. Reconstruction of this ligament is often required to restore functional stability of the knee. Outcome of ACL reconstruction is significantly affected by how the graft is fixed to the bone. This study is to determine if there is a different clinical outcome after cortical versus cortical-cancellous suspension femoral fixation in hamstring based anterior cruciate ligament (ACL reconstruction. Materials and Methods: This is a retrospective comparative study conducted between 2006 and 2010. We enrolled patients who underwent arthroscopic ACL reconstruction. Sixty two patients met inclusion criteria and 41 agreed to come for followup assessment. Median age was of 28 years (range 18–39 years. Demographic baseline profile of both groups was similar. The femoral fixation devices were cortical (n = 16 and cortical-cancellous suspension techniques (n = 25. The average period of evolution at the time of assessment was 40 months (range 12-72 months. The patients were examined according to Lachman test (using Rolimeter knee tester, anterior drawer test, pivot shift test, International Knee Documentation Committee questionnaire, and Tegner-Lysholm knee scoring scale. Results: The objective evaluation of the patients (Lachman test showed better results in terms of stability in the group of patients who underwent the cortical-cancellous suspension method. These differences were not reflected in the assessment of activity level (Tegner-Lysholm, where both groups showed the same results. Conclusions: ACL reconstruction with both cortical and cortical-cancellous suspension femoral fixation techniques show the same clinical results at medium long followup. However, cortical-cancellous fixations seem to provide greater stability to the reconstruction.

  9. Anatomic anterior cruciate ligament reconstruction: reducing anterior tibial subluxation

    NARCIS (Netherlands)

    Muller, Bart; Duerr, Eric R. H.; van Dijk, C. Niek; Fu, Freddie H.

    2016-01-01

    To measure and compare the amount of anterior tibial subluxation (ATS) after anatomic ACL reconstruction for both acute and chronic ACL-deficient patients. Fifty-two patients were clinically and radiographically evaluated after primary, unilateral, anatomic ACL reconstruction. Post-operative true

  10. 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

  11. 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

  12. 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.

  13. 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

  14. Synthetic devices for reconstructive surgery of the cruciate ligaments: a systematic review.

    Science.gov (United States)

    Batty, Lachlan M; Norsworthy, Cameron J; Lash, Nicholas J; Wasiak, Jason; Richmond, Anneka K; Feller, Julian A

    2015-05-01

    The role of synthetic devices in the management of the cruciate ligament-injured knee remains controversial. The aim of this systematic review was to assess the safety and efficacy of synthetic devices in cruciate ligament surgery. A systematic review of the electronic databases Medline, Embase, and The Cochrane Library (issue 1, 2014) on January 13, 2014, was performed to identify controlled and uncontrolled trials. Trials that assessed the safety and efficacy of synthetic devices for cruciate ligament surgery were included. The main variables assessed included rates of failure, revision, and noninfective effusion and synovitis. Patient-reported outcome assessments and complications were also assessed where reported. From 511 records screened, we included 85 articles published between 1985 and 2013 reporting on 6 synthetic devices (ligament augmentation and reconstruction system [Ligament Augmentation and Reconstruction System (LARS; Surgical Implants and Devices, Arc-sur-Tille, France)]; Leeds-Keio [Xiros (formerly Neoligaments), Leeds, England]; Kennedy ligament augmentation device [3M, St Paul, MN]; Dacron [Stryker, Kalamazoo, MI]; Gore-Tex [W.L. Gore and Associates, Flagstaff, AZ]; and Trevira [Telos (limited liability company), Marburg, Germany]). The heterogeneity of the included studies precluded meta-analysis. The results were analyzed by device and then type of reconstruction (anterior cruciate ligament [ACL]/posterior cruciate ligament [PCL]/combined ACL and PCL). The lowest cumulative rates of failure were seen with the LARS device (2.6% for ACL and 1% for PCL surgery). The highest failure rate was seen in the Dacron ACL group (cumulative rate, 33.6%). Rates of noninfective synovitis and effusion ranged from 0.2% in the LARS ACL group to 27.6% in the Gore-Tex ACL group. Revision rates ranged from 2.6% (LARS) to 11.8% (Trevira-Hochfest; Telos). Recent designs, specifically the LARS, showed good improvement in the outcome scores. The mean preoperative and

  15. 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.

  16. Magnesium inference screw supports early graft incorporation with inhibition of graft degradation in anterior cruciate ligament reconstruction

    Science.gov (United States)

    Cheng, Pengfei; Han, Pei; Zhao, Changli; Zhang, Shaoxiang; Zhang, Xiaonong; Chai, Yimin

    2016-05-01

    Patients after anterior cruciate ligament (ACL) reconstruction surgery commonly encounters graft failure in the initial phase of rehabilitation. The inhibition of graft degradation is crucial for the successful reconstruction of the ACL. Here, we used biodegradable high-purity magnesium (HP Mg) screws in the rabbit model of ACL reconstruction with titanium (Ti) screws as a control and analyzed the graft degradation and screw corrosion using direct pull-out tests, microCT scanning, and histological and immunohistochemical staining. The most noteworthy finding was that tendon graft fixed by HP Mg screws exhibited biomechanical properties substantially superior to that by Ti screws and the relative area of collagen fiber at the tendon-bone interface was much larger in the Mg group, when severe graft degradation was identified in the histological analysis at 3 weeks. Semi-quantitative immunohistochemical results further elucidated that the MMP-13 expression significantly decreased surrounding HP Mg screws with relatively higher Collagen II expression. And HP Mg screws exhibited uniform corrosion behavior without displacement or loosening in the femoral tunnel. Therefore, our results demonstrated that Mg screw inhibited graft degradation and improved biomechanical properties of tendon graft during the early phase of graft healing and highlighted its potential in ACL reconstruction.

  17. Early reconstruction should be considered in younger patients with symptomatic mucoid degeneration of the anterior cruciate ligament

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    Masashi Kusano

    2015-07-01

    Conclusion: Considering the rupture of residual ACL fibres after partial resection and the inevitability of total ACL resection due to degeneration of the entire ligament, ACL reconstruction should be considered in younger patients with symptomatic mucoid degeneration of the ACL.

  18. Relative individual workload changes may be a risk factor for rerupture of ulnar collateral ligament reconstruction.

    Science.gov (United States)

    Keller, Robert A; Mehran, Nima; Khalil, Lafi S; Ahmad, Christopher S; ElAttrache, Neal

    2017-03-01

    With an increasing number of Major League Baseball (MLB) players undergoing ulnar collateral ligament (UCL) reconstruction, there remains limited literature on appropriate post-reconstruction workload management to limit the risk of reinjury. A total of 28 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction were identified and compared with 137 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared 3 years before and after primary reconstruction. Results were then compared between groups. Pitchers who later required revision increased their games pitched by 14.1% after reconstruction whereas the no-revision group pitched 13.6% fewer games than before reconstruction (P < .01). Inning workload was reduced by 9.8% after surgery (89.8 innings after vs 99.6 innings before) for the revision group compared with the no-revision group, which threw 26% fewer innings after surgery (86.3 innings after vs 116.7 innings before) (P = .05). In addition, the revision group pitched 6.6% more pitches after reconstruction, 1138.9 pitches, compared with before reconstruction, 1068.6 pitches. Pitchers who did not require revision, in contrast, pitched 19.6% fewer pitches after reconstruction than before reconstruction (P = .08). This study's findings suggest that MLB pitchers who require revision UCL reconstruction after returning to play following primary UCL reconstruction pitch at or above their pre-primary UCL reconstruction workload whereas control pitchers who do not require revision pitch significantly less, below their pre-primary UCL reconstruction workload. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Comparison of the operation of arthroscopic tibial inlay and traditional tibial inlay for posterior cruciate ligament reconstruction

    OpenAIRE

    Lu, Daifeng; Xiao, Mochao; Lian, Yongyun; Zhou, Yong; Liu, Xuefeng

    2014-01-01

    Objective: To perform dual-bundle reconstruction of posterior cruciate ligament using full arthroscopic tibial inlay technology with self-designed tibia tunnel drilling system and to compare the effect of arthroscopic tibial inlay versus traditional technique for posterior cruciate ligament reconstruction. Material and methods: 32 patients were randomly divided into experiment group (improved tibial inlay, n = 17) and control group (traditional tibial inlay, n = 15). Self-designed tibia tunne...

  20. Anatomic anterior cruciate ligament reconstruction: reducing anterior tibial subluxation.

    Science.gov (United States)

    Muller, Bart; Duerr, Eric R H; van Dijk, C Niek; Fu, Freddie H

    2016-09-01

    To measure and compare the amount of anterior tibial subluxation (ATS) after anatomic ACL reconstruction for both acute and chronic ACL-deficient patients. Fifty-two patients were clinically and radiographically evaluated after primary, unilateral, anatomic ACL reconstruction. Post-operative true lateral radiographs were obtained of both knees with the patient in supine position and knees in full passive extension with heels on a standardized bolster. ATS was measured on the radiographs by two independent and blinded observers. ATS was calculated as the side-to-side difference in tibial position relative to the femur. An independent t test was used to compare ATS between those undergoing anatomic reconstruction for an acute versus chronic ACL injury. Chronic ACL deficiency was defined as more than 12 weeks from injury to surgery. Patients averaged 26.4 ± 11.5 years (mean ± SD) of age, 43.6 % were female, and 48.1 % suffered an injury of the left knee. There were 30 and 22 patients in the acute and chronic groups, respectively. The median duration from injury to reconstruction for the acute group was 5 versus 31 weeks for the chronic group. After anatomic ACL reconstruction, the mean ATS was 1.0 ± 2.1 mm. There was no statistical difference in ATS between the acute and chronic groups (1.2 ± 2.0 vs. 0.6 ± 2.3 mm, n.s.). Assessment of inter-tester reliability for radiographic evaluation of ATS revealed an excellent intraclass correlation coefficient of 0.894. Anatomic ACL reconstruction reduces ATS with a mean difference of 1.0 mm from the healthy contralateral limb. This study did not find a statistical difference in ATS between patients after anatomic ACL reconstruction in the acute or chronic phase. These observations suggest that anatomic ACL reconstruction, performed in either the acute or the chronic phase, approaches the normal AP relationship of the tibiofemoral joint. IV.

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

    Science.gov (United States)

    Fibiger, Wojciech; Kukiełka, Radosław T Kukiełka

    2011-01-01

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

  2. Nutrition of cruciate ligament reconstruction by diffusion. Collagen synthesis studied in rabbits.

    Science.gov (United States)

    Amiel, D; Akeson, W H; Renzoni, S; Harwood, F; Abel, M

    1986-06-01

    The reconstructed anterior cruciate ligament was studied in the rabbit using the medial third of the patellar tendon. Tritiated proline, 100 microCi/kg body weight, was injected intra-articularly to insure detection of the metabolic conversion product 3H-hydroxyproline in the avascular graft. During the immediate postoperative period, nutrients were found to derive from the synovial fluid through a process of diffusion, demonstrating that synovial nutrition occurs prior to revascularization of the graft.

  3. 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.

  4. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A COMPARISON BETWEEN BONE PATELLAR TENDON BONE GRAFT AND LIPSCOMB PROCEDURE - A FOLLOWUP STUDY OF 7 YEARS

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    Vijayamohan S

    2016-07-01

    Full Text Available BACKGROUND Anterior Cruciate Ligament injury has become more common and the demand by the patients to return to pre-injury level of activity has made reconstruction of the ligament very crucial. Though there are various techniques in reconstructing the anterior cruciate ligament, in this study, we compare two most commonly used techniques to see whether there is any significant difference in the outcome. METHODS Study included 25 patients in the age group of 19-36 years, of which 23 were males. The patients were divided randomly into 2 groups, and 15 patients underwent Anterior Cruciate Ligament reconstruction using Bone Patellar Tendon Bone Graft and 10 patients had Hamstring graft. RESULTS Patients were followed up at regular intervals monthly for the first six months and then at three monthly intervals. Patients were assessed using Knee Scoring Scale of Lysholm and Gillquist and International Knee Documentation Committee (IKDC scoring system. In addition, activity level, harvest site pain, thigh atrophy, kneeling pain and hamstring pain were assessed. All patients were followed up for a minimum period of 2 years. 20% of both groups were able to return to strenuous activity level, and 67% of Patellar tendon group and 50% of the Hamstring tendon group were able to return to moderate level of activity. 55% of patients in the patellar tendon group and 20% of patients in the hamstring tendon group had donor site pain in the first 6 months. 73% of patients in the hamstring group had at least 10 mm of thigh wasting. Pain on kneeling was seen only in the patellar tendon group (35% while hamstring pain was found only in the hamstring group (20%. CONCLUSIONS Patients in the patellar tendon group had increased anterior stability and were able to return to strenuous occupation. The difference in thigh atrophy between the two groups was not significant. The hamstring group had lower graft harvest site morbidity. Lachman test was the single most accurate

  5. Optimizing the reconstruction filter in cone-beam CT to improve periodontal ligament space visualization: An in vitro study

    International Nuclear Information System (INIS)

    Houno, Yuuki; Kodera, Yoshie; Hishikawa, Toshimitsu; Naitoh, Munetaka; Mitani, Akio; Noguchi, Toshihide; Ariji, Eiichiro; Gotoh, Kenichi

    2017-01-01

    Evaluation of alveolar bone is important in the diagnosis of dental diseases. The periodontal ligament space is difficult to clearly depict in cone-beam computed tomography images because the reconstruction filter conditions during image processing cause image blurring, resulting in decreased spatial resolution. We examined different reconstruction filters to assess their ability to improve spatial resolution and allow for a clearer visualization of the periodontal ligament space. Cone-beam computed tomography projections of 2 skull phantoms were reconstructed using 6 reconstruction conditions and then compared using the Thurstone paired comparison method. Physical evaluations, including the modulation transfer function and the Wiener spectrum, as well as an assessment of space visibility, were undertaken using experimental phantoms. Image reconstruction using a modified Shepp-Logan filter resulted in better sensory, physical, and quantitative evaluations. The reconstruction conditions substantially improved the spatial resolution and visualization of the periodontal ligament space. The difference in sensitivity was obtained by altering the reconstruction filter. Modifying the characteristics of a reconstruction filter can generate significant improvement in assessments of the periodontal ligament space. A high-frequency enhancement filter improves the visualization of thin structures and will be useful when accurate assessment of the periodontal ligament space is necessary

  6. Optimizing the reconstruction filter in cone-beam CT to improve periodontal ligament space visualization: An in vitro study

    Energy Technology Data Exchange (ETDEWEB)

    Houno, Yuuki; Kodera, Yoshie [Graduate School of Medicine, Nagoya University, Nagoya (Japan); Hishikawa, Toshimitsu; Naitoh, Munetaka; Mitani, Akio; Noguchi, Toshihide; Ariji, Eiichiro [Aichi Gakuin University, Nisshin (Japan); Gotoh, Kenichi [Div. of Radiology, Dental Hospital, Aichi Gakuin University, Nisshin (Japan)

    2017-09-15

    Evaluation of alveolar bone is important in the diagnosis of dental diseases. The periodontal ligament space is difficult to clearly depict in cone-beam computed tomography images because the reconstruction filter conditions during image processing cause image blurring, resulting in decreased spatial resolution. We examined different reconstruction filters to assess their ability to improve spatial resolution and allow for a clearer visualization of the periodontal ligament space. Cone-beam computed tomography projections of 2 skull phantoms were reconstructed using 6 reconstruction conditions and then compared using the Thurstone paired comparison method. Physical evaluations, including the modulation transfer function and the Wiener spectrum, as well as an assessment of space visibility, were undertaken using experimental phantoms. Image reconstruction using a modified Shepp-Logan filter resulted in better sensory, physical, and quantitative evaluations. The reconstruction conditions substantially improved the spatial resolution and visualization of the periodontal ligament space. The difference in sensitivity was obtained by altering the reconstruction filter. Modifying the characteristics of a reconstruction filter can generate significant improvement in assessments of the periodontal ligament space. A high-frequency enhancement filter improves the visualization of thin structures and will be useful when accurate assessment of the periodontal ligament space is necessary.

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

    Science.gov (United States)

    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

  8. Contralateral anterior cruciate ligament injury after anterior cruciate ligament reconstruction: a case controlled study.

    Science.gov (United States)

    Nakase, Junsuke; Tsuchiya, Hiroyuki; Kitaoka, Katsuhiko

    2012-12-10

    The purpose of this present study was to examine contralateral ACL injury cases after ACL reconstruction, to determine the characteristics of such injuries. We performed a retrospective analysis of 24 patients with contralateral ACL injury after ACL reconstruction. The control group consisted of 200 cases with unilateral ACL injury. The following were examined in the contralateral group: timing of the contralateral ACL injury, and the situations of the initial and contralateral ACL injuries. The following items were compared between the contralateral and control groups: age at the time of initial injury, level of competitive sports using Tegner activity scores, knee anterior laxity (KT-1000), and the ratio (%) of affected to unaffected legs in the strengths of the knee extensor and flexor muscles 6 months after surgery. Examination of injury situations showed that approximately 70% of the contralateral group was injured in situations similar to those at their initial injuries. There were no significant differences between the two groups in age at the time of initial injury , Tegner activity scores, knee anterior laxity, and the strengths of the knee extensor, flexor muscles and H/Q ratio 6 months after reconstruction. But, the age at the time of initial injury trended to be low in contralateral group. Knee anterior laxity and muscle weakness of the reconstructed legs six months following surgery were not individually related to contralateral ACL injury occurring approximately two years after surgery.

  9. Contralateral anterior cruciate ligament injury after anterior cruciate ligament reconstruction: a case controlled study

    Directory of Open Access Journals (Sweden)

    Nakase Junsuke

    2012-12-01

    Full Text Available Abstract Purpose The purpose of this present study was to examine contralateral ACL injury cases after ACL reconstruction, to determine the characteristics of such injuries. Methods We performed a retrospective analysis of 24 patients with contralateral ACL injury after ACL reconstruction. The control group consisted of 200 cases with unilateral ACL injury. The following were examined in the contralateral group: timing of the contralateral ACL injury, and the situations of the initial and contralateral ACL injuries. The following items were compared between the contralateral and control groups: age at the time of initial injury, level of competitive sports using Tegner activity scores, knee anterior laxity (KT-1000, and the ratio (% of affected to unaffected legs in the strengths of the knee extensor and flexor muscles 6 months after surgery. Results Examination of injury situations showed that approximately 70% of the contralateral group was injured in situations similar to those at their initial injuries. There were no significant differences between the two groups in age at the time of initial injury , Tegner activity scores, knee anterior laxity, and the strengths of the knee extensor, flexor muscles and H/Q ratio 6 months after reconstruction. But, the age at the time of initial injury trended to be low in contralateral group. Conclusions Knee anterior laxity and muscle weakness of the reconstructed legs six months following surgery were not individually related to contralateral ACL injury occurring approximately two years after surgery.

  10. In Vivo Study of Ligament-Bone Healing after Anterior Cruciate Ligament Reconstruction Using Autologous Tendons with Mesenchymal Stem Cells Affinity Peptide Conjugated Electrospun Nanofibrous Scaffold

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    Jingxian Zhu

    2013-01-01

    Full Text Available Electrospinning nanofibrous scaffold was commonly used in tissue regeneration recently. Nanofibers with specific topological characteristics were reported to be able to induce osteogenic differentiation of MSCs. In this in vivo study, autologous tendon grafts with lattice-like nanofibrous scaffold wrapping at two ends of autologous tendon were used to promote early stage of ligament-bone healing after rabbit ACL reconstruction. To utilize native MSCs from bone marrow, an MSCs specific affinity peptide E7 was conjugated to nanofibrous meshes. After 3 months, H-E assessment and specific staining of collagen type I, II, and III showed direct ligament-bone insertion with typical four zones (bone, calcified fibrocartilage, fibrocartilage, and ligament in bioactive scaffold reconstruction group. Diameters of bone tunnel were smaller in nanofibrous scaffold conjugated E7 peptide group than those in control group. The failure load of substitution complex also indicated a stronger ligament-bone insertion healing using bioactive scaffold. In conclusion, lattice-like nanofibrous scaffold with specific MSCs affinity peptide has great potential in promoting early stage of ligament-bone healing after ACL reconstruction.

  11. Trends in Revision Elbow Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers.

    Science.gov (United States)

    Wilson, Alexander T; Pidgeon, Tyler S; Morrell, Nathan T; DaSilva, Manuel F

    2015-11-01

    To determine the frequency of revision elbow ulnar collateral ligament (UCL) reconstruction in professional baseball pitchers. Data were collected on 271 professional baseball pitchers who underwent primary UCL reconstruction. Each player was evaluated retrospectively for occurrence of revision UCL reconstructive surgery to treat failed primary reconstruction. Data on players who underwent revision UCL reconstruction were compiled to determine total surgical revision incidence and revision rate by year. The incidence of early revision was analyzed for trends. Average career length after primary UCL reconstruction was calculated and compared with that of players who underwent revision surgery. Logistic regression analysis was performed to assess risk factors for revision including handedness, pitching role, and age at the time of primary reconstruction. Between 1974 and 2014, the annual incidence of primary UCL reconstructions among professional pitchers increased, while the proportion of cases being revised per year decreased. Of the 271 pitchers included in the study, 40 (15%) required at least 1 revision procedure during their playing career. Three cases required a second UCL revision reconstruction. The average time from primary surgery to revision was 5.2 ± 3.2 years (range, 1-13 years). The average length of career following primary reconstruction for all players was 4.9 ± 4.3 years (range, 0-22 years). The average length of career following revision UCL reconstruction was 2.5 ± 2.4 years (range, 0-8 years). No risk factors for needing revision UCL reconstruction were identified. The incidence of primary UCL reconstructions among professional pitchers is increasing; however, the rate of primary reconstructions requiring revision is decreasing. Explanations for the decreased revision rate may include improved surgical technique and improved rehabilitation protocols. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by

  12. Major League pitching workload after primary ulnar collateral ligament reconstruction and risk for revision surgery.

    Science.gov (United States)

    Keller, Robert A; Mehran, Nima; Marshall, Nathan E; Okoroha, Kelechi R; Khalil, Lafi; Tibone, James E; Moutzouros, Vasilios

    2017-02-01

    Literature has attempted to correlate pitching workload with risk of ulnar collateral ligament (UCL) injury; however, limited data are available in evaluating workload and its relationship with the need for revision reconstruction in Major League Baseball (MLB) pitchers. We identified 29 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction and compared them with 121 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared for the seasons after returning from primary reconstruction and for the last season pitched before undergoing revision surgery. The difference in workload between pitchers who did and did not require revision reconstruction was not statistically significant in games pitched, innings pitched, and MLB-only pitch counts. The one significant difference in workload was in total pitch counts (combined MLB and minor league), with the pitchers who required revision surgery pitching less than those who did not (primary: 1413.6 pitches vs. revision: 959.0 pitches, P = .04). In addition, pitchers who required revision surgery underwent primary reconstruction at an early age (22.9 years vs. 27.3 years, P risk for injury after primary UCL reconstruction. However, correlations of risk may be younger age and less MLB experience at the time of the primary reconstruction. Copyright © 2017. Published by Elsevier Inc.

  13. Annular ligament reconstruction with the superficial head of the brachialis: surgical technique and biomechanical evaluation.

    Science.gov (United States)

    Hackl, Michael; Wegmann, Kilian; Ries, Christian; Lappen, Sebastian; Scaal, Martin; Müller, Lars Peter

    2017-06-01

    The purpose of this study was to perform biomechanical testing of annular ligament (AL) reconstruction using the superficial head of the brachialis tendon (SHBT) as a distally based tendon graft. We hypothesized that posterior translation of the radial head following AL reconstruction with an SHBT graft does not significantly differ from intact specimens. Six fresh-frozen elbow specimens were used. The stability of the radial head against posterior translation forces (30 N) was evaluated in 0°, 45°, 90° and 120° of elbow flexion. Posterior translation was obtained for the intact AL, the sectioned AL and the reconstructed AL. Cyclic loading (100 cycles) in 90° of elbow flexion was performed for the intact and the reconstructed AL. Posterior translation of the radial head decreased during elbow flexion in native specimens. Sectioning of the AL significantly increased instability over the full range of motion. AL reconstruction with the SHBT restored the stability of the proximal radius but-other than the native AL-was not influenced by elbow flexion. In 120° of flexion the native AL provided significantly more stability when compared to the reconstructed AL. Cyclic loading did not provide significant differences between native and reconstructed specimens. We provide a feasible technique for AL reconstruction using the SHBT. The biomechanical results obtained in this study confirm the efficacy of the procedure. AL reconstruction restores the stability of the proximal radius, yet it cannot fully mimic the complex features of the intact AL.

  14. “‘Doc’ do I need an anterior cruciate ligament reconstruction? What happens if I do not reconstruct the cruciate ligament?”

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    KS Dhillon

    2014-11-01

    Full Text Available We are all aware that there has been a dramatic increase in the number of anterior cruciate ligament (ACL reconstructions that are carried out here in Malaysia as well as around the world. The numbers of ACL injuries have undoubtedly increased over the years with greater participation of young adults in sporting activities. However it is not certain whether the increase in the numbers of reconstructions can be accounted for by the increasing numbers of ACL injuries. Without doubt commercial interests as well the influence of the biomedical companies have a role to play. In the past the rationale for surgical treatment of an ACL tear was that the ACL is vital for knee function and that in the long term ACL deficiency will lead to more injuries of the meniscus and more degeneration of the joint. This belief was prevalent because the natural history of an ACL deficient knee and the ultimate outcome of reconstruction of the ACL were both not known. However in recent years a substantial amount of research has been published, which has elucidated the natural history of ACL deficient knees as well as the long term outcome of reconstruction of the ACL.

  15. Successful anterior cruciate ligament reconstruction and meniscal repair in osteogenesis imperfecta.

    Science.gov (United States)

    Park, Jae-Young; Cho, Tae-Joon; Lee, Myung Chul; Han, Hyuk-Soo

    2018-03-20

    A case of anterior cruciate ligament (ACL) reconstruction with meniscal repair in an osteogenesis imperfecta patient is reported. A 24-year-old female with osteogenesis imperfecta type 1a suffered from a valgus extension injury resulting in tear of ACL and medial meniscus. She underwent an arthroscopic-assisted ACL reconstruction and medial meniscus repair. Meniscal tear at the menisco-capsular junction of the posterior horn of medial meniscus was repaired with three absorbable sutures via inside-out technique. ACL reconstruction was then performed with a bone-patellar tendon-bone allograft. The patient was followed up for 1 year with intact ACL grafts and healed medial meniscus. This case report showed that successful ACL reconstruction and meniscal repair is possible in an osteogenesis imperfecta patient.Level of evidence V.

  16. Long-term outcome of anterior cruciate ligament tear without reconstruction: a longitudinal prospective study.

    Science.gov (United States)

    Konrads, Christian; Reppenhagen, Stephan; Belder, Daniel; Goebel, Sascha; Rudert, Maximilian; Barthel, Thomas

    2016-11-01

    To analyse subjective and objective long-term outcomes of patients with anterior cruciate ligament (ACL)-deficient knees and limited demands regarding sportive activities. This subgroup of patients might be well-treated without ligament reconstruction. We included 303 patients with unilateral tears of the ACL and conservative treatment into a prospective study. Mean age at injury was 33.8 (min. 18, max. 66) years. Follow-up was 27.1 (min. 21.3, max. 31.5) years. Follow-up examinations were conducted 12 and 27 years after injury. At the last follow-up we analysed 50 patients completely. To evaluate clinical and radiological outcomes we used the Lysholm score, Tegner activity scale, visual analogue scale for pain (VAS-pain), KOOS and Sherman score. Subjective outcome (Lysholm score and VAS-pain scale) improved between the 12th and 27th year after anterior cruciate ligament tear. At the same time activity level (Tegner activity scale) decreased. Also, arthritis (Sherman score) worsened over time. Twenty-seven years after injury, 90 % of the patients rated their ACL-deficient knee as normal or almost normal; 10 % of the patients rated it as abnormal. The findings of this study show that there is a subgroup of patients with ACL tears who are well treated with physiotherapy alone, not reconstructing the ligament. Also, other authors found this correlation between activity level reduction and better subjective outcome. Conservative treatment of an ACL tear is a good treatment option for patients with limited demands regarding activity. Patient age, sportive activities and foremost subjective instability symptoms in daily life should be considered when deciding for or against ACL reconstruction.

  17. 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

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

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    Navin Kumar Karn

    2015-12-01

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

  19. Return to prelesional Tegner level after anatomic anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Seijas, Roberto; Ares, Oscar; Sallent, Andrea; Alvarez, Pedro; Cusco, Xavier; Cugat, Ramón

    2016-12-01

    Injury and surgery of the anterior cruciate ligament (ACL) are very frequent within the sports environment. The purpose of the present study is to assess the level at which a group of athletes were able to return to play (RTP) after ACL reconstruction, and most importantly, the time for RTP. A prospective study with patients who presented an ACL injury and underwent ligament reconstruction surgery; a bone-tendon-bone reconstruction and a minimum follow-up of 24 months. The rates of RTP as well as correlations with IKDC and KT-1000 were collected. 42 patients were included (mean age 31.7 years old). Mean Tegner level was 6.7. 9.5 % of patients returned to sports 6 months after surgery, 52.3 % at 1 year, and 73.8 % at 2 years after ACL reconstruction. 11 patients did not achieve their preoperative Tegner level after 2 years of follow-up. Levels of KT-1000 of the operated side were normal, and IKDC levels reached 90 % of total. Fear to a new injury, psychological factors, personality, type of life, and sports level previous to the injury are factors that influence when it comes to RTP after an ACL surgery. Level of evidence Level II descriptive analysis.

  20. 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

  1. 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

  2. Correlates of knee laxity change in early rehabilitation after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Morrissey, M C; Hudson, Z L; Drechsler, W I; Coutts, F J; King, J B; McAuliffe, T B

    2000-10-01

    Factors other than ligament graft length (knee ROM, knee swelling, initial knee laxity) may need to be accounted for in interpreting changes in knee laxity during rehabilitation following anterior cruciate ligament reconstruction (ACLR) surgery. Twenty-three patients recovering from ACLR surgery (16 M, 7 F, age mean = 30) were tested at 2 and 6 weeks after ACLR with knee laxity measured using th Knee Signature System arthrometer, passive ROM with a standard goniometer and swelling by measuring knee circumference at the mid-patella level using a cloth measuring tape. Spearman correlation coefficients (in parentheses) were calculated using rankings of the change in the injured minus uninjured knee laxity as the dependent variable and the following independent variables: pre-test injured minus uninjured knee laxity (ranked; -0.457; statistically significant two-tailed P guide rehabilitation after ACLR.

  3. 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.

  4. Surgical timing of anterior cruciate ligament reconstruction to prevent associated meniscal and cartilage lesions.

    Science.gov (United States)

    Taketomi, Shuji; Inui, Hiroshi; Yamagami, Ryota; Kawaguchi, Kohei; Nakazato, Keiu; Kono, Kenichi; Kawata, Manabu; Nakagawa, Takumi; Tanaka, Sakae

    2018-02-28

    The purpose of this study was to analyze the association between the prevalence of meniscal and chondral lesions and the timing of surgery in patients undergoing primary anterior cruciate ligament (ACL) reconstruction to determine a safe time for surgery. This retrospective study involved 226 patients (91 females and 135 males; median age, 29 years) undergoing primary ACL reconstruction. Time interval from ACL injury to surgery (median, 4 months; range, 1-420 months) and concomitant meniscal and cartilage lesions in ACL reconstruction were reviewed. Receiver operating characteristic (ROC) curve analysis was used to determine the precise threshold interval to surgery to prevent meniscal or cartilage lesions. The risk of lesion occurrence after each cutoff period was determined using odds ratio (OR). The incidences of medial meniscus (MM), lateral meniscus (LM), and cartilage lesions were 43.8%, 32.7%, and 27.4%, respectively. ROC analysis revealed that patients who waited for more than 6, 4, and 5 months for ACL reconstruction had a significantly greater risk of associated MM, LM, and chondral lesions, respectively. Patients who underwent ACL reconstruction ≥7 months after injury had OR of 4.1 (p lesion as compared with those who underwent reconstruction within 6 months. Similarly, patients who underwent ACL reconstruction ≥5 months after injury had OR of 1.9 (p = 0.023) for the presence of LM lesion as compared with those who underwent reconstruction within 4 months, and patients who underwent ACL reconstruction ≥6 months after injury had OR of 2.9 (p lesion as compared with those who underwent reconstruction within 6 months. ACL reconstruction should be performed within approximately 6 months after the injury to prevent associated meniscal or chondral lesions. Copyright © 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

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

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    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.

  6. Gender differences in the restoration of knee joint biomechanics during gait after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    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.

  7. A comparison of acute and chronic anterior cruciate ligament reconstruction using LARS artificial ligaments: a randomized prospective study with a 5-year follow-up.

    Science.gov (United States)

    Chen, Jia; Gu, Aiqun; Jiang, Haitao; Zhang, Wenjie; Yu, Xiangrong

    2015-01-01

    This prospective randomized study compared acute and chronic anterior cruciate ligament (ACL) reconstruction using ligament advanced reinforcement system (LARS) artificial ligament in young active adults with a 5-year follow-up. Fifty-five patients were enrolled in this study and divided into two groups based on the elapsed time between the injury and reconstruction: the acute group (3-7 weeks) and the chronic group (6-11 months). The clinical outcomes were evaluated using the Lysholm knee scoring scale, the Tegner activity rating, a KT-1000 Arthrometer, and the International Knee Documentation Committee (IKDC) scoring system. Isokinetic strength of the quadriceps and hamstring was assessed using the Biodex System 3 isokinetic dynamometer. Anterior laxity was decreased and quadriceps/hamstring muscle strength was increased in the acute group compared to the chronic group (p > 0.05). There were no statistically significant differences in Lysholm scores, Tegner activity scores, and the IKDC evaluation form between the two groups. These results suggest that earlier ACL reconstruction using a LARS artificial ligament may provide an advantage in the treatment and rehabilitation of ACL rupture.

  8. Effectiveness of lateral slide exercise in an anterior cruciate ligament reconstruction rehabilitation home exercise program.

    Science.gov (United States)

    Blanpied, P; Carroll, R; Douglas, T; Lyons, M; Macalisang, R; Pires, L

    2000-10-01

    Two-group repeated measures design using a sample of convenience of subjects with anterior cruciate ligament (ACL) reconstructive surgery. To determine the effect of incorporating one specific weight-bearing exercise (lateral slide exercise using a slide board) into an ACL reconstruction home exercise program. Reduced clinic visits have increased the importance of home exercise programs in knee ligament reconstruction rehabilitation. Few studies have been conducted to test the efficacy of specific exercises as part of a home-based treatment program on subjects who have undergone ACL reconstruction. Fourteen subjects who underwent patella tendon autograft reconstruction on one of their ACLs were studied. Testing consisted of the following 4 measurements: peak isometric knee extension torque, peak isometric knee flexion torque, maximum lateral step height, and lateral step-up repetitions to fatigue. Subjects were pretested at 8 weeks after surgery and were randomly placed into either a control or experimental group. The postsurgical rehabilitation was similar for both groups, except the experimental group incorporated lateral slide exercise into their home exercise program. All subjects were re-evaluated 14 weeks after surgery. A 2-way repeated measure ANOVA (group by test session), and posthoc testing revealed significant improvements in the slide group for quadricep strength (101.9 +/- 31.3 N m to 140.5 +/- 31.3 N m of torque), while the control group showed no significant increase (125.1 +/- 61.7 N m to 125.8 +/- 45.1 N m of torque). Lateral step height also improved in the slide group (from 22.9 +/- 5.3 cm to 28.7 +/- 5.6 cm), while the control group showed no increase (20.0 +/- 4.5 cm to 20.7 +/- 3.4 cm). Both groups increased in lateral step-up repetitions to fatigue. Including lateral slide exercise in a home exercise program after ACL reconstruction appears to improve knee extension strength.

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

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    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.

  10. Biomechanical Comparison of Anterolateral Procedures Combined With Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Inderhaug, Eivind; Stephen, Joanna M; Williams, Andy; Amis, Andrew A

    2017-02-01

    Anterolateral soft tissue structures of the knee have a role in controlling anterolateral rotational laxity, and they may be damaged at the time of anterior cruciate ligament (ACL) ruptures. To compare the kinematic effects of anterolateral operative procedures in combination with intra-articular ACL reconstruction for combined ACL plus anterolateral-injured knees. Controlled laboratory study. Twelve cadaveric knees were tested in a 6 degrees of freedom rig using an optical tracking system to record the kinematics through 0° to 90° of knee flexion with no load, anterior drawer, internal rotation, and combined loading. Testing was first performed in ACL-intact, ACL-deficient, and combined ACL plus anterolateral-injured (distal deep insertions of the iliotibial band and the anterolateral ligament [ALL] and capsule cut) states. Thereafter, ACL reconstruction was performed alone and in combination with the following: modified MacIntosh tenodesis, modified Lemaire tenodesis passed both superficial and deep to the lateral collateral ligament, and ALL reconstruction. Anterolateral grafts were fixed at 30° of knee flexion with both 20 and 40 N of tension. Statistical analysis used repeated-measures analyses of variance and paired t tests with Bonferroni adjustments. ACL reconstruction alone failed to restore native knee kinematics in combined ACL plus anterolateral-injured knees ( P tension, except for ALL reconstruction ( P = .002-.01), restored anterior translation. With 40 N of tension, the superficial Lemaire and MacIntosh procedures overconstrained the anterior laxity in deep flexion. Only the deep Lemaire and MacIntosh procedures-with 20 N of tension-restored rotational kinematics to the intact state ( P > .05 for all), while the ALL underconstrained and the superficial Lemaire overconstrained internal rotation. The same procedures with 40 N of tension led to similar findings. In a combined ACL plus anterolateral-injured knee, ACL reconstruction alone failed to

  11. 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.

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    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. Review of evolution of tunnel position in anterior cruciate ligament reconstruction

    Science.gov (United States)

    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 development of newer techniques supplemented by more robust biological and mechanical concepts. In this review we are mainly focussing on the evolution of tunnel placement in ACL reconstruction, focusing on three main categories, i.e., anatomical, biological and clinical outcomes. The importance of tunnel placement in the success of ACL reconstruction is well researched. Definite clinical and functional data is lacking to establish the superiority of the single or double bundle reconstruction technique. While there is a trend towards the use of anteromedial portals for femoral tunnel placement, their clinical superiority over trans-tibial tunnels is yet to be established. PMID:25793165

  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. Evidence-based practice to improve outcomes of anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Ayeni, O R; Evaniew, N; Ogilvie, R; Peterson, D C; Denkers, M R; Bhandari, M

    2013-01-01

    Recent studies of anatomic anterior cruciate ligament (ACL) reconstruction have considered native knee anatomy and biomechanical function, and emphasized the long-term goals of protecting knee health and preventing the development of symptomatic ACL-deficient degenerative arthrosis. Validated and reproducible examination maneuvers are necessary for accurate diagnosis and appraisal of surgical interventions. Appropriately powered expertise-based trials should be emphasized to minimize bias, enhance validity, and reduce crossover. Best practice rehabilitation protocols can guide postoperative care while minimizing heterogeneity within studies. Functional outcome scores should be sensitive, responsive, and able to reliably detect small changes. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Imaging of posterior cruciate ligament (PCL) reconstruction: normal postsurgical appearance and complications

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    Alcala-Galiano, Andrea; Baeva, Maria; Jose Argueeso, Maria [Hospital ASEPEYO Coslada, Department of Radiology, Madrid (Spain); Ismael, Maryem [Hospital ASEPEYO Coslada, Department of Traumatology and Orthopaedic Surgery, Madrid (Spain)

    2014-12-15

    This article reviews the normal postsurgical anatomy and appearance of PCL reconstructions on MDCT and MRI with the different operative techniques considering the type of tibial fixation, use of a single or double bundle, type of tendon graft and the fixation material. Tunnel positioning, appearance of the ligament graft and findings at the donor site are considered. Imaging signs of PCL graft failure and its possible causes are discussed. Imaging manifestations of other potential complications of both the PCL graft and donor sites are described, such as laxity, impingement, arthrofibrosis, ganglion cyst formation or complications related to the fixation material. (orig.)

  18. Lateral collateral ligament reconstruction for chronic varus instability of the hallux interphalangeal joint.

    Science.gov (United States)

    Cho, Jaeho

    2014-01-01

    Chronic varus instability of the hallux interphalangeal joint is a rare injury, and only a few reports of this injury have been published. In some studies, this injury has been related to taekwondo. Taekwondo is an essential martial art in the Korean military. We have described a case of varus instability of the hallux interphalangeal joint in a professional soldier who had practiced taekwondo for 5 years and the surgical outcome after reconstruction of the lateral collateral ligament with the fourth toe extensor tendon. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  19. A Technique of Superficial Medial Collateral Ligament Reconstruction Using an Adjustable-Loop Suspensory Fixation Device.

    Science.gov (United States)

    Deo, Shaneel; Getgood, Alan

    2015-06-01

    This report describes superficial medial collateral ligament reconstruction of the knee using a novel method of graft fixation with the ACL Tightrope RT (Arthrex, Naples, FL). After tibial fixation with either a standard interference screw or staple, femoral fixation of the semitendinosus tendon is performed with the adjustable-loop suspensory fixation device, which allows for both initial graft tensioning and re-tensioning after cyclical knee range of motion. This provides the ability for the graft to accommodate for resultant soft-tissue creep and stress relaxation, thereby allowing for optimal soft-tissue tension and reduction in laxity at the end of the procedure.

  20. 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.

  1. Outcome of double bundle anterior cruciate ligament reconstruction using crosspin and aperture fixation

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    Deepak Joshi

    2014-01-01

    Full Text Available Background: Double bundle anterior cruciate ligament (DBACL reconstruction is said to reproduce the native anterior cruciate ligament (ACL anatomy better than single bundle anterior cruciate ligament, whether it leads to better functional results is debatable. Different fixation methods have been used for DBACL reconstruction, the most common being aperture fixation on tibial side and cortical suspensory fixation on the femoral side. We present the results of DBACL reconstruction technique, wherein on the femoral side anteromedial (AM bundle is fixed with a crosspin and aperture fixation was done for the posterolateral (PL bundle. Materials and Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA on the femoral side and bio interference screw (Arthrex, Naples, FL, USA on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC Score and isokinetic muscle strength testing. Results: The KT-1000 results were evaluated using paired t test with the P value set at 0.001. At the end of 1 year, the anteroposterior side to side translation difference (KT-1000 manual maximum showed mean improvement from 5.1 mm ± 1.5 preoperatively to 1.6 mm ± 1.2 ( P < 0.001 postoperatively. The Lysholm score too showed statistically significant ( P < 0.001 improvement from 52.4 ± 15.2 (range: 32-76 preoperatively to a postoperative score of 89.1 ± 3.2 (range 67-100. According to the IKDC score 90% patients had normal results (Category A and B. The AM femoral tunnel initial posterior blow out was seen in 4 patients and confluence in the intraarticular part of the femoral tunnels was seen in 6

  2. [Benefit of isokinetic evaluations of knee before and after anterior cruciate ligament reconstruction in soccer players].

    Science.gov (United States)

    Olivier, N; Rogez, J; Masquelier, B

    2007-10-01

    The aim of this study was to analyse the evolution of the isokinetic performance of the knee flexor and extensor muscles in soccer players before and after intra-articular anterior cruciate ligament reconstruction (Kennet-Jones). Two isokinetic evaluations were carried out before surgery and after rehabilitation (i.e. 4 months later) in 18 soccer players. The initial evaluation showed that the stabilizing muscles of the knee were affected differently after lesion of the external anterior crossed ligament. At the opposite of the flexor muscles, the performance of the knee extensor muscles of the injured leg was significantly reduced as compared with that of the healthy leg (peak torque at 90 degrees /s, -16%; power at 180 degrees /s, -14%; total work at 240 degrees /s, -11%). Even if 4 months after surgery, this deficit was accentuated (peak torque at 90 degrees /s, -26%; power at 180 degrees /s, -23%; total work at 240 degrees /s, -19%), the preoperative results of the knee extensor muscle do not condition the postoperative performance. After a rupture of the external anterior crossed ligament, a regular program of isokinetic evaluation of the knee seems to be relevant in the follow-up of the wounded athlete. The evaluation before surgery can be used as reference, and from a psychological point of view, this evaluation can create confidence in the athlete during hospitalization. A second evaluation 4 months after surgery can be used to quantify the muscular deficit to direct the exercises of rehabilitation.

  3. Effects of different femoral tunnel positions on tension changes in anterolateral ligament reconstruction.

    Science.gov (United States)

    Katakura, Mai; Koga, Hideyuki; Nakamura, Kaori; Sekiya, Ichiro; Muneta, Takeshi

    2017-04-01

    Several kinds of anterolateral ligament (ALL) reconstructions to augment intra-articular anterior cruciate ligament reconstruction to better control anterolateral rotational instability (ALRI) have been reported. However, the optimal femoral attachment site for ALL reconstruction is still unclear. The purpose of this study was to investigate the effects of different femoral attachment sites on the tension changes through knee motions in different situations in order to determine a recommended femoral attachment site for ALL reconstruction. Six fresh-frozen cadaveric knees were included. ALL reconstructions were performed with three different femoral attachment sites (F1: 2 mm anterior and 2 mm distal to the lateral epicondyle, F2: 4 mm posterior and 8 mm proximal to the lateral epicondyle and F3: position for the lateral extra-articular tenodesis). The graft tension changes were measured by a graft tensioning system during knee flexion-extension and manual maximum internal/external tibial rotation in the following situations: (1) intact, (2) ALL cut, (3) ALL and ACL cut and (4) ALL cut and ACL reconstructed. Effects of the different femoral attachment sites, the route superficial or deep to the LCL, and the situations of (1) to (4) were calculated via repeated-measures analysis of variance. The tension of F1 was higher in flexion and lower in extension, whereas the tension of F2 and F3 was higher in extension and lower in flexion. F2 showed the smallest tension change. Situations of (1) to (4) did not affect tension changes. The graft tension became higher with internal rotation and lower with external rotation regardless of femoral attachment sites or situations. With F2-4 mm posterior and 8 mm proximal to the lateral epicondyle-the reconstructed ALL had the least tension change with only a slight increase in tension as the knee extended. This result indicates that F2 is recommended for ALL reconstruction to better control ALRI, which will help determine the

  4. Pain experience and functional outcome of inpatient versus outpatient anterior cruciate ligament reconstruction, an equivalence randomized controlled trial with 12 months follow-up

    NARCIS (Netherlands)

    Valkering, K. P.; van Bergen, C. J. A.; Buijze, G. A.; Nagel, P. H. A. F.; Tuinebreijer, W. E.; Breederveld, R. S.

    2015-01-01

    Arthroscopic reconstruction of the anterior cruciate ligament (ACL) has traditionally been performed in an inpatient setting. Outpatient treatment may offer the advantages of cost reduction and higher patient satisfaction. We investigated whether ACL reconstruction in an outpatient setting is

  5. 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 sport characteristics were described, and multivariable Cox regression modeling was used to identify predictors of a second ACL injury. Candidate variables included patient factors (age, sex, physeal status, tibial slope, notch width index), surgical characteristics (graft type, surgical technique), measures of recovery (time to return to sport, duration of 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

  6. 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

  7. Comparison of Three Patellar Tendon Anterior Cruciate Ligament Reconstruction Techniques with Emphasis on Tunnel Location and Outcome. Are Our Results Improving?

    OpenAIRE

    Merchant, Thomas C

    2001-01-01

    In order to determine if recent changes in tunnel placement during anterior cruciate ligament reconstruction are producing better outcomes, the results of three different "bone-patellar tendon-bone" anterior cruciate ligament reconstruction techniques were compared. These techniques were: two-incision with the tibial tunnel at the anterior "footprint" of the anterior cruciate ligament (group I), two-incision with freehand placement of the tibial tunnel in the central or posterior "footprint" ...

  8. 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

  9. A multidisciplinary approach to clitoral reconstruction after female genital mutilation: the crucial role of counselling.

    Science.gov (United States)

    De Schrijver, Lotte; Leye, Els; Merckx, Mireille

    2016-08-01

    Female genital mutilation (FGM) is becoming more widely seen in the West, due to immigration and population movement. Health services are being confronted with the need to provide care for women with FGM. One of the more recent trends is the provision of clitoral reconstruction. It remains unclear, however, what constitutes good practice with regard to this type of surgery. Based on a keynote presentation about reconstructive clitoral surgery, we briefly discuss the possible consequences of FGM and the findings from recent publications on clitoral reconstruction. Recognising individual differences in women, we suggest a multidisciplinary counselling model to provide appropriate care for women requesting clitoral reconstruction. The literature shows that FGM influences physical, mental and sexual health. Clitoral reconstructive surgery can lead to an increase in sexual satisfaction and orgasm in some, but not all, women. A multidisciplinary approach would enable a more satisfactory and individually tailored approach to care. The multidisciplinary team should consist of a midwife, a gynaecological surgeon, a psychologist-psychotherapist, a sexologist and a social worker. Comprehensive health counselling should be the common thread in this model of care. Our proposed care pathway starts with taking a thorough history, followed by medical, psychological and sexological consultations. Women with FGM requesting clitoral reconstruction might primarily be looking to improve their sexual life, to recover their identity and to reduce pain. Surgery may not always be the right answer. Thorough counselling that includes medical, psychological and sexual advice is therefore necessary as part of a multidisciplinary approach.

  10. Comparison of analgesic effects of intra-articular tenoxicam and morphine in anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Guler, Gulen; Karaoglu, Sinan; Velibasoglu, Hediye; Ramazanogullari, Nesrin; Boyaci, Adem

    2002-07-01

    This study compared the analgesic effect of intra-articular injection of tenoxicam with that of morphine on postoperative pain after anterior cruciate ligament (ACL) reconstruction. Forty-two patients undergoing arthroscopically ACL reconstructions using hamstring tendons underwent the same anesthetic protocol. The patients were randomized to receive 25 ml normal saline, 20 mg tenoxicam in 25 ml normal saline, or 2 mg morphine in 25 ml normal saline. Postoperative pain was assessed using a visual analogue scale and measuring analgesic requirements. We found both that both intra-articular tenoxicam and intra-articular morphine provided better analgesia than that in the control group. Although pain scores were similar between tenoxicam and morphine groups 30 min postoperative, the analgesic requirements in with tenoxicam were significantly lower than those with morphine group 3-6 h postoperatively.

  11. Reconstruction of the chronically insufficient anterior cruciate ligament: long term results of the Eriksson procedure.

    Science.gov (United States)

    Natri, A; Järvinen, M; Lehto, M; Kannus, P

    1996-01-01

    Thirty-two patients (26 men and 6 women) with symptoms due to chronic insufficiency of the anterior cruciate ligament were treated by reconstruction using the medial one-third of the patellar tendon. The average delay between injury and operation was 4.8 years. Prior to this, 28 operations had been carried out on the knees of 20 of the patients. At follow up, at an average of 6.6 years after reconstruction, 50% were satisfied subjectively with the end result, and 57% were excellent or good on the Lysholm score. The Lachman test showed that 50% were completely stable and none had severe laxity. The anterior drawer test was negative in 59% and only one had moderate laxity. The pivot shift was negative in 69% and only 2 were 2+ positive. Twenty-one of the 29 patients who were active in sport before their injury were able to continue their activity at the same or a reduced level.

  12. Validation of the foot and ankle outcome score for ankle ligament reconstruction.

    Science.gov (United States)

    Roos, E M; Brandsson, S; Karlsson, J

    2001-10-01

    We studied the validity and reliability of the Foot and Ankle Outcome Score (FAOS) when used to evaluate the outcome of 213 patients (mean age 40 years, 85 females) who underwent anatomical reconstruction of the lateral ankle ligaments with an average postoperative follow-up of 12 years (range, three to 24 years). The FAOS is a 42-item questionnaire assessing patient-relevant outcomes in five separate subscales (Pain, Other Symptoms, Activities of Daily Living, Sport and Recreation Function, Foot- and Ankle-Related Quality of Life). The FAOS met set criteria of validity and reliability. The FAOS appears to be useful for the evaluation of patient-relevant outcomes related to ankle reconstruction.

  13. Anatomical reference point for harvesting a flexor graft during arthroscopic reconstruction of the anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Clécio de Lima Lopes

    2015-04-01

    Full Text Available OBJECTIVES: To evaluate the prevalence of a vascular network adjacent to the insertion of the pes anserinus, so that it could be used as an anatomical reference point to facilitate harvesting flexor grafts for arthroscopic reconstruction of the anterior cruciate ligament (ACL.METHODS: Thirty patients with ACL tears who were going to undergo ACL reconstruction using the tendons of the semitendinosus and gracilis muscles as grafts were selected randomly. During the harvesting of these tendons, the presence or absence of this anatomical reference point was noted.RESULTS: All the patients presented a vascular network of greater or lesser diameter.CONCLUSION: The vascular network seems to be a good reference point during harvesting of the tendons of the semitendinosus and gracilis muscles, for facilitating graft harvesting.

  14. 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.

  15. Simultaneous bilateral anterior cruciate ligament reconstruction: Cost comparison and functional results

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    Matjaž Sajovic

    2014-04-01

    Full Text Available Background: The ideal treatment for patients presenting with bilateral anterior cruciate ligament (ACL deficiency remains controversial. The purpose was to evaluate cost and mid-term functional results after one-stage bilateral ACL reconstruction using either hamstring or patella tendon autograft.Methods: We compared the mid-term outcome of 7 patients (14 knees who had one-stage bilateral ACL reconstruction with that of a matched group of patients who had unilateral reconstruction (21 patients.Results: The median duration of hospital stay was 4 nights (range 3 to 5 for the bilateral group and 2 nights (range, 1 to 4 for the control group. The duration of rehabilitation process in patients from the control group with unilateral ACL reconstruction was one week shorter (9 versus 8 weeks. In the bilateral group, the median Lysholm score was 96 (range 85–100 and in the control group, the median score was 93 (range 81–100. The median time to return to full-time work and to full sports was 9 weeks and 7 months for the simultaneous bilateral group and 8 weeks and 6 months for the unilateral group. Six patients (86 % in the bilateral group and 17 patients (81 % in the control group were still performing at their pre-injury level of activity. The Health Insurance Institute of Slovenia saves EUR 2,925 when we perform simultaneous bilateral ACL reconstruction instead of two stage ACL reconstruction.Conclusions: Mid-term clinical results suggested that simultaneous bilateral ACL reconstruction using either hamstring or patella tendon autograft is clinically effective. For patients presenting with symptomatic bilateral ACL deficient knees, one stage bilateral ACL reconstruction is reproducible, cost effective, and does not compromise functional results.

  16. The Cost-Effectiveness of Anterior Cruciate Ligament Reconstruction in Competitive Athletes.

    Science.gov (United States)

    Stewart, Bruce A; Momaya, Amit M; Silverstein, Marc D; Lintner, David

    2017-01-01

    Competitive athletes value the ability to return to competitive play after the treatment of anterior cruciate ligament (ACL) injuries. ACL reconstruction has high success rates for return to play, but some studies indicate that patients may do well with nonoperative physical therapy treatment. To evaluate the cost-effectiveness of the treatment of acute ACL tears with either initial surgical reconstruction or physical therapy in competitive athletes. Economic and decision analysis; Level of evidence, 2. The incremental cost, incremental effectiveness, and incremental cost-effectiveness ratio (ICER) of ACL reconstruction compared with physical therapy were calculated from a cost-effectiveness analysis of ACL reconstruction compared with physical therapy for the initial management of acute ACL injuries in competitive athletes. The ACL reconstruction strategy and the physical therapy strategy were represented as Markov models. Costs and quality-adjusted life-years (QALYs) were evaluated over a 6-year time horizon and were analyzed from a societal perspective. Quality of life and probabilities of clinical outcomes were obtained from the peer-reviewed literature, and costs were compiled from a large academic hospital in the United States. One-way, 2-way, and probabilistic sensitivity analyses were used to assess the effect of uncertainty in variables on the ICER of ACL reconstruction. The ICER of ACL reconstruction compared with physical therapy was $22,702 per QALY gained. The ICER was most sensitive to the quality of life of returning to play or not returning to play, costs, and duration of follow-up but relatively insensitive to the rates and costs of complications, probabilities of return to play for both operative and nonoperative treatments, and discount rate. ACL reconstruction is a cost-effective strategy for competitive athletes with an ACL injury.

  17. Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes.

    Science.gov (United States)

    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

  18. High failure rate of anterior cruciate ligament reconstruction with bimeniscal repair: A case-control study.

    Science.gov (United States)

    Gonçalves, H; Steltzlen, C; Boisrenoult, P; Beaufils, P; Pujol, N

    2017-10-01

    Bimeniscal lesions are common in patients with anterior cruciate ligament (ACL) tears. However, bimeniscal repair is rarely performed during ACL reconstruction. To assess outcomes after ACL reconstruction with bimeniscal repair. Bimeniscal lesions, even when repaired, are associated with poorer outcomes of ACL reconstruction. A retrospective case-control design was used. The cases were 15 patients who underwent ACL reconstruction, without procedures on any other ligaments, combined with bimeniscal repair, between May 2009 and May 2013 (3.2% of all ACL reconstructions during the study period). This group (2-Mc group) was matched on age, gender, body mass index, and time to surgery to 30 patients who underwent ACL reconstruction and had no meniscal lesions (0-Mc group) and to 30 patients who underwent ACL reconstruction and repair of the medial meniscus (1-Mc group). After a mean follow-up of 3.6 years, clinical outcomes were assessed based on the KOOS, Lysholm, and IKDC scores and knee laxity based on TELOS and GNRB measurements. The primary outcome measure was the rate of ACL re-rupture. Secondary outcome measures were functional outcomes and rate of delayed meniscectomy. The ACL re-rupture rate was significantly higher in the 2-Mc group than in the 0-Mc and 1-Mc groups pooled (20%, vs. 1.7%; P=0.02). The functional scores showed no significant differences across groups. Post-operative differential laxity was significantly greater in the 2-Mc group (3.3mm by TELOS, P=0.02; and 2.5mm by GNRB, P=0.03) than in the 0-Mc and 1-Mc groups pooled. Delayed meniscectomy was performed in none of the 2-Mc group patients and in 2 of the 1-Mc group patients. ACL reconstruction combined with bimeniscal repair is a rarely performed procedure. It is associated with a high ACL re-rupture rate and greater differential laxity. Meniscal outcomes of bimeniscal repair, in contrast, are good. III, matched case-control study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. Quadriceps muscle function after rehabilitation with cryotherapy in patients with anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Hart, Joseph M; Kuenze, Christopher M; Diduch, David R; Ingersoll, Christopher D

    2014-01-01

    Persistent muscle weakness after anterior cruciate ligament (ACL) reconstruction may be due to underlying activation failure and arthrogenic muscle inhibition (AMI). Knee-joint cryotherapy has been shown to improve quadriceps function transiently in those with AMI, thereby providing an opportunity to improve quadriceps muscle activation and strength in patients with a reconstructed ACL. To compare quadriceps muscle function in patients with a reconstructed ACL who completed a 2-week intervention including daily cryotherapy (ice bag), daily exercises, or both. Cross-sectional study. Laboratory. A total of 30 patients with reconstructed ACLs who were at least 6 months post-index surgery and had measurable quadriceps AMI. The patients attended 4 supervised visits over a 2-week period. They were randomly assigned to receive 20 minutes of knee-joint cryotherapy, 1 hour of therapeutic rehabilitation exercises, or cryotherapy followed by exercises. We measured quadriceps Hoffmann reflex, normalized maximal voluntary isometric contraction torque, central activation ratio using the superimposed-burst technique, and patient-reported outcomes before and after the intervention period. After the 2-week intervention period, patients who performed rehabilitation exercises immediately after cryotherapy had higher normalized maximal voluntary isometric contraction torques (P = .002, Cohen d effect size = 1.4) compared with those who received cryotherapy alone (P = .16, d = 0.58) or performed exercise alone (P = .16, d = 0.30). After ACL reconstruction, patients with AMI who performed rehabilitation exercises immediately after cryotherapy experienced greater strength gains than those who performed cryotherapy or exercises alone.

  20. Sports-specific differences in postsurgical infections after arthroscopically assisted anterior cruciate ligament reconstruction.

    Science.gov (United States)

    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 sports (n.s.). Staphylococcus aureus and epidermidis were the predominant detected bacteria. All patients were hospitalised and successfully treated with arthroscopic lavage and antibiotic medication. ACL infections showed sports-related differences. Athletes practising summer outdoor sports such as football had a significantly higher risk of infection after ACL reconstruction than winter sports athletes. No difference was found between professional and 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. Ability of a new hop test to determine functional deficits after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Augustsson, Jesper; Thomeé, Roland; Karlsson, Jon

    2004-09-01

    The aim of this study was to investigate the ability of a new hop test to determine functional deficits after anterior cruciate ligament (ACL) reconstruction. The test consists of a pre-exhaustion exercise protocol combined with a single-leg hop. Nineteen male patients with ACL reconstruction (mean time after operation 11 months) who exhibited normal single-leg hop symmetry values (> or =90% compared with the non-involved extremity) were tested for one-repetition maximum (1 RM) strength of a knee-extension exercise. The patients then performed single-leg hops following a standardised pre-exhaustion exercise protocol, which consisted of unilateral weight machine knee-extensions until failure at 50% of 1 RM. Although no patients displayed abnormal hop symmetry when non-fatigued, 68% of the patients showed abnormal hop symmetry for the fatigued test condition. Sixty-three per cent exhibited 1 RM strength scores of below 90% of the non-involved leg. Eighty-four percent of the patients exhibited abnormal symmetry in at least one of the tests. Our findings indicate that patients are not fully rehabilitated 11 months after ACL reconstruction. It is concluded that the pre-exhaustion exercise protocol, combined with the single-leg hop test, improved testing sensitivity when evaluating lower-extremity function after ACL reconstruction. For a more comprehensive evaluation of lower-extremity function after ACL reconstruction, it is therefore suggested that functional testing should be performed both under non-fatigued and fatigued test conditions.

  2. The effects of medial ulnar collateral ligament reconstruction on Major League pitching performance.

    Science.gov (United States)

    Keller, Robert A; Steffes, Matthew J; Zhuo, David; Bey, Michael J; Moutzouros, Vasilios

    2014-11-01

    Medial ulnar collateral ligament (MUCL) reconstruction is commonly performed on Major League Baseball (MLB) pitchers. Previous studies have reported that most pitchers return to presurgical statistical performance levels after MUCL reconstruction. Pitching performance data--specifically, earned run average (ERA), walks and hits per inning pitched (WHIP), winning percentage, and innings pitched--were acquired for 168 MLB pitchers who had undergone MUCL reconstruction. These data were averaged over the 3 years before surgery and the 3 years after surgery and also acquired from 178 age-matched, uninjured MLB pitchers. Of the pitchers who had MUCL reconstruction surgery, 87% returned to MLB pitching. However, compared with presurgical data, pitching performance declined in terms of ERA (P = .001), WHIP (P = .011), and innings pitched (P = .026). Pitching performance also declined in the season before the surgery compared with previous years (ERA, P = .014; WHIP, P = .036; innings pitched, P risk factor for requiring surgery. In addition, there is an increased risk of MUCL reconstruction for pitchers who enter the major leagues at a younger age. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  3. Analysis of 500 anterior cruciate ligament reconstructions from a private institutional register.

    Directory of Open Access Journals (Sweden)

    Lauro Augusto Costa

    Full Text Available The aims of this study are to describe the epidemiological characteristics of anterior cruciate ligament reconstructions in a private hospital in Brazil and to determine trends in medical practice for comparison with previous studies.We retrospectively reviewed the anterior cruciate ligament institutional register to obtain data from all patients who underwent primary anterior cruciate ligament reconstruction from July 2014 to June 2016. Descriptive statistics were used to summarize the sample. Specific statistical tests were used to assess associations between the meniscal lesion and other variables.During the study period, 72.6% out of 500 patients were male. The mean age at surgery was 35.1 years. The mean age was higher among females than among males (37.3 ± 12.1 vs 34.3 ± 10.8 years. The median time from injury to surgery was 44 days. The most common femoral and tibial fixations used were suspensory fixation (60.8% and interference screw (96%, respectively. The most commonly used graft was hamstring tendon (70.2%, followed by bone-patellar tendon-bone (28.8%. A meniscal lesion was noted in 44.8% of cases. Partial meniscectomy was performed in 69.5% of meniscal lesions, and meniscal repair was performed in 14.1% of lesions. The mean length of hospital stay was 1.4 days. The proportion of men in the group of patients with an associated meniscal lesion was higher than that in the group of patients without a meniscal lesion (p = 0.007.In this study, we identified that the vast majority of surgeries were performed in male patients in all age groups, and patients older than 30 years and with a short time from injury to surgery predominated. Concerning surgical technique, we noted a low rate of meniscal repair and a higher preference for the use of hamstring graft and suspensory fixation on the femoral side.

  4. Lateral Augmentation Procedures in Anterior Cruciate Ligament Reconstruction: Anatomic, Biomechanical, Imaging, and Clinical Evidence.

    Science.gov (United States)

    Weber, Alexander E; Zuke, William; Mayer, Erik N; Forsythe, Brian; Getgood, Alan; Verma, Nikhil N; Bach, Bernard R; Bedi, Asheesh; Cole, Brian J

    2018-02-01

    There has been an increasing interest in lateral-based soft tissue reconstructive techniques as augments to anterior cruciate ligament reconstruction (ACLR). The objective of these procedures is to minimize anterolateral rotational instability of the knee after surgery. Despite the relatively rapid increase in surgical application of these techniques, many clinical questions remain. To provide a comprehensive update on the current state of these lateral-based augmentation procedures by reviewing the origins of the surgical techniques, the biomechanical data to support their use, and the clinical results to date. Systematic review. A systematic search of the literature was conducted via the Medline, EMBASE, Scopus, SportDiscus, and CINAHL databases. The search was designed to encompass the literature on lateral extra-articular tenodesis (LET) procedures and the anterolateral ligament (ALL) reconstruction. Titles and abstracts were reviewed for relevance and sorted into the following categories: anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes. The search identified 4016 articles. After review for relevance, 31, 53, 27, 35, 45, and 78 articles described the anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes of either LET procedures or the ALL reconstruction, respectively. A multitude of investigations were available, revealing controversy in addition to consensus in several categories. The level of evidence obtained from this search was not adequate for systematic review or meta-analysis; thus, a current concepts review of the anatomy, biomechanics, imaging, surgical techniques, and clinical outcomes was performed. Histologically, the ALL appears to be a distinct structure that can be identified with advanced imaging techniques. Biomechanical evidence suggests that the anterolateral structures of the knee, including the ALL, contribute to minimizing anterolateral rotational instability

  5. Serial dilation versus extraction drilling in anterior cruciate ligament reconstruction: a biomechanical study.

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    Sørensen, O G; Jakobsen, B W; Kold, S; Hansen, T B; Søballe, K

    2010-06-01

    The hamstring tendon graft has become increasingly popular in anterior cruciate ligament reconstruction because of low donor-site morbidity. However, the tibial fixation is considered difficult, mainly because of low tibial mineral bone density. Therefore, we tested whether preparation of the tibial tunnel with compaction by serial dilation provided a stronger anchorage of the graft-fixation-device complex than does traditional extraction drilling of the tibial tunnel. In 20 bovine tibiae, the bone tunnels were created with either extraction drilling (group 1) or compaction by serial dilation (group 2). Twenty bovine digital extensor tendons were fixated in the bone tunnel with an Intrafix tibial fastener. The graft-fixation-device complexes were mounted in a hydraulic test machine. The fixation strength was evaluated after cyclic loading. The difference between the serial dilation group and the extraction drilling group ranged from a mean slippage of 0 mm at 70-220 N, to a mean slippage of 0.1 mm at 70-520 N. We found no significant difference in slippage of the graft-fixation-device complex after 1,600 cycles. This study failed to show a significant difference between compaction by serial dilation and extraction drilling of the tibia bone tunnel in anterior cruciate ligament reconstruction.

  6. Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft: a biomechanic and histologic study.

    Science.gov (United States)

    Shin, S S; Moore, D C; McGovern, R D; Weiss, A P

    1998-03-01

    A new surgical technique has been recently described that involves reconstruction of the dorsal aspect of the scapholunate ligament (DSLL) with a bone-retinaculum-bone (BRB) autograft preparation from Lister's tubercle. In this study, the mechanic and histologic properties of the 2 tissues were compared. The BRB and DSLL specimens were harvested from 6 fresh-frozen human cadaveric forearms. The specimens were measured and then tested in tension with an MTS 810 servohydraulic materials testing machine at a rate of 10 mm/min. The BRB autograft was significantly weaker than the DSLL. However, because the mean cross-sectional area of the DSLL was more than 3 times as large as that of the BRB autograft, the failure stress (failure force/cross-sectional area) of the BRB autograft was not significantly different from that of the DSLL. Histologically, the DSLL and BRB autograft were also similar. These findings suggest that the BRB autograft may be appropriate graft material for scapholunate ligament reconstruction, but that structural parity with DSLL will ultimately depend on remodeling and hypertrophy during healing. This also highlights the importance of using a large BRB autograft to approximate the strength of the DSLL as much as possible, and that the BRB autograft must be protected postoperatively as it heals and remodels.

  7. Effects of Wii balance board exercises on balance after posterior cruciate ligament reconstruction.

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    Puh, Urška; Majcen, Nia; Hlebš, Sonja; Rugelj, Darja

    2014-05-01

    To establish the effects of training on Wii balance board (WBB) after posterior cruciate ligament (PCL) reconstruction on balance. Included patient injured her posterior cruciate ligament 22 months prior to the study. Training on WBB was performed 4 weeks, 6 times per week, 30-45 min per day. Center of pressure (CoP) sway during parallel and one-leg stance, and body weight distribution in parallel stance were measured. Additionally, measurements of joint range of motion and limb circumferences were taken before and after training. After training, the body weight was almost equally distributed on both legs. Decrease in CoP sway was most significant for one-leg stance with each leg on compliant surface with eyes open and closed. The knee joint range of motion increased and limb circumferences decreased. According to the results of this single case report, we might recommend the use of WBB for balance training after PCL reconstruction. Case series with no comparison group, Level IV.

  8. 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.

  9. Prognosis of anterior cruciate ligament reconstruction: a data-driven approach.

    Science.gov (United States)

    Chandra, Abhijit; Kar, Oliva; Wu, Kuan-Chuen; Hall, Michelle; Gillette, Jason

    2015-04-08

    Individuals who suffer anterior cruciate ligament (ACL) injury are at higher risk of developing knee osteoarthritis (OA) and almost 50% display symptoms 10-20 years post injury. Anterior cruciate ligament reconstruction ( ACLR ) often does not protect against knee OA development . Accordingly, a multi-scale formulation for data-driven prognosis (DDP) of post-ACLR is developed. Unlike traditional predictive strategies that require controlled off-line measurements or 'training' for determination of constitutive parameters to derive the transitional statistics, the proposed DDP algorithm relies solely on in situ measurements. The proposed DDP scheme is capable of predicting onset of instabilities. As the need for off-line testing (or training) is obviated, it can be easily implemented for ACLR, where such controlled a priori testing is almost impossible to conduct. The DDP algorithm facilitates hierarchical handling of the large dataset and can assess the state of recovery in post-ACLR conditions based on data collected from stair ascent and descent exercises of subjects. The DDP algorithm identifies inefficient knee varus motion and knee rotation as primary difficulties experienced by some of the post-ACLR population. In such cases, levels of energy dissipation rate at the knee, and its fluctuation may be used as measures for assessing progress after ACL reconstruction.

  10. The accuracy of MRI in assessing graft integrity after anterior cruciate ligament reconstruction

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    Nakayama, Yoshihito; Shirai, Yasumasa; Narita, Tetsuya; Mori, Atsushi; Kobayashi, Kaoru [Nippon Medical School, Tokyo (Japan)

    2001-02-01

    To evaluate the efficacy of MRI in assessing anterior cruciate ligament (ACL) reconstruction graft integrity, we compared MRI findings with arthroscopic findings in 52 patients who had undergone arthroscopically assisted ACL reconstruction using semitendinosus and gracilis tendons augmented by woven polyester. MRI and arthroscopy were carried out 12 months after the operation. The MR appearance of ACL grafts was categorized into 3 types by signal intensity and continuity of the ligament according to Rak's method: well-defined type: the graft was visualized as a smoothly continuous band with low signal over the entire course; intermediate type: signal intensity increased and a low-signal band was visualized only in part of the graft; indiscernible type: the graft was not identified through the joint cavity due to markedly increased signal intensity. When the MR appearance of intermediate or indiscernible types was defined as torn, the grafts were presumed to be torn in 9 patients whose arthroscopic findings were 7 intact and 2 torn grafts. All cases with intact MRI findings were intact on arthroscopic examination. Thus, the sensitivity, specificity and accuracy of MRI as an evaluative tool for ACL graft tears were 100%, 86% and 86.5%, respectively. (author)

  11. A quantitative assessment of the insertional footprints of the hip joint capsular ligaments and their spanning fibers for reconstruction.

    Science.gov (United States)

    Telleria, Jessica J M; Lindsey, Derek P; Giori, Nicholas J; Safran, Marc R

    2014-04-01

    Quantitative descriptions of the hip joint capsular ligament insertional footprints have been reported. Using a three-dimensional digitizing system, and computer modeling, the area, and dimensions of the three main hip capsular ligaments and their insertional footprints were quantified in eight cadaveric hips. The iliofemoral ligament (ILFL) attaches proximally to the anterolateral supra-acetabular region (mean area = 4.2 cm(2)). The mean areas of the ILFL lateral and medial arm insertional footprints are 4.8 and 3.1 cm(2), respectively. The pubofemoral ligament (proximal footprint mean area = 1.4 cm(2)) blends with the medial ILFL anteriorly and the proximal ischiofemoral ligament (ISFL) distally without a distal bony insertion. The proximal and distal ISFL footprint mean areas are 6.4 and 1.2 cm(2), respectively. The hip joint capsular ligaments have consistent anatomic and insertional patterns. Quantification of the ligaments and their attachment sites may aid in improving anatomic repairs and reconstructions of the hip joint capsule using open and/or arthroscopic techniques. Copyright © 2013 Wiley Periodicals, Inc.

  12. Reconstruction of the medial patellofemoral ligament using the adductor magnus tendon: an anatomic study.

    Science.gov (United States)

    Jacobi, Matthias; Reischl, Nikolaus; Bergmann, Mathias; Bouaicha, Samy; Djonov, Valentin; Magnussen, Robert A

    2012-01-01

    The aims of this study were to evaluate the anatomic feasibility of medial patellofemoral ligament (MPFL) reconstruction using a part of the adductor magnus tendon and to identify possible risks. Twenty cadaveric knees were dissected. The distal part of the adductor magnus tendon was evaluated with respect to the anatomic topography and its utility for MPFL reconstruction. To estimate the risk of injuring the neurovascular structures, the distance from the adductor tubercle to the adductor hiatus was evaluated. An MPFL reconstruction was carried out by preserving the distal insertion on the adductor tubercle and redirecting the proximal portion of the tendon to the medial aspect of the patella. The anatomic investigation showed the following relationships: The mean distance from the adductor tubercle to the adductor hiatus was 99 ± 14 mm (range, 80 to 120 mm). A graft length of 52 ± 5 mm (range, 45 to 63 mm) with the addition of 10 to 20 mm for fixation was found to be necessary for MPFL reconstruction. The difference between the desired graft length and the distance to the adductor hiatus was found to be at least 30 mm in all cases (mean, 46 mm). Leaving the graft attached to the adductor tubercle resulted in a nearly anatomic femoral attachment of the reconstructed MPFL. Complete detachment of the distal adductor magnus attachment was consistently avoidable. The adductor magnus tendon was found to be a useful graft for MPFL reconstruction. However, anatomic dangers (damage to the neurovascular bundle of the adductor hiatus, the saphenous nerve, or the saphenous branch of the descending genicular artery) during graft harvest must be considered. Anatomic knowledge is essential during adductor magnus tendon harvest to avoid damage to neurovascular structures. The adductor magnus tendon is an interesting alternative graft option for MPFL reconstruction if anatomic dangers are considered and avoided. Copyright © 2012 Arthroscopy Association of North America

  13. Patient Outcomes and Predictors of Success After Revision Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Johnson, William R; Makani, Amun; Wall, Andrew J; Hosseini, Ali; Hampilos, Perry; Li, Guoan; Gill, Thomas J

    2015-10-01

    Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample. To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution. Case series; Level of evidence, 4. A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients' medical records were also thoroughly reviewed. Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction had a statistically significantly, although not clinically significant

  14. Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: a cohort study based on the Norwegian National Knee Ligament Registry.

    Science.gov (United States)

    Granan, Lars-Petter; Bahr, Roald; Lie, Stein Atle; Engebretsen, Lars

    2009-05-01

    There is inadequate evidence to determine when to perform surgery on anterior cruciate ligament-deficient knees. To study the association between timing of anterior cruciate ligament reconstruction and the risk of having meniscal tears and cartilage lesions. Cohort study (prognosis); Level of evidence, 2. All patients registered in the Norwegian National Knee Ligament Registry who had undergone primary anterior cruciate ligament reconstruction from 2004 and throughout 2006 were reviewed. Logistic regression analyses were used to estimate the relationship between time from injury until anterior cruciate ligament surgery and the risk of meniscal tears or cartilage lesions. Of a total of 3475 patients, there were 909 patients (26%) with cartilage lesions, 1638 patients (47%) with meniscal tears, and 527 patients (15%) with both cartilage and meniscal lesions. The odds of a cartilage lesion in the adult knee (>16 years) increased by 1.006 (95% confidence interval, 1.003-1.010) for each month that elapsed from injury to surgery. The cartilage in young adults (17-40 years) deteriorated further with an increase in odds of 1.03 (95% confidence interval, 1.02-1.05) related to the aging in years of the patient. The odds for meniscal tears in young adults increased by 1.004 (95% confidence interval, 1.002-1.006) for each month that elapsed since injury. The presence of 1 degenerative lesion increased the odds of having the other degenerative lesion by between 1.6 and 2.0 in all patient groups. The odds of a cartilage lesion in the adult knee increased by nearly 1% for each month that elapsed from the injury date until the surgery date and that of cartilage lesions were nearly twice as frequent if there was a meniscal tear, and vice versa.

  15. Double bundle arthroscopic Anterior Cruciate Ligament reconstruction with remnant preserving technique using a hamstring autograft

    Directory of Open Access Journals (Sweden)

    Ochi Mitsuo

    2011-12-01

    Full Text Available Abstract Background Preservation of the Anterior Cruciate Ligament (ACL remnant is important from the biological point of view as it enhances revascularization, and preserves the proprioceptive function of the graft construct. Additionally, it may have a useful biomechanical function. Double bundle ACL reconstruction has been shown to better replicate the native ACL anatomy and results in better restoration of the rotational stability than single bundle reconstruction. Methods We used the far anteromedial (FAM portal for creation of the femoral tunnels, with a special technique for its preoperative localization using three dimensional (3D CT. The central anteromedial (AM portal was used to make a longitudinal slit in the ACL remnant to allow visualization of the tips of the guide pins during anatomical creation of the tibial tunnels within the native ACL tibial foot print. The use of curved hemostat allow retrieval of the wire loop from the apertures of the femoral tunnels through the longitudinal slit in the ACL remnant thereby, guarding against impingement of the reconstruction graft against the ACL remnant as well as the roof of the intercondylar notch. Conclusion Our technique allows for anatomical double bundle reconstruction of the ACL while maximally preserving the ACL remnant without the use of intra-operative image intensifier.

  16. 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.

  17. Athletic performance and career longevity following anterior cruciate ligament reconstruction in the National Basketball Association.

    Science.gov (United States)

    Kester, Benjamin S; Behery, Omar A; Minhas, Shobhit V; Hsu, Wellington K

    2017-10-01

    To identify the impact of anterior cruciate ligament (ACL) reconstruction on performance and career longevity for National Basketball Association (NBA) players. Seventy-nine players (80 knees) with acute ACL tears in the NBA between the 1984-2014 seasons, and 112 age, height, weight, and performance-matched controls were identified. Pre- and post-injury performance outcomes including seasons played, games played, games started, minutes per game, points per game, field goals, 3-point shots, rebounds, assists, steals, blocks, turnovers, personal fouls, usage percentage and player efficiency ratings were compared between cases and controls using independent samples t tests and Fisher's exact tests. Sixty-eight of seventy-nine players (86.1 %) returned to play in the NBA following ACL reconstruction. Mean length of post-operative play was 1.84 years shorter than matched controls (P = 0.001). There was a significantly higher rate of attrition from professional basketball for players with a history of ACL reconstruction (P = 0.014). In the first full season following surgery, players started in 15.5 fewer games (P = 0.001), they played in 17.3 fewer games (P NBA following ACL reconstruction, although playing time, games played, player efficiency ratings and career lengths are significantly impacted in the post-operative period. These data should be used to manage patients' expectations regarding their abilities to return to elite levels of athletic performance.

  18. Revascularisation pattern of ruptured flexor tendon grafts in anterior cruciate ligament reconstruction: A histological study.

    Science.gov (United States)

    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.

  19. EFFECT OF BONE TUNNELS POSITIONING ON OUTCOMES OF TRANSTIBIAL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

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    S. A. Bantser

    2017-01-01

    Full Text Available Purpose of the study — to evaluate position of bone tunnels after transtibial anterior cruciate ligament reconstruction (ACLR and to determine the relationship of outcomes on their localization.Material and methods. 54 patients in follow up from 25 to 57 months after transtibial ACLR with hamstring tendons. In all patients was performed magnetic resonance imaging (MRI to evaluate structure of graft. Bone tunnels localization was determined by computed tomography with three-dimensional reconstruction. Subjective score evaluation was performing by scales IKDC-2000, KOOS, Lysholm. Knee laxity was measured by anterior drawer, Lachman, pivot-shift tests and with arthrometr. Patient was separated in groups depending on the localization of the femoral tunnel for lateral intercondylar ridge (1 group — center of femoral tunnel in front of the LIR, 2 group — in zone of the LIR.Results. Tibial tunnel position in both groups of patients was the same and localized in central or back third of the footprint. The center of femoral tunnel in 32 patients (59% was localized in front of the LIR (1 group, in other 22 (41% — in proximal part of LIR (2 group. Clinical results show statistically significant differences between groups in knee stability and IKDC-2000. In 1 group 78% patients have knee instability grade 1 or 2, while in 2 group similar symptoms was in 32% patients. IKDC-2000 grade A were attributed 19% patients from 1 group and 64% from 2 group, rest of them was grade B or C.Conclusions. Transtibial anterior cruciate ligament reconstruction with hamstring tendons in most patients did not allow anatomical femoral tunnel placement. Clinical outcomes were much affected by the localization of bone tunnels.

  20. Local delivery of controlled-release simvastatin to improve the biocompatibility of polyethylene terephthalate artificial ligaments for reconstruction of the anterior cruciate ligament.

    Science.gov (United States)

    Zhang, Peng; Han, Fei; Li, Yunxia; Chen, Jiwu; Chen, Tianwu; Zhi, Yunlong; Jiang, Jia; Lin, Chao; Chen, Shiyi; Zhao, Peng

    2016-01-01

    The Ligament Advanced Reinforcement System has recently been widely used as the primary graft of choice in anterior cruciate ligament (ACL) reconstruction. But the biological graft-bone healing still remains a problem. Previous studies have shown that simvastatin (SIM) stimulates bone formation. The objective of this study was to investigate whether surface coating with collagen containing low-dose SIM microsphere could enhance the surface biocompatibility of polyethylene terephthalate (PET) artificial ligaments to accelerate graft-to-bone healing. The in vitro studies demonstrated that bone marrow stromal cells on the collagen-coated PET scaffolds (COL/PET) and simvastatin/collagen-coated PET scaffolds (SIM/COL/PET) proliferated vigorously. Compared with the PET group and the COL/PET group, SIM could induce bone marrow stromal cells' osteoblastic differentiation, high alkaline phosphatase activity, more mineralization deposition, and more expression of osteoblast-related genes, such as osteocalcin, runt-related transcription factor 2, bone morphogenetic protein-2, and vascular endothelial growth factor, in the SIM/COL/PET group. In vivo, rabbits received ACL reconstruction with different scaffolds. Histological analysis demonstrated that graft-bone healing was significantly greater with angiogenesis and osteogenesis in the SIM/COL/PET group than the other groups. In addition, biomechanical testing at the eighth week demonstrated a significant increase in the ultimate failure load and stiffness in the SIM/COL/PET group. The low dose of SIM-sustained release from SIM/COL/PET promoted the graft-bone healing via its effect on both angiogenesis and osteogenesis. This study suggested that collagen containing low-dose SIM microsphere coating on the surface of PET artificial ligaments could be potentially applied for ACL reconstruction.

  1. COMPARATIVE STUDY OF ARTHROSCOPIC SINGLE BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION AND NON-ANATOMICAL DOUBLE BUNDLE WITH SINGLE TIBIAL TUNNEL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH SEMITENDINOSUS ± GRACILIS AUTOGRAFTS USING LAXOMETRY

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    Sivananda

    2016-01-01

    Full Text Available BACKGROUND The knee joint is the most commonly injured of all joints and the ACL is the most commonly injured ligament. Arthroscopic reconstruction of ACL has become gold standard in treating these injuries. AIM 1. To compare the short-term results of ACL reconstruction using single bundle (one Tibial + one Femoral tunnel and non-anatomical double-bundle (one Tibial + two Femoral tunnels techniques using Hamstrings (Semitendinosus ± Gracilis graft. 2. To evaluate ACL graft reconstruction stability measured by laxometry and to find out an association with clinical findings. MATERIAL & METHODS We performed a prospective study between 2014-2015 of 20 case of ACL injuries & compared single bundle reconstruction with Non – anatomical double Bundle reconstruction with semitendinosus ± Gracilis, Autograft using laxometry. CONCLUSION Arthroscopic Non-anatomical double ACL Reconstruction is Bio-mechanically stable reconstruction resembling anatomy of the ACL.

  2. Transportal anterior cruciate ligament reconstruction with quadrupled hamstring tendon graft: A prospective outcome study

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    Chandan Kumar

    2017-01-01

    Full Text Available Background: Anterior cruciate ligament (ACL reconstruction has been one of the most commonly performed procedures throughout the world. Unsatisfactory outcome with conventional ACL reconstruction has been attributed to nonanatomic graft placement. Researchers have advised placing the graft in the native footprint of ACL to avoid nonanatomic graft placement. The goal of this study was to analyze the outcome of anatomic single bundle ACL reconstruction using transportal technique. Materials and Methods: This was a prospective outcome study conducted on 85 consecutive patients of ACL reconstruction of which 62 patients met inclusion and exclusion criteria and were analyzed for final results. All the patients underwent ACL reconstruction by quadrupled hamstring tendon graft using transportal technique and the accessory anteromedial (AAM portal for femoral tunnel creation. The graft was fixed with endobutton on femoral side and bioabsorbable screw on the tibial side. Patients were evaluated for range of motion, International Knee Documentation Committee (IKDC score, and Lysholm scores at a minimum followup period of 2 years. The mean pre- and postoperative scores were compared using Wilcoxon signed-rank test. Results: The mean Lysholm and IKDC scores improved significantly (P < 0.0001 from preoperative value. According to IKDC score, 90.3% (n = 56 were either normal or near normal at final followup. According to Lysholm score, 75.8% of patients had excellent and 13.3% had good results. Preoperatively, pivot shift was present in 85.5% (n = 53 of patients which reduced to 4.8% (n = 3 postoperatively. Infection and knee stiffness occurred in two patients, and femoral tunnel blowout and graft re-rupture occurred in one patient each. Conclusion: Anatomic ACL reconstruction by AAM portal is a reproducible technique which gives good clinical outcome at short-term followup.

  3. Use of a fluoroscopic overlay to guide femoral tunnel placement during posterior cruciate ligament reconstruction.

    Science.gov (United States)

    Araujo, Paulo H; Moloney, Gele; Rincon, Gustavo; Carey, Robert; Zhang, Xudong; Harner, Christopher

    2014-11-01

    Intraoperative recognition of the local anatomy of the posterior cruciate ligament (PCL) is difficult for many surgeons, and correct positioning of the graft can be challenging. To investigate the efficacy of an overlay system based on fluoroscopic landmarks in guiding femoral tunnel placement during PCL reconstruction. Controlled laboratory study. Twenty cadaveric knees were arthroscopically prepared, and their PCL femoral insertion sites were digitized. The digitized images were co-registered to computed tomography-acquired 3-dimensional bone models. Twenty surgeons with diverse backgrounds performed simulated arthroscopic reconstruction of the anterolateral (AL) and posteromedial (PM) bundles of the PCL, first without and then with the aid of a lateral fluoroscopic image on which the position of a target insertion site based on literature data was displayed as an overlay. The surgeons were allowed to adjust tunnel placement in accordance with the displayed target position. A 3-way comparison was made of the tunnel positions placed by the surgeons, the native insertion site positions, and the literature-based positions. The overlay system was effective in helping surgeons to improve femoral tunnel placement toward the target and toward the anatomic insertion site (P 5 mm from the native insertion site. With the use of the overlay, 70% of the surgeons were overlay to guide intraoperative placement of the femoral tunnel(s) during PCL reconstruction can result in more anatomic reconstructions and therefore assist in re-creating native knee kinematics after PCL reconstruction. Intraoperative fluoroscopy is an effective, easy, and safe method for improving femoral tunnel positioning during PCL reconstruction. © 2014 The Author(s).

  4. 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

  5. Optimization of the Return-to-Sport Paradigm After Anterior Cruciate Ligament Reconstruction : A Critical Step Back to Move Forward

    NARCIS (Netherlands)

    Dingenen, Bart; Gokeler, Alli

    Athletes who have sustained an anterior cruciate ligament (ACL) injury often opt for an ACL reconstruction (ACLR) with the goal and expectation to resume sports. Unfortunately, the proportion of athletes successfully returning to sport is relatively low, while the rate of second ACL injury has been

  6. Anatomy of the inferior extensor retinaculum and its role in lateral ankle ligament reconstruction: a pictorial essay

    NARCIS (Netherlands)

    Dalmau-Pastor, M.; Yasui, Y.; Calder, J. D.; Karlsson, J.; Kerkhoffs, G. M. M. J.; Kennedy, J. G.

    2016-01-01

    The inferior extensor retinaculum (IER) is an aponeurotic structure, which is in continuation with the anterior part of the sural fascia. The IER has often been used to augment the reconstruction of the lateral ankle ligaments, for instance in the Broström-Gould procedure, with good outcomes

  7. Complete acromioclavicular joint dislocation treated with reconstructed ligament by trapezius muscle fascia and observation of fascial metaplasia

    Directory of Open Access Journals (Sweden)

    Wang Chaoliang

    2015-01-01

    Full Text Available We evaluated the long-term clinical results of acute complete acromioclavicular dislocations treated by reconstruction of the acromioclavicular and coracoclavicular ligament using trapezius muscle fascia. Open reduction and internal fixation was performed using the clavicular hook plate in 12 patients with acute complete acromioclavicular joint dislocation, and the acromioclavicular and coracoclavicular ligaments were reconstructed using trapezius muscle fascia. Radiographic evaluations were conducted postoperatively. We evaluated the functional results with constant scoring system and radiological results at the final follow-up visit. The mean Constant score at the final follow-up visit was 91.67 (range, 81 to 100. The results were excellent in eight patients (66.7% and good in four patients (33.3%. Three patients with scores from 80 to 90 had mild pain during activity, but this did not affect the range of motion of the shoulder. All patients have returned to their preoperative work without any limitations. Compared with the contralateral side, radiography showed anatomical reposition in the vertical plane in all cases. The hook-plate fixation with ligament reconstruction was successful in treating AC dislocations. The acromioclavicular and coracoclavicular ligament were reconstructed by trapezius muscle fascia that keep the distal clavicle stable both vertically and horizontally after type III injuries.

  8. Comparison of Results between Hook Plate Fixation and Ligament Reconstruction for Acute Unstable Acromioclavicular Joint Dislocation

    Science.gov (United States)

    Yoon, Jong Pil; Lee, Byoung-Joo; Nam, Sang Jin; Chung, Seok Won; Jeong, Won-Ju; Min, Woo-Kie

    2015-01-01

    Background In the present study, we aimed to compare clinical and radiographic outcomes between hook plate fixation and coracoclavicular (CC) ligament reconstruction for the treatment of acute unstable acromioclavicular (AC) joint dislocation. Methods Forty-two patients who underwent surgery for an unstable acute dislocation of the AC joint were included. We divided them into two groups according to the treatment modality: internal fixation with a hook plate (group I, 24 cases) or CC ligament reconstruction (group II, 18 cases). We evaluated the clinical outcomes using a visual analog scale (VAS) for pain and Constant-Murley score, and assessed the radiographic outcomes based on the reduction and loss of CC distance on preoperative, postoperative, and final follow-up plain radiographs. Results The mean VAS scores at the final follow-up were 1.6 ± 1.5 and 1.3 ± 1.3 in groups I and II, respectively, which were not significantly different. The mean Constant-Murley scores were 90.2 ± 9.9 and 89.2 ± 3.5 in groups I and II, respectively, which were also not significantly different. The AC joints were well reduced in both groups, whereas CC distance improved from a mean of 215.7% ± 50.9% preoperatively to 106.1% ± 10.2% at the final follow-up in group I, and from 239.9% ± 59.2% preoperatively to 133.6% ± 36.7% at the final follow-up in group II. The improvement in group I was significantly superior to that in group II (p subluxation was not observed in any case in group I, but was noted in six cases (33%) in group II. Erosions of the acromion undersurface were observed in 9 cases in group I. Conclusions In cases of acute unstable AC joint dislocation, hook plate fixation and CC ligament reconstruction yield comparable satisfactory clinical outcomes. However, radiographic outcomes based on the maintenance of reduction indicate that hook plate fixation is a better treatment option. PMID:25729525

  9. 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

  10. Underappreciated Factors to Consider in Revision Anterior Cruciate Ligament Reconstruction: A Current Concepts Review

    Science.gov (United States)

    Southam, Brendan R.; Colosimo, Angelo J.; Grawe, Brian

    2018-01-01

    Primary anterior cruciate ligament (ACL) reconstructions (ACLRs) are being performed with increasing frequency. While many of these will have successful outcomes, failures will occur in a subset of patients who will require revision ACLRs. As such, the number of revision procedures will continue to rise as well. While many reviews have focused on factors that commonly contribute to failure of primary ACLR, including graft choice, patient factors, early return to sport, and technical errors, this review focused on several factors that have received less attention in the literature. These include posterior tibial slope, varus malalignment, injury to the anterolateral ligament, and meniscal injury or deficiency. This review also appraised several emerging techniques that may be useful in the context of revision ACL surgery. While outcomes of revision ACLR are generally inferior to those of primary procedures, identifying these potentially underappreciated contributing factors preoperatively will allow the surgeon to address them at the time of revision, ideally improving patient outcomes and preventing recurrent ACL failure. PMID:29399591

  11. Anterior cruciate ligament reconstruction with synthetic grafts. A review of literature

    Science.gov (United States)

    Ventura, Alberto; Terzaghi, Clara; Borgo, Enrico; Albisetti, Walter

    2010-01-01

    Anterior cruciate ligament (ACL) rupture, one of the most common knee injuries in sports, results in anteroposterior laxity, which often leads to an unstable knee. Traditional ACL reconstruction is performed with autograft; disadvantages of this technique are donor site morbidity and a long rehabilitation period. In the 1980s, artificial ligaments became an attractive alternative to biological grafts. The initial enthusiasm surrounding their introduction stemmed from their lack of donor morbidity, their abundant supply and significant strength, immediate loading and reduced postoperative rehabilitation. Synthetic grafts made of different materials such as carbon fibers, polypropylene, Dacron and polyester have been utilised either as a prosthesis or as an augmentation for a biological ACL graft substitute. Nevertheless, every material presented serious drawbacks: cross-infections, immunological responses, breakage, debris dispersion leading to synovitis, chronic effusions, recurrent instability and knee osteoarthritis. Recently, a resurgence of interest in the use of synthetic prostheses has occurred and studies regarding new artificial grafts have been reported. Although many experimental studies have been made and much effort has been put forth, currently no ideal prosthesis mimicking natural human tissue has been found. PMID:20157811

  12. Improved visualization of collateral ligaments of the ankle: multiplanar reconstructions based on standard 2D turbo spin-echo MR images

    International Nuclear Information System (INIS)

    Duc, Sylvain R.; Mengiardi, Bernard; Pfirrmann, Christian W.A.; Hodler, Juerg; Zanetti, Marco

    2007-01-01

    The purpose of the study was to evaluate the visualization of the collateral ankle ligaments on multiplanar reconstructions (MPR) based on standard 2D turbo spin-echo images. Coronal and axial T2-weighted turbo spin-echo and MPR angled parallel to the course of the ligaments of 15 asymptomatic and 15 symptomatic ankles were separately analyzed by two musculoskeletal radiologists. Image quality was assessed in the asymptomatic ankles qualitatively. In the symptomatic ankles interobserver agreement and reader confidence was determined for each ligament. On MPR the tibionavicular and calcaneofibular ligaments were more commonly demonstrated on a single image than on standard MR images (reader 1: 13 versus 0, P=0.002; reader 2: 14 versus 1, P=0.001 and reader 1: 13 versus 2, P=0.001; reader 2: 14 versus 0, P<0.001). The tibionavicular ligament was considered to be better delineated on MPR by reader 1 (12 versus 3, P=0.031). In the symptomatic ankles, reader confidence was greater with MPR for all ligaments except for the tibiocalcanear ligament (both readers) and the anterior and posterior talofibular ligaments (for reader 2). Interobserver agreement was increased with MPR for the tibionavicular ligament. Multiplanar reconstructions of 2D turbo spin-echo images improve the visualization of the tibionavicular and calcaneofibular ligaments and strengthen diagnostic confidence for these ligaments. (orig.)

  13. Athletic Performance at the NFL Scouting Combine After Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

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

    2015-12-01

    Anterior cruciate ligament (ACL) injuries are common and potentially career ending in the National Football League (NFL). Although statistical performance has been demonstrated after ACL reconstruction, functional performance is not well defined. The purpose of this study was to determine the functional performance of NFL combine participants after ACL reconstruction compared with an age-, size-, and position-matched control group. The hypothesis was that there would be no difference between players after ACL reconstruction as compared with controls in functional athletic performance. Cohort study; Level of evidence, 3. A total of 98 NFL-caliber athletes who had undergone primary ACL reconstruction and participated in the NFL scouting combine between 2010 and 2014 were reviewed and compared with an age-, size-, and position-matched control group. Data recorded for each player included a 40-yard dash, vertical leap, broad jump, shuttle drill, and 3-cone drill. With regard to speed and acceleration, the mean 40-yard dash time for ACL-reconstructed players was 4.74 seconds (range, 4.33-5.55 seconds) compared with controls at 4.74 seconds (range, 4.34-5.38 seconds; P = .96). Jumping performance was also similar, with a mean vertical leap for ACL-reconstructed players of 33.35 inches (range, 23-43 inches) and broad jump of 113.9 inches (range, 96-136 inches) compared with respective values for the controls of 33.22 inches (range, 23.5-43.5 inches; P = .84) and 113.9 inches (range, 92-134 inches; P = .99). Agility and quickness testing measures also did not show a statistically significantly difference, with ACL-reconstructed players performing the shuttle drill in 4.37 seconds (range, 4.02-4.84 seconds) and the 3-cone drill in 7.16 seconds (range, 6.45-8.14 seconds), respectively, compared with respective times for the controls of 4.37 seconds (range, 3.96-5.00 seconds; P = .91) and 7.18 seconds (range, 6.64-8.24 seconds; P = .75). This study suggests that after ACL

  14. Athletic Performance at the National Basketball Association Combine After Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Mehran, Nima; Williams, Phillip N; Keller, Robert A; Khalil, Lafi S; Lombardo, Stephen J; Kharrazi, F Daniel

    2016-05-01

    Anterior cruciate ligament (ACL) injuries are significant injuries in elite-level basketball players. In-game statistical performance after ACL reconstruction has been demonstrated; however, few studies have reviewed functional performance in National Basketball Association (NBA)-caliber athletes after ACL reconstruction. To compare NBA Combine performance of athletes after ACL reconstruction with an age-, size-, and position-matched control group of players with no previous reported knee injury requiring surgery. We hypothesized that there is no difference between the 2 groups in functional performance. Cross-sectional study; Level of evidence, 3. A total of 1092 NBA-caliber players who participated in the NBA Combine between 2000 and 2015 were reviewed. Twenty-one athletes were identified as having primary ACL reconstruction prior to participation in the combine. This study group was compared with an age-, size-, and position-matched control group in objective functional performance testing, including the shuttle run test, lane agility test, three-quarter court sprint, vertical jump (no step), and maximum vertical jump (running start). With regard to quickness and agility, both ACL-reconstructed athletes and controls scored an average of 11.5 seconds in the lane agility test and 3.1 seconds in the shuttle run test (P = .745 and .346, respectively). Speed and acceleration was measured by the three-quarter court sprint, in which both the study group and the control group averaged 3.3 seconds (P = .516). In the maximum vertical jump, which demonstrates an athlete's jumping ability with a running start, the ACL reconstruction group had an average height of 33.6 inches while the controls averaged 33.9 inches (P = .548). In the standing vertical jump, the ACL reconstruction group averaged 28.2 inches while the control group averaged 29.2 inches (P = .067). In athletes who are able to return to sport and compete at a high level such as the NBA Combine, there is no

  15. Local delivery of controlled-release simvastatin to improve the biocompatibility of polyethylene terephthalate artificial ligaments for reconstruction of the anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Zhang P

    2016-01-01

    Full Text Available Peng Zhang,1,* Fei Han,2,* Yunxia Li,1 Jiwu Chen,1 Tianwu Chen,1 Yunlong Zhi,1 Jia Jiang,1 Chao Lin,2 Shiyi Chen,1 Peng Zhao2 1Department of Sports Medicine, Huashan Hospital, Fudan University, 2Shanghai East Hospital, The Institute for Biomedical Engineering and Nanoscience, School of Medicine, Tongji University, Shanghai, People’s Republic of China *These authors contributed equally to this work Abstract: The Ligament Advanced Reinforcement System has recently been widely used as the primary graft of choice in anterior cruciate ligament (ACL reconstruction. But the biological graft–bone healing still remains a problem. Previous studies have shown that simvastatin (SIM stimulates bone formation. The objective of this study was to investigate whether surface coating with collagen containing low-dose SIM microsphere could enhance the surface biocompatibility of polyethylene terephthalate (PET artificial ligaments to accelerate graft-to-bone healing. The in vitro studies demonstrated that bone marrow stromal cells on the collagen-coated PET scaffolds (COL/PET and simvastatin/collagen-coated PET scaffolds (SIM/COL/PET proliferated vigorously. Compared with the PET group and the COL/PET group, SIM could induce bone marrow stromal cells’ osteoblastic differentiation, high alkaline phosphatase activity, more mineralization deposition, and more expression of osteoblast-related genes, such as osteocalcin, runt-related transcription factor 2, bone morphogenetic protein-2, and vascular endothelial growth factor, in the SIM/COL/PET group. In vivo, rabbits received ACL reconstruction with different scaffolds. Histological analysis demonstrated that graft–bone healing was significantly greater with angiogenesis and osteogenesis in the SIM/COL/PET group than the other groups. In addition, biomechanical testing at the eighth week demonstrated a significant increase in the ultimate failure load and stiffness in the SIM/COL/PET group. The low dose of SIM

  16. 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.

  17. Suspension Arthroplasty Combined with Ligament Reconstruction of the Thumb Carpometacarpal Joint to Salvage Two Failed Arthroplasties: A Case Report.

    Science.gov (United States)

    Kakinoki, Ryosuke; Hashimoto, Kazuhiko; Tanaka, Hiroki; Akagi, Masao

    2017-01-01

    Thumb basal joint arthroplasty with removal of the entire trapezium is often followed by proximal subsidence and impingement of the thumb metacarpal to the scaphoid, which is a common cause of post-operative thumb pain. Treatment of this impingement is a challenge among surgeons. We performed suspension arthroplasty combined with intercarpal ligament reconstruction using a strip of the extensor carpi radialis longus (ECRL) tendon on a patient suffering from pain caused by this type of the impingement and obtained a successful outcome. We treated a 52-year-old female pianist who complained of pain in her left thumb carpometacarpal (CMC) joint. She had undergone two previous ligament reconstruction and tendon interposition arthroplasty procedures on the joint, for which strips of the flexor carpi radialis tendon and the abductor pollicis longus tendon were used in the first and second operations, respectively. The pre-operative X-ray demonstrated proximal subsidence and impingement of the first metacarpal on the scaphoid. We performed suspension arthroplasty combined with intercarpal ligament reconstruction using a strip of the ECRL tendon to create the trapezial space. 3 years after surgery, despite the 3 mm subsidence of the thumb compared with immediately after surgery, her thumb pinch and grip strength had improved, and the thumb basal pain was relieved. This case shows that suspension arthroplasty with intermetacarpal ligament reconstruction using an ECRL strip can be applied in revision surgery for impingement of the first metacarpal with the scaphoid following thumb CMC joint arthroplasty after removal of the entire trapezium. This is the first report to describe the treatment of first metacarpal impingement after CMC joint arthroplasty using suspension arthroplasty combined with intercarpal ligament reconstruction.

  18. 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.

  19. 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.

  20. 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.

  1. NTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: WITH BRACE VS WITHOUT BRACE AFTER OPERATION A RANDOMIZED CONTROLLED CLINICAL TRIAL

    Directory of Open Access Journals (Sweden)

    KH.A NAZEM

    2002-03-01

    Full Text Available Introduction. Anterior cruciate ligament (ACL ruputer specially in athletics induces knee instability results in pateint disability. Surgical treatment consist of ACL reconstruction and repair. In this study the efficacy of surgical management with brace after operation was compaired to surgical management without brace.
    Methods. One hundred ACL ruptured pateints had reconstructed with BPB graft in two randomzed gruops (50 with brace afetr operation and 50 without brace. Study durated 4 year (1997-2000 in alzahra hospital (affiliated to IUMSHS. Patients had followed for 12 months after operation.
    Results. Knee range of motion after 1, 3, 6, 12 months follow up were the same in both groups (P > 0.05. Degree and duration of returning to sport, complications, need to reoperation, stair climbing, specific ACL tests, patelofemoral pain, pain in squatting, running and cutting and quadriceps atrophy, after 12 months follow up were the same in both groups (P > 0.05. Patients without brace returned to their job more sooner than another group (P < 0.05.
    Discussion. There are no significant differnce in cilinical results in tow groups and ACL reconstruction with BPB dose not require to routine bracing. Faster return to job in non bracing group is due to removal of liminting effect of brace wearing. Lesser rate of pain in patients that return to sport due to quadriceps strengthening.

  2. Short-term results of medial patellofemoral ligament reconstruction for patellar dislocation

    International Nuclear Information System (INIS)

    Sakuraba, Koji; Miura, Hiromasa; Matsuda, Shuichi; Okazaki, Ken; Iwamoto, Yukihide; Fukuoka, Shinji

    2009-01-01

    The short-term results of medial patellofemoral ligament (MPFL) reconstruction were reviewed. MPFL reconstruction surgery was performed on 13 patients (13 knees, three male, five female, mean age 24.1 years) with recurrent and habitual dislocation of the patella. After average 18.5 month follow-up, there has been no recurrence of dislocation and limitation of range of motion except for one case. The mean Kujula score was 60±20.2 preoperatively and 91±15 postoperatively. According to the Crosby and Insall grading system, six ceses were excellent, six cases were good, and one case was fair to poor. On axial radiographs, the mean congruence angle was 31.3±21.4deg preoperatively and -3.65±20.72deg postoperatively. The mean tilting angle was 32.1±7.9deg preoperatively and 21.9±8.39deg postoperatively. The mean lateral shift was 41.6±9.7% preoperatively and 24.5±9.9% postoperatively. These results demonstrate the short-term effectiveness of MPFL reconstruction. (author)

  3. Interlimb differences in lower extremity bone mineral density following anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Reiman, Michael P; Rogers, Michael E; Manske, Robert C

    2006-11-01

    Prospective descriptive study. To determine the extent of bone mineral density (BMD) interlimb differences at several hip locations in the involved versus noninvolved lower extremity following anterior cruciate ligament (ACL) surgery. Disuse following ACL reconstruction can be extensive. This disuse not only affects the soft tissue, but may also affect the skeletal structure. The extent of this disuse specific to the proximal femur has not been previously determined. BMD was assessed in 15 subjects, 17 to 51 years old, who were between 6 and 32 months post-ACL reconstruction surgery. Bone mineral content (BMC) and BMD of the femoral neck, trochanteric region, intertrochanteric region, and entire hip were measured as a primary emphasis of this study. BMD and BMC of the entire lower extremities were also measured bilaterally. BMD was significantly less in the involved lower extremity compared to noninvolved lower extremity at several hip sites: 6.6% less (Phip, and 3.4% less (P = .004) for the intertrochanteric region. No significant differences were noted comparing the entire lower extremities for either BMD (0.9%, P = .48) or BMC (3.7%, P= .09). BMD differences at the hip are significant in patient's postoperative ACL reconstruction, especially in the trochanteric region.

  4. One-stage revision anatomic anterior cruciate ligament reconstruction with rectangular tunnel technique

    Directory of Open Access Journals (Sweden)

    Konsei Shino

    2015-04-01

    Full Text Available We developed the anatomic rectangular tunnel anterior cruciate ligament reconstruction (ART ACLR with a bone–patellar tendon–bone graft to mimic fibre arrangement inside the native ACL via tunnels with smaller apertures. With a 10-mm-wide graft, the cross-sectional area of the tunnels of 50 mm2 in ART ACLR is less than that of 79 mm2 in a 10-mm round tunnel one. Because tunnel encroachment would be less of a problem, the ART ACLR technique could be most frequently applied to patients after a failed primary ACLR. In this instructional lecture, the indication and technical considerations for ART ACLR as one-stage revision ACLR are described.

  5. 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...... center of mass (HBCM) were calculated from the ground reaction force. The normalized EMG amplitudes were obtained at takeoff, at the 25-ms interval prelanding, and at postlanding for the ACLR limb (affected limb), contralateral limb, and limbs of the control subjects (control limb). RESULTS: Jump height...

  6. Development of Radiation Fusion Technology for the Ruptured Ligament Reconstruction with a Porcine Xenograft

    International Nuclear Information System (INIS)

    Kim, Jaehun; Kim, Jaekyung; Park, Jongheum

    2013-08-01

    This project was accomplished to develop the radiation fusion technology for production of bioitransplant materials (tendon/ligament) which have high bio-suitability, resulting in import replacement and improved industrial competency and public health. The major results of this project are development of the technology to remove immunogen, which repressing immune rejection, response, development of cross-linking technology to improve physical properties, development of the technology to improve safety and remove pathogenic sources, evaluation of tissue suitability and reconstruction through short/long term animal experiment, and development of materials for customized preclinical use. From the results, we can expect the replacement of import and establishment of export base by development of hetero-tissues, establishment of safe supply and improvement of public health for high demand of biotissue product because of low birth rate, aging society, and industralization

  7. Association Between Meniscal and Chondral Lesions and Timing of Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    de Campos, Gustavo Constantino; Nery, Wilton; Teixeira, Paulo Eduardo Portes; Araujo, Paulo Henrique; Alves, Wilson de Mello

    2016-10-01

    Rupture of the anterior cruciate ligament (ACL) is a common sports injury and is known to be associated with an increased risk of knee osteoarthritis. Several studies have indicated that the risk of additional injuries to the menisci and articular cartilage increases with delays in the treatment of ACL tears. However, no consensus has been reached regarding the ideal timing for ACL reconstruction in terms of preventing secondary lesions. To determine how the time elapsed between an ACL lesion and its reconstruction affects the incidence of meniscal and chondral lesions. Case series; Level of evidence, 4. Medical records of 764 patients who underwent primary ACL reconstruction were reviewed. Data from arthroscopic findings that included information about meniscal lesions and full-thickness articular cartilage lesions at the time of surgery were collected. The association between time elapsed between ACL lesion and reconstruction surgery and incidence of articular cartilage and meniscal lesions was analyzed by chi-square or Fisher exact test. The risk of secondary lesion was calculated by odds ratios (ORs) obtained from simple logistic regression analysis. A positive correlation was observed between time after injury and the presence of any articular lesions ( P = .003), cartilage lesions ( P = .01), and medial meniscus lesions ( P lesion relative to the reference period (24 months (OR = 5.88). Furthermore, the odds of lesions on the medial meniscus increased when the timing between injury and surgery was 6 to 12 months (OR = 2.71) and continued to increase when the timing was 12 to 24 months (OR = 3.78) and >24 months (OR = 9.07). Associated articular lesions are more common if ACL reconstruction is delayed by ≥6 months (medial meniscus lesion) and ≥1 year (chondral or any meniscal lesion).

  8. Arthroscopically blind anatomical anterior cruciate ligament reconstruction using only navigation guidance: a cadaveric study.

    Science.gov (United States)

    Park, Sin Hyung; Moon, Sang Won; Lee, Byung Hoon; Park, Sehyung; Kim, Youngjun; Lee, Deukhee; Lim, Sunghwan; Wang, Joon Ho

    2016-10-01

    To develop a preoperative planning and navigation system for anatomic anterior cruciate ligament (ACL) reconstruction and to evaluate the accuracy and the efficacy of anatomical ACL reconstruction using only navigation guidance. A three-dimensional (3D) preoperative planning and navigation system was developed from open source libraries. Twenty knees from 10 fresh-frozen human cadavers underwent navigation-only guided double-bundle ACL reconstruction using the transportal technique. A computed tomography (CT) scan was performed after ACL reconstruction to create a 3D surface model of the distal femur. We evaluated the tunnel position by Bernard's quadrant method, the tunnel orientation by measuring the tunnel angle in three projected planes, and the incidence of posterior cortical damage. Then, we compared preoperative planning with the postoperative results. The difference in tunnel position between preoperative planning and the postoperative results was a mean of 2.50±1.75mm (range, 0.77 to 5.85mm) in the anteromedial (AM) tunnel and a mean of 3.53±2.20mm (range, 0.39 to 7.92mm) in the posterolateral (PL) tunnel. The difference in tunnel orientation was a mean of 6.74±6.70° (range, 0.35 to 25.6°) in the AM tunnel and a mean of 5.73±3.51° (range, 1.58 to 15.04°) in the PL tunnel. No statically significant difference was observed. Posterior cortical damage developed in seven cases (35%). Our navigation-only guided ACL reconstruction produced consistent femoral tunnel position and orientation results. The accuracy and consistency of femoral tunneling were improved by using the preoperative planning and navigation system. Copyright © 2016. Published by Elsevier B.V.

  9. Use of a fluoroscopic overlay to assist arthroscopic anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Moloney, Gele; Araujo, Paulo; Rabuck, Stephen; Carey, Robert; Rincon, Gustavo; Zhang, Xudong; Harner, Christopher

    2013-08-01

    A growing body of evidence supports the importance of anatomic tunnel positioning in the success of anterior cruciate ligament (ACL) reconstruction, which stimulates the need for technologies to aid surgeons in achieving accurate anatomic tunnel placement. Intraoperative fluoroscopy is potentially one such technology, while its efficacy and usability have yet to be established. To investigate the performance of an intraoperative fluoroscopic overlay in guiding tunnel placement during ACL reconstruction. Controlled laboratory study. Twenty cadaveric knees underwent computed tomography (CT) scans and arthroscopic digitization of ACL insertion sites. The outlines of the digitized insertion sites were mapped to the corresponding CT-acquired bone models through a co-registration procedure. Twenty orthopaedic surgeons performed simulated ACL reconstructions, each on a randomly assigned cadaveric knee, first without and then with the aid of a fluoroscopic overlay system. The overlay system displayed on a lateral fluoroscopic image targets points representing the locations of the ACL insertion sites estimated from the literature data. Surgeons were allowed to adjust their tunnel positions under the guidance of the fluoroscopic image. Their initial, intermediate, and final positions were documented and compared with the target points as well as the native insertion sites. Surgeons demonstrated significant (P < .01) improvements in femoral and tibial tunnel placements relative to the target points from an average distance of 3.9 mm to 1.6 mm on the femur and 2.1 mm to 0.9 mm on the tibia. The improvements toward the knee-specific actual insertion sites were significant on the tibial side but not on the femoral side. Surgeons can be successfully guided with fluoroscopy to create more consistent femoral and tibial tunnels during ACL reconstruction. More research is warranted to develop better population representations of the locations of natural insertion sites

  10. Variables Associated With Return to Sport Following Anterior Cruciate Ligament Reconstruction: A Systematic Review

    Science.gov (United States)

    Czuppon, Sylvia; Racette, Brad A.; Klein, Sandra E.; Harris-Hayes, Marcie

    2014-01-01

    Background As one of the purposes of anterior cruciate ligament reconstruction (ACLR) is to return athletes to their pre-injury activity level, it is critical to understand variables influencing return to sport. Associations between return to sport and variables representing knee impairment, function and psychological status have not been well studied in athletes following ACLR. Purpose The purpose of this review is to summarize the literature reporting on variables proposed to be associated with return to sport following anterior cruciate ligament reconstruction. Study Design Systematic Review Methods Medline, Embase, CINAHL and Cochrane databases were searched for articles published before November 2012. Articles included in this review met these criteria: 1) included patients with primary ACLR, 2) reported at least one knee impairment, function or psychological measure, 3) reported a return to sport measure and 4) analyzed the relationship between the measure and return to sport. Results Weak evidence existed in sixteen articles suggesting variables associated with return to sport included higher quadriceps strength, less effusion, less pain, greater tibial rotation, higher Marx Activity score, higher athletic confidence, higher pre-operative knee self-efficacy, lower kinesiophobia and higher pre-operative self-motivation. Conclusion Weak evidence supports an association between knee impairment, functional, and psychological variables and return to sport. Current return to sport guidelines should be updated to reflect all variables associated with return to sport. Utilizing evidence-based return to sport guidelines following ACLR may ensure athletes are physically and psychologically capable of sports participation, which may reduce re-injury rates and the need for subsequent surgery. PMID:24124040

  11. 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.

  12. MR imaging of the knee following cruciate ligament reconstruction and meniscal surgery; MRT des Kniegelenks nach Kreuzband- und Meniskusoperationen

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    Woertler, K. [Technische Univ. Muenchen, Klinikum rechts der Isar (Germany). Inst. fuer Roentgendiagnostik

    2009-03-15

    Due to the increasing number of surgical procedures performed on the knee, MR imaging of the postoperative knee has gained more and more importance. For the evaluation of anterior cruciate ligament grafts and postoperative menisci, basic knowledge of surgical techniques is essential in order to differentiate normal postoperative findings from transplant failure, retears, and complications. This article reviews technical aspects of MR imaging following knee surgery, basic principles of operative techniques for anterior cruciate ligament reconstruction and therapy of meniscal tears, normal postoperative findings, MR imaging criteria for recurrent lesions, and findings with typical complications. (orig.)

  13. Double-bundle revision anterior cruciate ligament reconstruction is effective in rescuing failed primary reconstruction and re-introducing patients to physical exercise

    Science.gov (United States)

    Jiang, Changqing; Chen, Guofei; Chen, Peng; Li, Wei; Zhang, Honglei; Zhang, Wentao

    2018-01-01

    The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments in the human knee and is critical for knee stability, as it limits anterior tibial translation on the femur, restrains rotation and resists varus and valgus joint forces. The present study aimed to assess the effect of double-bundle revision anterior cruciate ligament (ACL) reconstruction in improving the subjective and objective functions and re-introducing patients to physical activity after primary ACL reconstruction had failed. A total of 34 patients who underwent double-bundle ACL revision surgeries were included in the present retrospective study. Lysholm, Tegner and IKDC scores as well as KT-2000 arthrometry measures were obtained pre- and post-operatively. The follow-up time was at least 2 years. The results indicated that the IKDC, Lysholm and Tegner scores as well as KT-2000 flexion scores were significantly improved after revision ACL reconstruction. All patients resumed to performing physical exercise activities after revision surgeries, 65% of whom reached pre-injury levels. In conclusion, these results demonstrated that double-bundle revision ACL reconstruction was consistently effective in rescuing failed primary ACL reconstruction and re-introducing patients to physical exercise. PMID:29434808

  14. Double-bundle revision anterior cruciate ligament reconstruction is effective in rescuing failed primary reconstruction and re-introducing patients to physical exercise.

    Science.gov (United States)

    Jiang, Changqing; Chen, Guofei; Chen, Peng; Li, Wei; Zhang, Honglei; Zhang, Wentao

    2018-02-01

    The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments in the human knee and is critical for knee stability, as it limits anterior tibial translation on the femur, restrains rotation and resists varus and valgus joint forces. The present study aimed to assess the effect of double-bundle revision anterior cruciate ligament (ACL) reconstruction in improving the subjective and objective functions and re-introducing patients to physical activity after primary ACL reconstruction had failed. A total of 34 patients who underwent double-bundle ACL revision surgeries were included in the present retrospective study. Lysholm, Tegner and IKDC scores as well as KT-2000 arthrometry measures were obtained pre- and post-operatively. The follow-up time was at least 2 years. The results indicated that the IKDC, Lysholm and Tegner scores as well as KT-2000 flexion scores were significantly improved after revision ACL reconstruction. All patients resumed to performing physical exercise activities after revision surgeries, 65% of whom reached pre-injury levels. In conclusion, these results demonstrated that double-bundle revision ACL reconstruction was consistently effective in rescuing failed primary ACL reconstruction and re-introducing patients to physical exercise.

  15. 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.

  16. Factors affecting quadriceps strength recovery after anterior cruciate ligament reconstruction with hamstring autografts in athletes.

    Science.gov (United States)

    Ueda, Yuya; Matsushita, Takehiko; Araki, Daisuke; Kida, Akihiro; Takiguchi, Kohei; Shibata, Yohei; Ono, Kumiko; Ono, Rei; Matsumoto, Tomoyuki; Takayama, Koji; Sakai, Yoshitada; Kurosaka, Masahiro; Kuroda, Ryosuke

    2017-10-01

    Patients typically return to sports activities 6-12 months after anterior cruciate ligament (ACL) reconstruction, and quadriceps strength has been used as one of the criteria to return to sports activities. The purpose of this study is to identify the factors that affect quadriceps strength recovery after ACL reconstruction with a hamstring tendon autograft 6 months after surgery. Isokinetic quadriceps strength at 60°/s was measured preoperatively and 6 months after surgery in 193 athletes who underwent ACL reconstruction with a hamstring tendon autograft. The quadriceps strength index was calculated by normalizing the peak torque of the involved leg with the uninvolved leg. The subjects were divided into two groups according to the quadriceps strength index 6 months after surgery: at least 85 % (n = 84) or less than 85 % (n = 109). Multivariate logistic regression analysis and a receiver operating curve analysis were performed. The preoperative quadriceps strength index [odds ratio (OR) 1.02; 95 % confidence interval (CI) 1.01-1.03], age (OR 0.92; 95 % CI 0.86-0.98), sex (OR 2.45; 95 % CI 1.19-5.18), and knee pain (OR 0.17; 95 % CI 0.04-0.52) were independently associated with quadriceps strength recovery. The cut-off value of the preoperative quadriceps strength index was 70.2 % to obtain at least 85 % quadriceps strength index 6 months after surgery. To achieve sufficient quadriceps strength recovery at the timing of return to sports activities following ACL reconstruction using a hamstring tendon autograft, preoperative quadriceps strength, age, sex, and knee pain should be considered. III.

  17. Returning to sport after anterior cruciate ligament reconstruction in amateur sports men: a retrospective study.

    Science.gov (United States)

    Notarnicola, Angela; Maccagnano, Giuseppe; Barletta, Federico; Ascatigno, Leonardo; Astuto, Leopoldo; Panella, Antonio; Tafuri, Silvio; Moretti, Biagio

    2016-01-01

    According to the literature, 95% of professional athletes return to their sport after anterior cruciate ligament (ACL) reconstruction surgery. The main objective of this study was to verify the return to sport after ACL reconstruction in a homogenous group of amateur sportsmen and sportswomen in a series of Italian patients. We designed a retrospective study in which we analyzed the amateur sports patients operated for ACL reconstruction. We verified whether they had returned to sporting activities by comparing the pre- and post-operative Tegner activity scores. We then analyzed the average time to restart the sporting activity and the Lysholm and International Knee Documenting Committee (IKDC) scores. We analyzed 80 subjects: 47.5% restarted a sports activity, on average after eight months, with a significant reduction of their competitive level or physical commitment, as expressed by the Tegner activity score (pre-operative: 6.9; post-operative: 3.9; psport for international case studies and amateur sports is higher than our data. In our population we found the lack of information provided by the medical staff at discharge and follow-up. The assessment at a short-term follow up allowed us to verify that at the end of the post-surgical rehabilitation program the patients were uninformed about the timing and the ability to resume a sporting activity. An efficacious relationship between orthopedic doctor, physiotherapist and a doctor in motorial science may ensure proper treatment the patient after ACL reconstruction. It is important to guarantee the restarting of the sports activity to have a better quality of life in amateur sports. Level of evidence: V.

  18. Using pre-operative MRI to predict intraoperative hamstring graft size for anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Leiter, Jeff; Elkurbo, Mohamed; McRae, Sheila; Chiu, James; Froese, Warren; MacDonald, Peter

    2017-01-01

    Large variation in tendon size between individuals makes hamstring graft diameter for anterior cruciate ligament (ACL) reconstruction unpredictable. Inadequate graft diameter may necessitate an alternative source of tissue requiring pre-operative planning. The purpose of this study was to determine whether magnetic resonance image (MRI) measurements and clinical anthropometric data are predictive of hamstring tendon graft diameter. Data from 109 patients having ACL reconstruction with semitendinosus-gracilis (STGT) autograft were retrospectively evaluated. Cross-sectional area (CSA) of the gracilis tendon (GT) and semitendinosus tendon (ST) were determined from pre-operative MRI scans. Variables included pre-operative height, weight, body mass index (BMI), age and gender; and intra-operative graft diameter. Correlations between anthropometric variables, hamstring tendons CSA and intra-operative graft diameter were calculated. Multiple stepwise regression was performed to assess the predictive value of these variables to graft diameter. Sensitivity and specificity were calculated to evaluate the utility of MRI CSA measurements in accurately identifying inadequate graft diameter (<8 mm). All anthropometric variables were positively correlated with intraoperative graft diameter (p < 0.01). Semitendinosus-gracilis tendon CSA (p < 0.001) and STGT CSA and weight (p < 0.001) were significantly predictive models of graft diameter. Sensitivity and specificity were 79 and 74 %, respectively. The strongest indicators of a four-stranded STGT graft for primary ACL reconstruction were STGT CSA on MRI plus weight. Measurement of graft diameter can be performed pre-operatively via MRI to identify tendons that may be of inadequate size for ACL reconstruction. This can assist with surgical planning to determine the most appropriate graft choice. III.

  19. Pediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review of Transphyseal Versus Physeal-Sparing Techniques.

    Science.gov (United States)

    Pierce, Todd P; Issa, Kimona; Festa, Anthony; Scillia, Anthony J; McInerney, Vincent K

    2017-02-01

    Anterior cruciate ligament reconstruction is becoming more common in skeletally immature individuals, and it may be performed with transphyseal or physeal-sparing techniques. A number of studies have assessed the outcomes of these techniques, but there is a need to systematically evaluate the pooled data from these studies. To compare the differences in demographics and outcomes of transphyseal and physeal-sparing techniques by assessing (1) demographics, (2) incidence of growth disturbances, and (3) graft survivorship in the pediatric population. Systematic review. A thorough review of 3 databases was performed to identify all studies that evaluated outcomes after pediatric reconstruction based on transphyseal or physeal-sparing techniques. After completing our search and cross-referencing for additional sources, 43 reports were identified for this review. Reports were analyzed for differences in demographics as well as incidence of leg-length discrepancies, angular deformities, and graft survivorship. After review of manuscripts, 27 studies were included for review (21 transphyseal and 6 physeal-sparing studies). Those who had transphyseal reconstruction were more likely to be female (39% vs 20%; P = .0001), while those with the physeal-sparing surgery were younger (12 vs 13.5 years of age; P = .0001). The transphyseal and physeal-sparing cohorts demonstrated similar incidence rates of leg-length discrepancies (0.81% vs 1.2%, respectively; P = .64) and angular deformities (0.61% vs 0%, respectively; P = .36). The transphyseal and physeal-sparing cohorts also showed similar rates of rerupture (6.2% vs 3.1%, respectively; P = .11). Although the study groups were not well matched with regard to age and sex, our results show that these surgical techniques have no differences in incidence of growth disturbances or graft survivorship. Younger males tend to undergo physeal-sparing reconstruction. Future research should focus on long-term outcome metrics with the physeal

  20. Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review.

    Science.gov (United States)

    Everhart, Joshua S; Best, Thomas M; Flanigan, David C

    2015-03-01

    Lack of return to sport following anterior cruciate ligament (ACL) reconstruction often occurs despite adequate restoration of knee function, and there is growing evidence that psychological difference among patients may play an important role in this discrepancy. The purpose of this review is to identify baseline psychological factors that are predictive of clinically relevant ACL reconstruction outcomes, including return to sport, rehab compliance, knee pain, and knee function. A systematic search was performed in PubMed, Google Scholar, CINAHL, UptoDate, Cochrane Reviews, and SportDiscus, which identified 1,633 studies for potential inclusion. Inclusion criteria included (1) prospective design, (2) participants underwent ACL reconstruction, (3) psychological traits assessed at baseline, and (4) outcome measures such as return to sport, rehabilitation compliance, and knee symptoms assessed. Methodological quality was evaluated with a modified Coleman score with several item-specific revisions to improve relevance to injury risk assessment studies in sports medicine. Eight prospective studies were included (modified Coleman score 63 ± 4.9/90, range 55-72). Average study size was 83 ± 42 patients with median 9-month follow-up (range 3-60 months). Measures of self-efficacy, self-motivation, and optimism were predictive of rehabilitation compliance, return to sport, and self-rated knee symptoms. Pre-operative stress was negatively predictive, and measures of social support were positively predictive of knee symptoms and rehabilitation compliance. Kinesiophobia and pain catastrophizing at the first rehabilitation appointment did not predict knee symptoms throughout the early rehabilitation phase (n.s.). Patient psychological factors are predictive of ACL reconstruction outcomes. Self-confidence, optimism, and self-motivation are predictive of outcomes, which is consistent with the theory of self-efficacy. Stress, social support, and athletic self-identity are

  1. Immediate postoperative anterior knee stability: double- versus triple-bundle anterior cruciate ligament reconstructions.

    Science.gov (United States)

    Mae, Tatsuo; Shino, Konsei; Matsumoto, Norinao; Yoneda, Kenji; Yoshikawa, Hideki; Nakata, Ken

    2013-02-01

    The purpose of this study was to compare the triple-bundle (TB) anterior cruciate ligament (ACL) reconstruction with the double-bundle (DB) ACL reconstruction in immediate postoperative anterior knee stability. This study involved 133 patients who had undergone the anatomic ACL reconstruction with autogenous hamstring tendon unilaterally. Then 83 patients (mean age, 28.8 years) underwent the DB between November 2004 and December 2005, and 50 patients (mean age, 29.6 years) underwent the TB ACL reconstruction between January and December 2006. The 2 femoral tunnels were created in the ideal ACL attachment area, whereas 2 tibial tunnels for the DB and 3 tunnels for the TB were created in the ACL footprint. The 2 doubled tendon grafts were fixed with EndoButton-CL (Smith & Nephew Endoscopy, Andover, MA) on the femur. The grafts were fixed to the tibia using a Double Spike Plate and a screw under the total initial tension of 20 N at 20° of flexion, after meticulous in situ pretensioning using a tensioning boot. Then immediate postoperative anterior knee laxity in response to 89 N of anterior load was measured by one experienced examiner (T.M.) with the KT-2000 Knee Arthrometer (MEDmedtric, San Diego, CA) under general anesthesia at 30° of knee flexion with muscle relaxants. The measured anterior laxity was 3.4 ± 1.2 mm in the DB and 2.5 ± 0.7 mm in the TB ACL reconstruction, a statistically significant difference. The side-to-side difference of the laxity was -3.2 ± 1.6 mm in the DB and -4.2 ± 2.0 mm in the TB, again a significant difference. TB ACL reconstruction resulted in better immediate postoperative anterior knee stability than DB ACL reconstruction under 89 N of anterior tibial load (P = .031). Level III, therapeutic retrospective comparative study. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. 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...

  3. Autograft soaking in vancomycin reduces the risk of infection after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Pérez-Prieto, Daniel; Torres-Claramunt, Raúl; Gelber, Pablo E; Shehata, Tamer M A; Pelfort, Xavier; Monllau, Joan Carles

    2016-09-01

    To determine whether the bathing of an anterior cruciate ligament (ACL) autograft in vancomycin reduces the rate of infection following an ACL reconstruction. Retrospective analysis of all ACL reconstructions over an 8-year period in two University Hospitals. In the initial 4-year period, all patients were operated on under classical antibiotic intravenous prophylaxis (group 1). Over the last 4-year period, this prophylaxis was supplemented with presoaking of the autograft (group 2). Presoaking was performed with sterile gauze previously saturated with a vancomycin solution (5 mg/ml). There were 810 and 734 patients in group 1 and 2, respectively. Fifteen cases of knee joint infections were identified in the series (0.97 %). All of these infections occurred in group 1, representing a rate of infection of 1.85 % in comparison with 0 % in group 2 (p vancomycin in combination with classical intravenous antibiotic prophylaxis reduced the rate of knee joint infection following an ACLR in comparison with antibiotic prophylaxis alone. This technique could be of relevance in daily clinical practice to prevent infection after ACLR. Case control study, retrospective comparative study, Level III.

  4. 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.

  5. Anterior cruciate ligament reconstruction reduces bone mineral areal mass.

    Science.gov (United States)

    Stener, Sven; Kartus, Jüri; Ejerhed, Lars

    2013-11-01

    The aim of this study was to prospectively follow bone mineral areal mass (BMA) changes in the calcaneii, hips, and lumbar spine after anterior cruciate ligament (ACL) reconstruction using hamstring tendon autografts. Patients with a unilateral ACL injury scheduled for reconstruction were included in the study. The BMA mass was measured in both calcaneii, the hips, and the lumbar spine using the dual-energy x-ray absorptiometry (DEXA) technique. Quality of life was estimated using the EQ-5D questionnaire, and activity was measured using the Tegner activity score. The patients were assessed before surgery and after 6, 18, 36, and 60 months. Forty-eight patients (21 female and 27 male patients), median age 31 years (17 to 64 years), participated in the study for 5 years. After 5 years, the female patients had lost 9.5% (P hips, the female patients had lost 4.0% (P hips on the operated and the nonoperated sides, respectively. The EQ-5D index was a mean (standard deviation [SD]) of 0.72 (0.23) before surgery and 0.86 (0.17) (P hips during the 5-year study period compared with a reference population of Swedish healthy women and men. The patients increased their Tegner activity level and improved their EQ-5D index during the 5-year follow-up period. Level II, prognostic prospective study. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  6. 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.

  7. 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

  8. A prospective comparative study of clinical and functional outcomes between anatomic double bundle and single bundle hamstring grafts for arthroscopic anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Morey, Vivek M; Nag, Hira Lal; Chowdhury, Buddhadev; Sankineani, Sukesh Rao; Naranje, Sameer M

    2015-09-01

    Despite a number of studies comparing postoperative stability and function after anatomic single bundle and double bundle anterior cruciate ligament reconstruction, it remains unclear whether double bundle reconstruction has better functional outcome than single bundle anterior cruciate ligament reconstruction. To compare the subjective functional outcome as well as clinical stability in patients treated with either anatomic single bundle or anatomic double bundle anterior cruciate ligament (ACL) reconstruction. We hypothesized that there would be no difference in the postoperative functional outcome and clinical stability between anatomical double bundle anterior cruciate ligament reconstructions when compared to single bundle anterior cruciate ligament reconstructions. We prospectively followed 40 patients out of which, 20 patients were operated for anatomic single bundle ACL reconstruction and other 20 patients underwent anatomic double bundle ACL reconstruction. Patient evaluation using the laxity tests and outcome scales was done preoperatively and at 12, 24 and 48 months after the surgery. Clinical stability was assessed by Lachman test, Pivot shift test and Delhi active test. Functional outcome was assessed by International Knee Documentation Committee (IKDC), Lysholm and Modified Cincinnati scores. Patients in both groups were evaluated at regular intervals for a minimum period of 48 months (mean 51 months, range 48-56 months). For all subjective scores, double bundle group patients reported statistically significant higher scores compared to single bundle group patients. Graded stability results of the Lachman, and Pivot shift tests were significantly higher in the anatomically reconstructed double bundle patient group. We suggest that functional outcome and clinical stability may be better with anatomical double bundle anterior cruciate ligament reconstruction as compared to anatomical single bundle anterior cruciate ligament reconstruction. Copyright

  9. Ligament reconstruction with single bone tunnel technique for chronic symptomatic subtle injury of the Lisfranc joint in athletes.

    Science.gov (United States)

    Miyamoto, Wataru; Takao, Masato; Innami, Ken; Miki, Shinya; Matsushita, Takashi

    2015-08-01

    Only few procedures for Lisfranc ligaments reconstruction to treat subtle injury of the Lisfranc joint have been reported. We have developed a novel technique for Lisfranc ligaments reconstruction, which was applied to treat chronic symptomatic subtle injuries that had failed to respond to initial treatment or were misdiagnosed. This article describes the technique and its operative outcome in a small case series. Between April 2011 and October 2013, 5 (4 male and 1 female) athletes with a mean age of 19.4 (range 17-21) years were diagnosed with chronic subtle injury of the Lisfranc joint and underwent our novel reconstructive operation. In this technique, only a bone tunnel between the medial cuneiform and the second metatarsal bone is needed for near-anatomical reconstruction of the dorsal and interosseous ligaments. All patients were evaluated before and at 1 year after surgery using the American Orthopaedic Foot and Ankle Society (AOFAS) scale for the ankle-midfoot. In addition, the interval between surgery and return to athletic activity, defined as return to near pre-injury performance level, was investigated. Mean duration of postoperative follow-up was 18.8 (range 12-26) months. Mean AOFAS score improved significantly from 74.6 ± 2.5 (range 71-77) preoperatively to 96.0 ± 5.5 (range 90-100) at 1 year after the operation (p athletic activities and the interval between surgery and return to athletic activity was 16.8 ± 1.1 (range 15-18) weeks. There was no complication related to the operation. The results of this study suggest that our technique of Lisfranc ligaments reconstruction using autologous graft is effective for athletes with chronic subtle injury. Level IV, retrospective case series.

  10. Functional Movement Competency and Dynamic Balance After Anterior Cruciate Ligament Reconstruction in Adolescent Patients.

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    Boyle, Matthew J; Butler, Robert J; Queen, Robin M

    2016-01-01

    Adolescent patients undergoing anterior cruciate ligament (ACL) reconstruction may not adequately recover safe movement patterns before returning to sport participation. The aims of this study were to assess functional movement and dynamic balance 9 months after primary ACL reconstruction in adolescent patients, and to assess for any maturity-specific differences that may guide rehabilitation strategies. A series of 39 adolescent patients who underwent primary, anatomic, transphyseal ACL reconstruction using hamstrings autograft from October 2009 to January 2013 were identified from a research database: 17 skeletally immature (SI) patients (mean age 13.6±1.6 y) and 22 skeletally mature (SM) patients (mean age 16.6±1.2 y). An adult reference population of 16 primary ACL reconstruction patients (mean age 27.4±4.0 y) was also identified. All patients followed a standardized operative and rehabilitation protocol. The 3 patient groups were compared 9 months postoperatively using the Functional Movement Screen (FMS) to assess movement competency and the Lower Quarter Y-Balance Test (LQYBT) to assess single-limb dynamic balance. Nine months postoperatively, the FMS scores for all 3 groups indicated an increased risk for lower extremity injury (total score ≤14). With respect to specific movement patterns, the SI group displayed inferior active straight leg raise score (P=0.006) despite a lower incidence of pain with this movement. With the LQYBT, there was no significant difference in mean anterior (P=0.987), posterolateral (P=0.349), or posteromedial (P=0.870) reach asymmetry between the 3 groups; however, the adolescent groups demonstrated wider ranges of anterior reach asymmetry than the adult group indicating an increased risk for injury. Adolescent patients undergoing primary ACL reconstruction do not consistently recover adequate functional movement patterns by 9 months postoperatively to permit a safe return to sport. We have identified unique functional

  11. [Anatomic reconstruction of the anterior cruciate ligament in single bundle technique].

    Science.gov (United States)

    Petersen, W; Forkel, P; Achtnich, A; Metzlaff, S; Zantop, T

    2013-04-01

    Restore the knee stability by ACL reconstruction of the anterior cruciate ligament. Acute and chronic functional instability with rupture of the anterior cruciate ligament giving way phenomena, acute rupture of the anterior cruciate ligament with concomitant meniscus repair. Local infection in the knee joint, local soft tissue damage, lack of cooperation of the patient. The operation begins with the examination under anesthesia. It follows an arthroscopic examination of the knee and the arthroscopic treatment of accompanying intra-articular lesions (meniscus and cartilage damage). The semitendinosus tendon is harvested via a 3 cm skin incision medial to the tibial tuberosity. A four stranded tendon graft is prepared with a minimum length of 6.5 cm. Alternative grafts for this technique are the patellar tendon, quadriceps tendon, and allografts. The femoral tunnel for the ACL graft is drilled via a deep anteromedial portal under arthroscopic control. For precise placement of the guide wire a specific offset aimer is used. For drilling the knee must be flexed more than 110°. Landmarks are the intercondylar line and the cartilage-bone interface. The position of the guide wire is always controlled by the medial portal (medial portal view). The guide wire is overdrilled with a cannulated drill (4.5 mm when a flip tack is used). The drill diameter for the 30 mm long blind tunnel is chosen according to the graft diameter. A gentle tunnel preparation may be achieved with the use of dilators. At the tibia, the anterior horn of the lateral meniscus is used as a landmark in the absence of ACL stump. The guide wire is first overdrilled with a 6 mm drill. Slight adjustments to the tibial tunnel location can be archieved when the guide wire is overdrilled eccentrically with a larger drill. At the femur an extracortical fixation technique with a flip button is preferred. At the tibia, a hybrid fixation with absorbable interference screw and button is used. The rehabilitation

  12. Flexor-extensor relationship knee after reconstruction of the anterior cruciate ligament

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    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.

  13. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery.

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    Ardern, Clare L; Taylor, Nicholas F; Feller, Julian A; Whitehead, Timothy S; Webster, Kate E

    2013-07-01

    Up to two-thirds of athletes may not return to their preinjury level of sport by 12 months after anterior cruciate ligament (ACL) reconstruction surgery, despite being physically recovered. This has led to questions about what other factors may influence return to sport. To determine whether psychological factors predicted return to preinjury level of sport by 12 months after ACL reconstruction surgery. Case control study; Level of evidence, 3. Recreational and competitive-level athletes seen at a private orthopaedic clinic with an ACL injury were consecutively recruited. The primary outcome was return to the preinjury level of sports participation. The psychological factors evaluated were psychological readiness to return to sport, fear of reinjury, mood, emotions, sport locus of control, and recovery expectations. Participants were followed up preoperatively and at 4 and 12 months postoperatively. In total, 187 athletes participated. At 12 months, 56 athletes (31%) had returned to their preinjury level of sports participation. Significant independent contributions to returning to the preinjury level by 12 months after surgery were made by psychological readiness to return to sport, fear of reinjury, sport locus of control, and the athlete's estimate of the number of months it would take to return to sport, as measured preoperatively (χ(2) 2 = 18.3, P Psychological responses before surgery and in early recovery were associated with returning to preinjury level of sport at 12 months, suggesting that attention to psychological recovery in addition to physical recovery after ACL injury and reconstruction surgery may be warranted. Clinical screening for maladaptive psychological responses in athletes before and soon after surgery may help clinicians identify athletes at risk of not returning to their preinjury level of sport by 12 months.

  14. Patient Knowledge and Beliefs About Knee Osteoarthritis After Anterior Cruciate Ligament Injury and Reconstruction.

    Science.gov (United States)

    Bennell, Kim L; van Ginckel, Ans; Kean, Crystal O; Nelligan, Rachel K; French, Simon D; Stokes, Maria; Pietrosimone, Brian; Blackburn, Troy; Batt, Mark; Hunter, David J; Spiers, Libby; Hinman, Rana S

    2016-08-01

    To explore patients' knowledge and beliefs about osteoarthritis (OA) and OA risk following anterior cruciate ligament (ACL) injury, to explore the extent to which information about these risks is provided by health professionals, and to examine associations among participant characteristics, knowledge, and risk beliefs and health professional advice. A custom-designed survey was conducted in Australian and American adults who sustained an ACL injury, with or without reconstruction, 1-5 years prior. The survey comprised 3 sections: participant characteristics, knowledge about OA and OA risk, and health professional advice. Complete data sets from 233 eligible respondents were analyzed. Most (70%, n = 164) rated themselves as being at greater risk of OA than their healthy peers, although only 56% (n = 130) were able to identify the correct OA definition. While most agreed that ACL (73%, n = 168) and/or meniscal injuries (n = 181, 78%) increase the risk of OA, 65% (n = 152) believed that ACL reconstruction reduced the risk of OA, or they did not know. A total of 27% (n = 62) recalled discussing their OA risk with a health professional. Participants who were female, younger, or had a lower body mass index or higher physical activity level were more likely to recognize meniscal tears and meniscectomy as risk factors of OA. A history of professional advice was associated with beliefs about increased OA risks. Patients sustaining an ACL injury require better education from health professionals about OA as a disease entity and their elevated risk of OA, irrespective of whether or not they undergo surgical reconstruction. © 2016, American College of Rheumatology.

  15. 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.

  16. SIMPLE DECISION RULES REDUCE REINJURY RISK AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    Science.gov (United States)

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

    2016-01-01

    Background Knee reinjury after anterior cruciate ligament (ACL) reconstruction is common and increases the risk of osteoarthritis. There is sparse evidence to guide return to sport (RTS) decisions in this population. Objectives To assess the relationship between knee reinjury after ACL reconstruction and 1) return to level I sports, 2) timing of return to sports, and 3) knee function prior to return. Methods 106 patients who participated in pivoting sports participated in this prospective two year cohort study. Sports participation and knee reinjury were recorded monthly. Knee function was assessed with the Knee Outcome Survey–Activities of Daily Living Scale, global rating scale of function, and quadriceps strength and hop test symmetry. Pass RTS criteria was defined as scores >90 on all tests, failure as failing any. Results Patients who returned to level I sports had 4.32 (p=0.048) higher reinjury rate than those who did not. The reinjury rate was significantly reduced by 51 % for each month RTS was delayed until 9 months after surgery, after which no further risk reduction was observed. 38.2 % of those who failed RTS criteria suffered reinjuries versus 5.6 % of those who passed (HR: 0.16, p=0.075). More symmetrical quadriceps strength prior to return significantly reduced the knee reinjury rate. Conclusion Returning to level I sports after ACL reconstruction leads to a more than 4-fold increase in reinjury rates over 2 years. Return to sport 9 months or later after surgery and more symmetrical quadriceps strength prior to return substantially reduces the reinjury rate. PMID:27162233

  17. Isokinetic evaluation of internal/external tibial rotation strength after the use of hamstring tendons for anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Armour, Tanya; Forwell, Lorie; Litchfield, Robert; Kirkley, Alexandra; Amendola, Ned; Fowler, Peter J

    2004-01-01

    Evaluation of the knee after an anterior cruciate ligament reconstruction with the use of the semitendinosus and gracilis (hamstring) autografts has primarily focused on flexion and extension strength. The semitendinosus and gracilis muscles contribute to internal tibial rotation, and it has been suggested that harvest of these tendons for the purpose of an anterior cruciate ligament reconstruction contributes to internal tibial rotation weakness. Internal tibial rotation strength may be affected by the semitendinosus and gracilis harvest after anterior cruciate ligament reconstruction. Prospective evaluation of internal and external tibial rotation strength. Inclusion criteria for subjects (N = 30): unilateral anterior cruciate ligament reconstruction at least 2 years previously, a stable anterior cruciate ligament (problems after initial knee reconstruction, a normal contralateral knee, and the ability to comply with the testing protocol. In an attempt to minimize unwanted subtalar joint motion, subjects were immobilized using an ankle brace and tested at angular velocities of 60 degrees /s, 120 degrees /s, and 180 degrees /s at a knee flexion angle of 90 degrees . The mean peak torque measurements for internal rotation strength of the operative limb (60 degrees /s, 17.4 +/- 4.5 ft-lb; 120 degrees /s, 13.9 +/- 3.3 ft-lb; 180 degrees /s, 11.6 +/- 3.0 ft-lb) were statistically different compared to the nonoperated limb (60 degrees /s, 20.5 +/- 4.7 ft-lb; 120 degrees /s, 15.9 +/- 3.8 ft-lb; 180 degrees /s, 13.4 +/- 3.8 ft-lb) at 60 degrees /s (P = .012), 120 degrees /s (P = .036), and 180 degrees /s (P = .045). The nonoperative limb demonstrated greater strength at all speeds. The mean torque measurements for external rotation were statistically similar when compared to the nonoperated limb at all angular velocities. We have shown through our study that patients who undergo surgical intervention to repair a torn anterior cruciate ligament with the use of autogenous

  18. One stage revision single-bundle anterior cruciate ligament reconstruction with impacted morselized bone graft following a failed double-bundle reconstruction

    Directory of Open Access Journals (Sweden)

    Ho Jong Ra

    2017-01-01

    Full Text Available Although double-bundle anterior cruciate ligament (ACL reconstruction has theoretical benefits such as more accurate reproduction of ACL anatomy, it is technically more demanding surgery. This report describes the case of a one stage revision single-bundle ACL reconstruction after primary double-bundle ACL reconstruction. A professional dancer had an ACL previously reconstructed with a double-bundle technique, but the femoral tunnels were malpositioned resulting in residual laxity and rotational instability. The previous femoral tunnel positions were vertical and widened. The previous vertical tunnels were filled with impacted bone graft and a revision single-bundle ACL reconstruction was performed via the new femoral tunnel with a 2 O'clock position between the previous two tunnels. After 10 months of postoperative rehabilitation, the patient returned to professional dancing with sound bony union and without any residual instability.

  19. [Rehabilitation after anterior cruciate ligament reconstruction: inpatient or outpatient rehabilitation? A series of 103 patients].

    Science.gov (United States)

    Rousseau, B; Dauty, M; Letenneur, J; Sauvage, L; De Korvin, G

    2001-05-01

    The goal of this work was to evaluate outpatient rehabilitation after anterior curciate ligament reconstruction using the bone-tendon technique. This was a prospective non-randomized study of 103 consecutive patients participating in the same rehabilitation program, excepting for the first month. During the first postoperative month, 55 patients (group A) attended a physical therapy outpatient clinic near their home and 48 patients (group B) followed the same rehabilitation protocol at an inpatient facility of their choice. We recorded preoperative data for age, sex, weight, height and function (sports, occupational activities). Surgery data concerned delay between severe sprain and surgery, and the exact surgical procedure used (meniscal tear, associated procedure). Clinical assessment (mobility, effusion, clinical and radiological laxity) and functional scores (Tegner, Lysholm, Arpege, IKDC) as well as delay to recovery of gait and to renewed physical activity were recorded at 3 and 6 weeks and 4, 6 and 12 months postoperatively. Two isokinetic tests were done 4 and 6 months postoperatively. There was no statistical difference for the pre and peroperative data between the two groups, with the exception of meniscal tears that were more frequent in group A (p<0.05). Postoperative outcome and complications were not significantly different between the 2 groups except for greater flexion at 3 weeks in group B (related to difference in measurement date). Fifteen complications were observed in each group: 4 reflex dystrophies and 2 cyclope syndromes in each group, 5 patellar syndromes in group A and 1 in group B; 3 painful surgical wound sites in group A and 8 in group B (including one requiring revision). In group A there was one early failure due to a surgical error requiring revision. At 1 year, there were 2 cases of persistent femoropatellar syndromes, one of which occurred after reflex dystrophy. A high percentage of the patients were lost to follow-up (45% in

  20. Broken Bioabsorbable Tibial Interference Screw after Anterior Cruciate Ligament (ACL Reconstruction using a Semitendinosus-gracilis Graft: A Case Report

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    Huang ME Deborah

    2012-07-01

    Full Text Available When a patient presents with knee pain and locking after an anterior cruciate ligament (ACL reconstruction, a new meniscal injury or an osteochondral loose body are usually considered for differential diagnosis. We present the case of a 22-year-old female with just these complaints 6 months after ACL reconstruction surgery. Magnetic resonance imaging (MRI of the knee showed a broken screw tip which was later arthroscopically removed. At arthroscopy, an 11mm long broken bioabsorbable interference screw tip was found lying in the intercondylar notch; this resulted in a 0.5cm Outerbridge grade II chondral ulcer located at mid- patella. Both menisci and cruciate ligaments were intact and no other loose bodies were found in the knee joint.

  1. Hamstring and quadriceps strength balance in normal and hamstring anterior cruciate ligament-reconstructed subjects.

    Science.gov (United States)

    Hiemstra, Laurie A; Webber, Sandra; MacDonald, Peter B; Kriellaars, Dean J

    2004-09-01

    The purpose of this study was to evaluate and characterize the agonist-antagonist strength balance (hamstring/quadriceps [H/Q] ratio and dynamic control ratio [DCR]) about the knee specific to velocity, range of motion, and contraction type. We hypothesized that there would be systematic variation in the H/Q ratio and DCR based on knee joint angle, angular velocity, and contraction type. We also hypothesized that these ratios would be altered in the anterior cruciate ligament (ACL)-reconstructed group in favor of protecting the ACL graft (relative knee flexor strength when strain on the ACL is the greatest). Cross-sectional design. A tertiary care sport medicine clinic. Sixteen subjects more than 1 year after hamstring tendon ACL reconstruction were compared with 30 active uninjured control subjects. Isokinetic strength testing was performed over 5 degrees to 95 degrees knee joint range of motion, 5 angular velocities (50, 100, 150, 200, 250 degrees/s), for concentric and eccentric contractions. Angle and velocity-matched H/Q ratio maps and DCR maps were produced for each group. Difference maps allowed quantification of the differences between the groups. Angle and velocity-matched H/Q ratio maps demonstrated systematic variation based on joint angle, velocity, and contraction type for both the control (H/Q, approximately 0-1.42; DCR, approximately 0-1.57) and the ACL-reconstructed group (H/Q, approximately 0-1.33; DCR, approximately 0-1.35). Difference maps demonstrate regional (angle and velocity-specific) alteration in the ratio between the ACL-reconstructed and control groups. Specific imbalances were demonstrated in the ACL-reconstructed group compared with control. In high knee flexion angles, the low H/Q ratio may represent a compromised ability of the hamstrings to stabilize the knee joint throughout the full range of motion. Near full knee extension shifts in favor of the knee flexors may represent an attempt to stabilize the knee at the angle of greatest

  2. 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

  3. Kinesiophobia After Anterior Cruciate Ligament Rupture and Reconstruction: Noncopers Versus Potential Copers

    Science.gov (United States)

    Hartigan, Erin H.; Lynch, Andrew D.; Logerstedt, David S.; Chmielewski, Terese L.; Snyder-Mackler, Lynn

    2016-01-01

    STUDY DESIGN Secondary-analysis, longitudinal cohort study. OBJECTIVES To compare kinesiophobia levels in noncopers and potential copers at time points spanning pre– and post–anterior cruciate ligament (ACL) reconstruction and to examine the association between changes in kinesiophobia levels and clinical measures. BACKGROUND After ACL injury, a screening examination may be used to classify patients as potential copers or noncopers based on dynamic knee stability. Quadriceps strength, single-leg hop performance, and self-reported knee function are worse in noncopers. High kinesiophobia levels after ACL reconstruction are associated with poorer self-reported knee function and lower return-to-sport rates. Kinesiophobia levels have not been examined before ACL reconstruction, across the transition from presurgery to postsurgery, or based on potential coper and noncoper classification. METHODS Quadriceps strength indexes, single-leg hop score indexes, self-reported knee function (Knee Outcome Survey activities of daily living subscale, global rating scale), and kinesiophobia (Tampa Scale of Kinesiophobia [TSK-11]) scores were compiled for potential copers (n = 50) and noncopers (n = 61) from 2 clinical trial databases. A repeated-measures analysis of variance was used to compare TSK-11 scores between groups and across 4 time points (before preoperative treatment, after preoperative treatment, 6 months post–ACL reconstruction, and 12 months post–ACL reconstruction). Correlations determined the association of kinesiophobia levels with other clinical measures. RESULTS Presurgery TSK-11 scores were significantly higher in noncopers than in potential copers. Postsurgery, no group differences existed. TSK-11 scores in both groups decreased across all time points; however, TSK-11 scores decreased more in noncopers in the interval between presurgery and postsurgery. In noncopers, the decreases in TSK-11 scores from presurgery to postsurgery and after surgery were

  4. Anterior cruciate ligament reconstruction with tibial attachment preserving hamstring graft without implant on tibial side

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    Skand Sinha

    2018-01-01

    Full Text Available Background: Tibial attachment preserving hamstring graft could prevent potential problems of free graft in anterior cruciate ligament (ACL reconstruction such as pull out before graft-tunnel healing or rupture before ligamentization. Different implants have been reportedly used for tibial side fixation with this technique. We investigated short-term outcome of ACL reconstruction (ACLR with tibial attachment sparing hamstring graft without implant on the tibial side by outside in technique. Materials and Methods: Seventy nine consecutive cases of ACL tear having age of 25.7 ± 6.8 years were included after Institutional Board Approval. All subjects were male. The mean time interval from injury to surgery was of 7.5 ± 6.4 months. Hamstring tendons were harvested with open tendon stripper leaving the tibial insertion intact. The free ends of the tendons were whip stitched, quadrupled, and whip stitched again over the insertion site of hamstring with fiber wire (Arthrex. Single bundle ACLR was done by outside in technique and the femoral tunnel was created with cannulated reamer. The graft was pulled up to the external aperture of femoral tunnel and fixed with interference screw (Arthrex. The scoring was done by Lysholm, Tegner, and KT 1000 by independent observers. All cases were followed up for 2 years. Results: The mean length of quadrupled graft attached to tibia was 127.65 ± 7.5 mm, and the mean width was 7.52 ± 0.78 mm. The mean preoperative Lysholm score of 47.15 ± 9.6, improved to 96.8 ± 2.4 at 1 year. All cases except two returned to the previous level of activity after ACLR. There was no significant difference statistically between preinjury (5.89 ± 0.68 and postoperative (5.87 ± 0.67 Tegner score. The anterior tibial translation (ATT (KT 1000 improved from 11.44 ± 1.93 mm to 3.59 ± 0.89 mm. The ATT of operated knee returned to nearly the similar value as of the opposite knee (3.47 ± 1.16 mm. The Pivot shift test was negative in

  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. Optimization of the Return-to-Sport Paradigm After Anterior Cruciate Ligament Reconstruction: A Critical Step Back to Move Forward

    OpenAIRE

    Dingenen, Bart; Gokelier, Alli

    2017-01-01

    Athletes who have sustained an anterior cruciate ligament (ACL) injury often opt for an ACL reconstruction (ACLR) with the goal and expectation to resume sports. Unfortunately, the proportion of athletes successfully returning to sport is relatively low, while the rate of second ACL injury has been reported to exceed 20% after clearance to return to sport, especially within younger athletic populations. Despite the development of return-to-sport guidelines over recent years, there are still m...

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

    Science.gov (United States)

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

    2017-04-01

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

  8. Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling

    OpenAIRE

    Lacey, Matthew; Lamplot, Joseph; Walley, Kempland C; DeAngelis, Joseph P; Ramappa, Arun J

    2017-01-01

    AIM To describe an approach to anterior cruciate ligament (ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary (IM) femoral nail. METHODS Once preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware (locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant...

  9. 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.

  10. 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

  11. 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.

  12. Dorsal capsulodesis associated with arthoscopy-assisted scapholunate ligament reconstruction using a palmaris longus tendon graft

    Directory of Open Access Journals (Sweden)

    Victor Bignatto Carvalho

    Full Text Available ABSTRACT OBJECTIVES: To measure the quality of life, the time to work return, and clinical, functional, and radiographic parameters of patients treated with dorsal capsulodesis associated with scapholunate (SL reconstruction, assisted by arthroscopy. METHODS: From January 2015 to September 2016, 14 adult patients with SL dissociation underwent surgical treatment with the SL reconstruction procedure assisted by arthroscopy, using the new technique proposed in this study. All patients were assessed by the occupational therapy department at regular intervals after surgery and performed the same sequence of rehabilitation. The parameters analyzed were: range of motion (ROM, Disability of the Arm, Shoulder, and Hand (DASH, visual analog scale (VAS, and radiographic analysis to visualize the pre- and postoperative SL gap and the pre- and postoperative dorsal intercalated segment instability (DISI deformity the. The complications and the time to return to work activities were described. RESULTS: The follow-up time was 12 months (3-17. The ROM averaged 321° (96.9% of the normal side. VAS was 1.79/10 (1-6. DASH was 6.50/100 (1-30. The time to work return work was 4.42 months (2-17. As for complications, one patient developed SLAC, and underwent four-corner fusion one year after ligament reconstruction. Currently, he has experienced pain relief, with a functional range of motion of the wrist, and has not yet returned to professional activities. The preoperative SL gap was 4.29 mm (2-7; in the postoperative period, it was 1.79 mm (1-4. The DISI deformity was present in ten patients with SL angle > 70° (preoperative and it was corrected after surgery, in all patients. SLAC stage I was identified in a patient. Arthroscopy was performed in all cases. The SL instability was classified as Geissler grade III in four cases and as grade IV in ten cases. CONCLUSION: The new approach (dorsal capsulodesis associated with SL reconstruction, assisted by arthroscopy

  13. [Anatomical study on the femoral tunnel anatomy reconstruction of anterior cruciate ligament].

    Science.gov (United States)

    Dong, Yi-Long; Cai, Chun-Yuan; Jiang, Wen-Hui; Jiang, Gang-Yi; Qian, Yue-Nan; Zhao, Zhang-Wei; Yang, Guo-Jing

    2013-09-01

    To measure anatomical data of the femoral tunnel anatomy reconstruction of anterior cruciate ligament (ACL), so provide anatomical basis for clinical anatomy reconstruction of ACL. There were 30 adults' cadaveric knee specimens. The ACL femoral tunnel was reconstructed through anterior medial approach (AMP) in genuflex position of 120 degree, and was marked by Kirschner. The soft tissue of the specimen was removed and the femoral condyle was split at the middle side. The index including length of the femoral tunnel, the distance from internal opening of tunnel to cortical edge of femoral condyle and vertical distance to the top of femoral intercondylar notch were measured. Then the time position of internal opening of tunnel in the intercondylar notch was recorded, and the location of outside opening of tunnel to the femoral condyle was detected. The mean length of the femoral tunnel was (36.35 +/- 3.14) mm (ranged, 30.65 to 42.35 mm). The distance from internal opening of tunnel to cortical edge of femoral condyle was (17.84 +/- 3.35) mm (ranged, 14.02 to 23.49 mm), vertical distance to the top of femoral intercondylar notch was (14.05 +/- 2.32) mm (ranged, 9.17 to 20.08 mm). According to the way of circular dial,internal opening of tunnel located at 02:30 +/- 00:10 (ranged, 01:50 to 02:50) in the left knee,and 09:30 +/- 0:15 (ranged, 08:30 to 10:40) in the right knee. The outside opening of femoral tunnel located at (3.16 +/- 2.51) mm (ranged, 1.61 to 6.30 mm) to the proximal end of external epicondyle of femur, and (4.25 +/- 2.16) mm (ranged, 1.73 to 8.52 mm) to the posterior of external epicondyle of femur. The anatomical features of femoral tunnel for reconstruction of ACL is revealed,which will provide anatomical basis for clinical practice.

  14. Anatomic double-bundle anterior cruciate ligament reconstruction using hamstring tendons with minimally required initial tension.

    Science.gov (United States)

    Mae, Tatsuo; Shino, Konsei; Matsumoto, Norinao; Natsu-Ume, Takashi; Yoneda, Kenji; Yoshikawa, Hideki; Yoneda, Minoru

    2010-10-01

    Our purpose was to clarify the clinical outcomes at 2 years after anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with 20 N of the initial tension, which was the minimally required initial tension to perform the reconstruction successfully according to our previous report about the pre-tension necessary to restore the laxity found in the opposite knee (7.3 N; range, 2.2 to 14 N). Of 64 patients who underwent anatomic double-bundle ACL reconstruction with autogenous semitendinosus tendon, 45 were periodically examined for 2 years. Two double-looped grafts were fixed with EndoButton CL devices (Smith & Nephew Endoscopy, Andover, MA) on the femoral side and Double Spike Plates (Smith & Nephew Endoscopy) on the tibial side, while a total of 20 N of initial tension (10 N to each graft) was applied at 20° of knee flexion. The International Knee Documentation Committee Knee Examination Form and Lysholm score were used for the subjective assessment, whereas range of motion and knee stability were evaluated as the objective assessment. Grafts were evaluated in 25 patients with second-look arthroscopy. According to the International Knee Documentation Committee subjective assessment, 62% of knees were graded as normal and 38% as nearly normal. The Lysholm score was 72 points in the preoperative period and improved to 99 points at 2 years' follow-up. A loss of knee extension of less than 3° was found in 2 patients. The pivot-shift test was evaluated as negative in all patients except for 5 as a glide. KT-2000 knee arthrometer side-to-side difference (MEDmetric, San Diego, CA) was 0.1 ± 0.9 mm at 2 years' follow-up. Of the subset of grafts evaluated by second-look arthroscopy, most were considered to have good synovial coverage and to be taut. The anatomic double-bundle ACL reconstruction with 20 N of low initial tension yielded good clinical outcomes at 2 years postoperatively, and second-look arthroscopic findings were excellent. Level IV

  15. Combined Anterior Cruciate Ligament Reconstruction and High Tibial Osteotomy in Anterior Cruciate Ligament-Deficient Varus Knees

    Directory of Open Access Journals (Sweden)

    Ayman M. Ebied

    2017-12-01

    Conclusion: The combined procedure of ACL reconstruction and high tibial osteotomy restored knee stability and reduced pain over the medial compartment. Although the combined procedure has a longer period of rehabilitation than an isolated ACL reconstruction, the elimination of lateral thrust and preservation of articular cartilage of the medial compartment are of paramount importance to the future of these knees.

  16. The Use of Hamstring Fatigue to Reduce Quadriceps Inhibition After Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Lowe, Timothy; Dong, Xuanliang Neil

    2018-02-01

    Arthrogenic muscle inhibition, an inability to fully activate the quadriceps muscles, has been persistently observed after anterior cruciate ligament reconstruction (ACLr) surgery. Reductions in quadriceps activation may be partly due to the flexion reflex pathway, hamstrings activation, and reciprocal quadriceps inhibition. Since central fatigue has been shown to modify hamstring excitability and change the hamstring reflex response, hamstring fatigue might alleviate quadriceps muscle inhibition by counteracting the flexion reflex. In this study, nine young adult athletes (age: M = 19.9 years, SD = 1.7) with unilateral ACLr and nine control athletes (age: M = 24.0 years, SD = 2.4) with no previous history of knee injury performed tempo squats to induce fatigue. The ACLr group tended to use hamstrings for more hip flexion and trunk forward flexion than the control group. We assessed each participant's quadriceps inhibition through the central activation ratio (CAR), measured by twitch interpolation, before and after the induced fatigue. A mixed analysis of variance was used to examine the effect of fatigue on the CAR between pre- and post-fatigue and for both ACLr and control groups. The ACLr group showed significantly ( p = .010) greater CAR of the quadriceps post-fatigue ( M = 96.0%, SD = 7.6%) than pre-fatigue ( M = 81.2%, SD = 15.8%), while the control group showed no significant ( p = .969) pre-fatigue ( M = 96.9%, SD = 9.6%) and post-fatigue ( M = 97.0%, SD = 17.1%) differences. Thus, fatigue training may be used as a rehabilitation strategy to restore normal quadriceps function at the knee joint following ACL reconstruction by relaxing the hamstrings and overcoming quadriceps inhibition.

  17. Knee pain after anterior cruciate ligament reconstruction: evaluation of a rehabilitation protocol.

    Science.gov (United States)

    Gadea, F; Monnot, D; Quélard, B; Mortati, R; Thaunat, M; Fayard, J M; Sonnery-Cottet, B

    2014-07-01

    Anterior knee pain (AKP) is a rare and difficult complication following anterior cruciate ligament (ACL) reconstruction. This disabling pain is persistent with conventional rehabilitation protocols. The aim of this work is to validate a new rehabilitation protocol that may improve the patients and allow return to daily activities including sports. Forty-three patients identified with functional AKP after ACL reconstruction was enrolled in the rehabilitation protocol between 2009 and 2011. The series included twenty-six patients with hamstring grafting and seventeen patients with patellar tendon transplant. This study compares the functional outcomes and pain scores before and after the isokinetic protocol until the last follow-up at an average of 25.7 months after surgery. The evaluation was performed according to the International Knee Documentation Committee (IKDC) and included a pain assessment using the visual analog scale. Statistical analysis used Student's t-test for unpaired data and the Pearson correlation test for the variables. The IKDC scores were compared by the Wilcoxon test. Functional outcomes and pain are significantly improved (ppain improved with 3.2 points on the visual analog scale (VAS). The results are correlated with the follow-up time (p=0.008) but not correlated with the delay between the surgery and the beginning of the isokinetic protocol. Isokinetic rehabilitation provides a significant improvement in the knee function as measured by the IKDC score and by the VAS, regardless of the painful period preceding the program. The function improvement continues after the end of the protocol, but the pain may not completely disappear. The isokinetic rehabilitation program may resume functional AKP related to muscular deficit and may be used as the starter of other physical therapy protocols. IV.

  18. Index of fatigue quadriceps in soccer athletes after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Cavalcante, Maria Luzete Costa; Teixeira, Paulo Renan Lima; Sousa, Tamara Cristina Silva; Lima, Pedro Olavo de Paula; Oliveira, Rodrigo Ribeiro

    2016-01-01

    The present study aimed to evaluate the muscle fatigue of the quadriceps muscle in high-performance soccer players undergoing (anterior cruciate ligament) ACL reconstruction. We evaluated 17 high-performance soccer players from three professional soccer teams of a state in Brazil from August 2011 to July 2012. All subjects were evaluated between 5.5 and 7 months after ACL reconstruction with a Biodex® isokinetic dynamometer (System 4 Pro) with test protocol CON/CON at 60°/s and 300°/s with 5 and 15 repetitions, respectively. In the calculation of local muscle fatigue, the fatigue index was used, which is calculated by dividing the labor done in the first one-third of the repetitions by that done at the final one-third of the repetitions, and multiplying by 100 to express a unit in percentage (i.e., as a discrete quantitative variable). All subjects were male, with a mean age of 21.3 ± 4.4 years and mean BMI 23.4 ± 1.53 cm; left dominance was observed in 47% ( n  = 8) of athletes, and right dominance, in 53% ( n  = 9) of athletes; and the limb involved in the lesion was the dominant in 29% ( n  = 5) and the non-dominant in 71% ( n  = 12). Fatigue rates were 19.6% in the involved limb and 29.0% in the non-involved limb. The results allow us to conclude that there was no significant difference between the limbs involved and not in ACL injuries regarding local muscle fatigue. No association was observed between the dominant side and the limb involved in the ACL injury.

  19. Time Line for Noncopers to Pass Return-to-Sports Criteria After Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Hartigan, Erin H.; Axe, Michael J.; Snyder-Mackler, Lynn

    2013-01-01

    STUDY DESIGN Randomized clinical trial. OBJECTIVES Determine effective interventions for improving readiness to return to sports post-operatively in patients with complete, unilateral, anterior cruciate ligament (ACL) rupture who do not compensate well after the injury (noncopers). Specifically, we compared the effects of 2 preoperative interventions on quadriceps strength and functional outcomes. BACKGROUND The percentage of athletes who return to sports after ACL reconstruction varies considerably, possibly due to differential responses after acute ACL rupture and different management. Prognostic data for noncopers following ACL reconstruction is absent in the literature. METHODS Forty noncopers were randomly assigned to receive either progressive quadriceps strength-training exercises (STR group) or perturbation training in conjunction with strength-training exercises (PERT group) for 10 preoperative rehabilitation sessions. Postoperative rehabilitation was similar between groups. Data on quadriceps strength indices [(involved limb/uninvolved limb force) ×100], 4 hop score indices, and 2 self-report questionnaires were collected preoperatively and 3, 6, and 12 months postoperatively. Mann-Whitney U tests were used to compare functional differences between the groups. Chi-square tests were used to compare frequencies of passing functional criteria and reasons for differences in performance between groups postoperatively. RESULTS Functional outcomes were not different between groups, except a greater number of patients in the PERT group achieved global rating scores (current knee function expressed as a percentage of overall knee function prior to injury) necessary to pass return-to-sports criteria 6 and 12 months after surgery. Mean scores for each functional outcome met return-to-sports criteria 6 and 12 months postoperatively. Frequency counts of individual data, however, indicated that 5% of noncopers passed RTS criteria at 3, 48% at 6, and 78% at 12 months

  20. Index of fatigue quadriceps in soccer athletes after anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Maria Luzete Costa Cavalcante

    Full Text Available ABSTRACT OBJECTIVE: The present study aimed to evaluate the muscle fatigue of the quadriceps muscle in high-performance soccer players undergoing (anterior cruciate ligament ACL reconstruction. METHODS: We evaluated 17 high-performance soccer players from three professional soccer teams of a state in Brazil from August 2011 to July 2012. All subjects were evaluated between 5.5 and 7 months after ACL reconstruction with a Biodex(r isokinetic dynamometer (System 4 Pro with test protocol CON/CON at 60°/s and 300°/s with 5 and 15 repetitions, respectively. In the calculation of local muscle fatigue, the fatigue index was used, which is calculated by dividing the labor done in the first one-third of the repetitions by that done at the final one-third of the repetitions, and multiplying by 100 to express a unit in percentage (i.e., as a discrete quantitative variable. RESULTS: All subjects were male, with a mean age of 21.3 ± 4.4 years and mean BMI 23.4 ± 1.53 cm; left dominance was observed in 47% (n = 8 of athletes, and right dominance, in 53% (n = 9 of athletes; and the limb involved in the lesion was the dominant in 29% (n = 5 and the non-dominant in 71% (n = 12. Fatigue rates were 19.6% in the involved limb and 29.0% in the non-involved limb. CONCLUSION: The results allow us to conclude that there was no significant difference between the limbs involved and not in ACL injuries regarding local muscle fatigue. No association was observed between the dominant side and the limb involved in the ACL injury.

  1. Valgus osteotomy of the tibia with a Puddu plate combined with anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    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.

  2. [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.

  3. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update

    Science.gov (United States)

    Nyland, John; Mattocks, Alma; Kibbe, Shane; Kalloub, Alaa; Greene, Joe W; Caborn, David N M

    2016-01-01

    Anatomical discoveries and a growing appreciation of the knee as a complex organ are driving innovations in patient care decision-making following anterior cruciate ligament (ACL) injury. Surgeons are increasing their efforts to restore combined mechanical-neurosensory ACL function and placing more consideration on when to reconstruct versus repair native anatomical structures. Surgical options now include primary repair with or without reinforcing the injured ACL with suture-based internal bracing, and growing evidence supports biological augmentation using platelet-rich plasma and mesenchymal stem cells to enhance tissue healing. Physical therapists and athletic trainers are increasing their efforts to facilitate greater athlete cognitive engagement during therapeutic exercise performance to better restore nonimpaired neuromuscular control activation amplitude and timing. Knee brace design and use needs to evolve to better match these innovations and their influence on the rehabilitation plan timetable. There is a growing appreciation for the multifaceted characteristics of the rehabilitation process and how they influence neuromuscular, educational, and psychobehavioral treatment goal achievement. Multiple sources may influence the athlete during the return to sports process and clinical outcome measures need to be refined to better evaluate these influences. This update summarizes contemporary ACL surgical, medical, and rehabilitation interventions and future trends. PMID:26955296

  4. Isokinetic Identification of Knee Joint Torques before and after Anterior Cruciate Ligament Reconstruction.

    Directory of Open Access Journals (Sweden)

    Adam Czaplicki

    Full Text Available The aim of this study was to evaluate the serial change of isokinetic muscle strength of the knees before and after anterior cruciate ligament reconstruction (ACLR in physically active males and to estimate the time of return to full physical fitness. Extension and flexion torques were measured for the injured and healthy limbs at two angular velocities approximately 1.5 months before the surgery and 3, 6, and 12 months after ACLR. Significant differences (p ≤ 0.05 in peak knee extension and flexion torques, hamstring/quadriceps (H/Q strength ratios, uninvolved/involved limb peak torque ratios, and the normalized work of these muscles between the four stages of rehabilitation were identified. Significant differences between extension peak torques for the injured and healthy limbs were also detected at all stages. The obtained results showed that 12 months of rehabilitation were insufficient for the involved knee joint to recover its strength to the level of strength of the uninvolved knee joint. The results helped to evaluate the progress of the rehabilitation and to implement necessary modifications optimizing the rehabilitation training program. The results of the study may also be used as referential data for physically active males of similar age.

  5. Medial hamstring tendon regeneration following harvest for anterior cruciate ligament reconstruction: fact, myth, and clinical implication.

    Science.gov (United States)

    Carofino, Brad; Fulkerson, John

    2005-10-01

    It has been demonstrated that the medial hamstring tendons regenerate in the majority of patients following their harvest for anterior cruciate ligament reconstruction. The anatomy and morphology of these regenerated tendons have been radiographically and surgically documented. The neotendons originate within the appropriate muscle belly but display an altered insertion anatomy. Their histological composition is largely tendinous but has regions that resemble scar tissue. Concordantly, an animal model indicates that the neotendon has decreased mechanical strength, which has implications for tendon re-harvest. The regenerated tendons do restore a muscle tendon complex that is able to generate force; however, strength testing indicates that the function of the hamstring muscles is altered by harvest and regeneration. The most significant strength deficits are present in deep knee flexion and internal rotation of the tibia, whereas the peak torque of knee flexion is minimally affected. Additional harvest of the gracilis tendon results in greater deficits. The current literature indicates that hamstring tendon regeneration does indeed occur, but with structural and functional alterations.

  6. MR imaging of the knee extension and flexion. Diagnostic value for reconstructed anterior cruciate ligament

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    Niitsu, Mamoru; Ikeda, Kotaroh; Fukubayashi, Tohru [Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine] [and others

    1995-09-01

    The purpose of this study is to determine the value of extended and flexed knee positions in MR imaging of the surgically reconstructed anterior cruciate ligament (ACL). With a mobile knee brace and a flexible surface coil, knee joint was enabled to extend to a full-extension and bend vertically to a semi-flexion (average 45deg of flexion) within the confines of the magnet bore. Sets of 3-mm-thick oblique sagittal proton-weighted turbo spin echo MR images were obtained at both extended and flexed positions. Twenty-five knees with intact ACL grafts and three knees with arthroscopically proved graft tears were evaluated. Compared to the extended position, MR images of flexed knee provided better delineation of the intact and complicated ACL grafts with statistical significance. The intact graft appeared relaxed at the semi-flexion and taut at the extension. Overall lengths of the intact grafts were readily identified at the flexion. Stretched along the intercondylar roof, the grafts were poorly outlined at the extension. MR images with knee flexion delineated the disrupted site from the impingement more clearly than that with knee extension. (author).

  7. An Ambulatory Method of Identifying Anterior Cruciate Ligament Reconstructed Gait Patterns

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    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. Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: American football.

    Science.gov (United States)

    Verstegen, Mark; Falsone, Susan; Orr, Russell; Smith, Steve

    2012-04-01

    Returning an American football player to sport after an anterior cruciate ligament reconstruction is challenging on several fronts. First, there are approximately 15 different positions a football player could play, depending on how specifically you define the positions on the field. Each of these positions has specific demands for optimal size, strength, power, body composition, cardiovascular fitness, and movement. Understanding all of these factors is paramount to returning a football player not only to his sport but also to his specific position. Second, the chaotic, contact-rich nature of the sport requires that heavy demands be placed on the lower extremities to attenuate external contact forces from other players and from ground reaction forces associated with accelerating, decelerating, quick stops and starts, and changing direction. Finally, return to a competitive level of performance is further influenced by playing surface, shoe selection, the equipment the player wears, and various potential psychosocial factors. It is the responsibility of the clinician to provide a progressive and systematic rehabilitation program by first introducing preprogrammed movements that, once mastered, are progressed with elements of more reactive and random movement patterns. The precise nature of this systematic progression of advanced rehabilitation is key in developing return-to-play criteria and, ultimately, in readying an American football player for eventual return to sport and a particular position.

  9. Age-Related Differences in Predictors of Adherence to Rehabilitation After Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Brewer, Britton W.; Cornelius, Allen E.; Van Raalte, Judy L.; Petitpas, Albert J.; Sklar, Joseph H.; Pohlman, Mark H.; Krushell, Robert J.; Ditmar, Terry D.

    2003-06-01

    OBJECTIVE: To examine whether the relationships between psychological factors and rehabilitation adherence after knee surgery differ as a function of age. DESIGN AND SETTING: Participants completed inventories of self-motivation, social support, athletic identity, and psychological distress before anterior cruciate ligament (ACL) reconstruction. After surgery, participants recorded their completion of home rehabilitation exercises and cryotherapy, and the sport rehabilitation professionals providing their treatment reported on the patients' attendance at, and adherence during, rehabilitation sessions. SUBJECTS: Sixty-one individuals with acute ACL tears. MEASUREMENTS: The Self-Motivation Inventory, Social Support Inventory, Athletic Identity Measurement Scale, Brief Symptom Inventory, and Sport Injury Rehabilitation Adherence Scale were used to measure self-motivation, social support, athletic identity, psychological distress, and adherence, respectively, during rehabilitation sessions. RESULTS: Hierarchic regression analyses indicated that age moderated the relationships between (1) self-motivation and home exercise completion, (2) social support and home exercise completion, (3) athletic identity and home exercise completion, and (4) athletic identity and home cryotherapy completion. CONCLUSIONS: The prospective moderating relationships for between psychological factors and indices of adherence to home-based rehabilitation activities indicate the need to consider developmental issues when examining psychological aspects of sport-injury rehabilitation.

  10. Biomechanical analysis on transverse tibial fixation in anterior cruciate ligament reconstructions

    Directory of Open Access Journals (Sweden)

    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.

  11. 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.

  12. 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.

  13. Using an accelerometer and the step-up-and-over test to evaluate the knee function of patients with anterior cruciate ligament reconstruction.

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    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.

  14. Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature.

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    Keyhani, Sohrab; Vaziri, Arash Sharafat; Shafiei, Hossein; Mardani-Kivi, Mohsen

    2015-04-01

    A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture. A 35-year old male soccer player with a history of ACL tear from one 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 assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages first fixation of the fracture and then ACL re-revision after fracture healing was complete. Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction.

  15. Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review.

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    Barber-Westin, Sue D; Noyes, Frank R

    2011-09-01

    To review anterior cruciate ligament (ACL) clinical studies to assess the objective functional criteria used to determine when patients can return to athletics postoperatively, and to determine the rates of reinjury to either knee when these criteria are applied. A literature search was conducted using the Medline database. The inclusionary criteria were the English language, publication between April 2001 and April 2011, original clinical trials, all levels of evidence, primary ACL reconstruction, skeletal maturity, minimum 2 years of follow-up, and ≥1 objective test used to allow release to sports activities. The exclusionary criteria were revision ACL reconstructions or dislocated knees; studies that specifically excluded patients with ACL graft failure or reinjuries; major concomitant procedures such as high tibial osteotomy, meniscus allograft, other knee ligament reconstructions; and case reports, abstracts, review articles, and technical notes. Three objective criteria were used to allow release to sports activities. The most common were lower extremity muscle strength, followed by lower limb symmetry, and knee examination parameters of range of knee motion and effusion. Twelve studies listed 1 criterion for release to sports, 8 studies listed 2 criteria, and 1 study recommended 3 criteria. Failure rates of the ACL reconstructions ranged from 0% to 3% in 7 studies, from 4% to 6% in 6 studies, from 7% to 10% in 4 studies, and from 14% to 24% in 4 studies. There were no injuries in the contralateral ACL in 14 studies (67%); in the other 7 studies, contralateral injury was reported in 2% to 15% of patients. Few objective functional criteria are used to determine when patients return to unrestricted sports activities. Clinically feasible recommendations are made for measurement of muscle strength, lower limb symmetry, lower limb neuromuscular control, and ligament function in patients who desire to return to athletics after ACL reconstruction. Future studies

  16. Anterior cruciate ligament reconstruction in a rabbit model using canine small intestinal submucosa and autologous platelet-rich plasma.

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    Lee, A-Jin; Chung, Wook-Hun; Kim, Dae-Hyun; Lee, Kyung-Pil; Chung, Dai-Jung; Do, Sun Hee; Kim, Hwi-Yool

    2012-11-01

    The bone-ligament interface is the main point of failure after anterior cruciate ligament reconstruction. Synthetic ligament materials have problems such as a greater failure rate of the bone-ligament insertion than autografts. Small intestinal submucosa (SIS) is a biologic scaffold that has been used to repair musculoskeletal tissue and has been shown to promote cell migration and enhance collagen fiber regeneration. Autologous platelet-rich plasma (PRP) has also been investigated as a potential promoter of tendon healing. We investigated SIS and PRP as biomaterials that might strengthen the bone-tunnel interface and improve tendon structure formation. Anterior cruciate ligament grafts were formed of braid-twist canine SIS. These canine SIS ligament grafts were used for anterior cruciate ligament reconstruction in 20 New Zealand white rabbits. The rabbits were divided into 2 treatment groups. In 1 group (SIS group; n = 10), we only implanted the canine SIS grafts. In the second group (PRP group; n = 10), we applied autologous PRP to the surgical area after implantation of canine SIS grafts. We determined the cytokine level of the autologous PRP using a transforming growth factor-β1 enzyme-linked immunosorbent assay kit. At 1 and 4 wk after surgery, magnetic resonance imaging was performed to evaluate the grafts. The femur-graft-tibia complex was assessed histologically and biomechanically at 8 wk after surgery. At 1 wk after surgery, the magnetic resonance imaging scans of the PRP group showed high signal-intensity lesions. In biomechanical tests, the SIS group had a significantly greater maximum load, maximum stress, and ultimate load and strain than the PRP group. The histologic findings of the PRP group revealed a greater cellular response, fibrotic tissue regeneration around the graft, broad chondrocyte cell infiltration, and collagen fibers that were loosely attached to the bone. The PRP group had significantly lower tension load values than the SIS group

  17. Factors affecting anterior knee pain following anatomic double-bundle anterior cruciate ligament reconstruction.

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    Niki, Yasuo; Hakozaki, Akihiro; Iwamoto, Wataru; Kanagawa, Hiroya; Matsumoto, Hideo; Toyama, Yoshiaki; Suda, Yasunori

    2012-08-01

    The purpose of this study was to evaluate the prevalence of anterior knee pain in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction and to identify critical factors affecting postoperative anterior knee pain development. Subjects comprised 171 patients (171 knees) who underwent anatomic double-bundle ACL reconstruction with a follow-up period of ≥2 years. The procedure used bone-patellar tendon-bone plus gracilis tendon (BTB-G) in 56 knees, semitendinosus tendon (ST) in 71 knees, and ST-G in 44 knees. Clinical results and prevalence and severity of anterior knee pain were assessed at 3 months and 2 years postoperatively. Clinical variables influencing anterior knee pain development at each postoperative period were subjected to univariate analysis, followed by logistic regression analysis to identify risk factors for anterior knee pain. Overall prevalences of anterior knee pain at 3 months and 2 years postoperatively were 42.0 and 11.1%, respectively. Use of BTB-G graft represented the highest prevalence of anterior knee pain between the 3 different grafts (P = 0.001); however, this statistical significance disappeared at 2 years postoperatively. Prevalence of postoperative extension deficit was significantly higher in anterior knee pain-positive cohort than in anterior knee pain-negative cohort at 3 months postoperatively. Level of quadriceps strength was significantly lower, and Lysholm score was significantly worse in anterior knee pain-positive cohort than in anterior knee pain-negative cohort at 2 years postoperatively. According to logistic regression analysis, knee extension deficit was a predisposing factor for the development of anterior knee pain at 3 months postoperatively (odds ratio, 2.76; P = 0.004); however, there was no significant predisposing factor for anterior knee pain at 2 years postoperatively. Knee extension deficit was an important predisposing factor for postoperative anterior knee pain in the early

  18. Radiological analysis on femoral tunnel positioning between isometric and anatomical reconstructions of the anterior cruciate ligament,

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    Rodrigo Barreiros Vieira

    2014-04-01

    Full Text Available OBJECTIVE: the aim of this study was to radiologically evaluate the femoral tunnel position in anterior cruciate ligament (ACL reconstructions using the isometric and anatomical techniques.METHODS: a prospective analytical study was conducted on patients undergoing ACL reconstruction by means of the isometric and anatomical techniques, using grafts from the knee flexor tendons or patellar tendon. Twenty-eight patients were recruited during the immediate postoperative period, at the knee surgery outpatient clinic of FCMMG-HUSJ. Radiographs of the operated knee were produced in anteroposterior (AP view with the patient standing on both feet and in lateral view with 30◦ of flexion. The lines were traced out and the distances and angles were measured on the lateral radiograph to evaluate the sagittal plane. The distance from the center of the screw to the posterior cortical bone of the lateral condyle was measured and divided by the Blumensaat line. In relation to the height of the screw, the distance from the center of the screw to the joint surface of the lateral condyle of the knee was measured. On the AP radiograph, evaluating the coronal plane, the angle between the anatomical axis of the femur and a line traced at the center of the screw was measured.RESULTS: with regard to the pmeasurement (posteriorization of the interference screw, the tests showed that the p-value (0.4213 was greater than the significance level used (0.05; the null hypothesis was not rejected and it could be stated that there was no statistically significant difference between the anatomical and isometric techniques. With regard to the H measurement (height of the screw in relation to the lower cortical bone of the knee, the p-value observed (0.0006 was less than the significance level used (0.05; the null hypothesis was rejected and it could be stated that there was a statistically significant difference between the anatomical and isometric techniques. It can be

  19. Pain Management After Outpatient Anterior Cruciate Ligament Reconstruction: A Systematic Review of Randomized Controlled Trials.

    Science.gov (United States)

    Secrist, Eric S; Freedman, Kevin B; Ciccotti, Michael G; Mazur, Donald W; Hammoud, Sommer

    2016-09-01

    Effective pain management after anterior cruciate ligament (ACL) reconstruction improves patient satisfaction and function. To collect and evaluate the available evidence from randomized controlled trials (RCTs) on pain control after ACL reconstruction. Systematic review. A systematic literature review was performed using PubMed, Medline, Google Scholar, UpToDate, Cochrane Reviews, CINAHL, and Scopus following PRISMA guidelines (July 2014). Only RCTs comparing a method of postoperative pain control to another method or placebo were included. A total of 77 RCTs met inclusion criteria: 14 on regional nerve blocks, 21 on intra-articular injections, 4 on intramuscular/intravenous injections, 12 on multimodal regimens, 6 on oral medications, 10 on cryotherapy/compression, 6 on mobilization, and 5 on intraoperative techniques. Single-injection femoral nerve blocks provided superior analgesia to placebo for up to 24 hours postoperatively; however, this also resulted in a quadriceps motor deficit. Indwelling femoral catheters utilized for 2 days postoperatively provided superior analgesia to a single-injection femoral nerve block. Local anesthetic injections at the surgical wound site or intra-articularly provided equivalent analgesia to regional nerve blocks. Continuous-infusion catheters of a local anesthetic provided adequate pain relief but have been shown to cause chondrolysis. Cryotherapy improved analgesia compared to no cryotherapy in 4 trials, while in 4 trials, ice water and water at room temperature provided equivalent analgesic effects. Early weightbearing decreased pain compared to delayed weightbearing. Oral gabapentin given preoperatively and oral zolpidem given for the first week postoperatively each decreased opioid consumption as compared to placebo. Ibuprofen reduced pain compared to acetaminophen. Oral ketorolac reduced pain compared to hydrocodone-acetaminophen. Regional nerve blocks and intra-articular injections are both effective forms of analgesia

  20. Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17,682 patients from the Swedish National Knee Ligament Register.

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    Desai, Neel; Andernord, Daniel; Sundemo, David; Alentorn-Geli, Eduard; Musahl, Volker; Fu, Freddie; Forssblad, Magnus; Samuelsson, Kristian

    2017-05-01

    To investigate the association between surgical variables and the risk of revision surgery after ACL reconstruction in the Swedish National Knee Ligament Register. This cohort study was based on data from the Swedish National Knee Ligament Register. Patients who underwent primary single-bundle ACL reconstruction with hamstring tendon were included. Follow-up started with primary ACL reconstruction and ended with ACL revision surgery or on 31 December, 2014, whichever occurred first. Details on surgical technique were collected using an online questionnaire. All group comparisons were made in relation to an "anatomic" reference group, comprised of essential AARSC items, defined as utilization of accessory medial portal drilling, anatomic tunnel placement, visualization of insertion sites and pertinent landmarks. Study end-point was revision surgery. A total of 108 surgeons (61.7%) replied to the questionnaire. A total of 17,682 patients were included [n = 10,013 males (56.6%) and 7669 females (43.4%)]. The overall revision rate was 3.1%. Older age as well as cartilage injury evident at index surgery was associated with a decreased risk of revision surgery. The group using transtibial drilling and non-anatomic bone tunnel placement was associated with a lower risk of revision surgery [HR 0.694 (95% CI 0.490-0.984); P = 0.041] compared with the anatomic reference group. The anatomic reference group showed no difference in risk of revision surgery compared with the transtibial drilling groups with partial anatomic [HR 0.759 (95% CI 0.548-1.051), n.s.] and anatomic tunnel placement [HR 0.944 (95% CI 0.718-1.241), n.s.]. The anatomic reference group showed a decreased risk of revision surgery compared with the transportal drilling group with anatomic placement [HR 1.310 (95% CI 1.047-1.640); P = 0.018]. Non-anatomic bone tunnel placement via transtibial drilling resulted in the lowest risk of revision surgery after ACL reconstruction. The risk of revision surgery

  1. Capacity of muscle derived stem cells and pericytes to promote tendon graft integration and ligamentization following anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Ćuti, Tomislav; Antunović, Maja; Marijanović, Inga; Ivković, Alan; Vukasović, Andreja; Matić, Igor; Pećina, Marko; Hudetz, Damir

    2017-06-01

    The aim of this study is to examine the capacity of muscle tissue preserved on hamstring tendons forming candy-stripe grafts in order to improve tendon to bone ingrowth and ligamentization. We hypothesized that muscle tissue does possess a stem cell population that could enhance the healing process of the ACL graft when preserved on the tendons. Human samples from gracilis and semitendinosus muscles were collected during ACL surgery from ten patients and from these tissue samples human muscle-derived stem cells and tendon-derived stem cells were isolated and propagated. Both stem cell populations were in-vitro differentiated into osteogenic lineage. Alkaline phosphatase activity was determined at days zero and 14 of the osteogenic induction and von Kossa staining to assess mineralization of the cultures. Total RNA was collected from osteoblast cultures and real time quantitative PCR was performed. Western-blot for osteocalcin and collagen type I followed protein isolation. Immunofluorescence double labeling of pericytes in muscle and tendon tissue was performed. Mesenchymal stem cells from muscle and tendon tissue were isolated and expanded in cell culture. More time was needed to grow the tendon derived culture compared to muscle derived culture. Muscle derived stem cells exhibited more alkaline phosphatase actvity compared to tendon derived stem cells, whereas tendon derived stem cells formed more mineralized nodules after 14 days of osteoinduction. Muscle derived stem cells exhibited higher expression levels of bone sialoprotein, and tendon derived stem cells showed higher expression of dental-matrix-protein 1 and osteocalcin. Immunofluorescent staining against pericytes indicated that they are more abundant in muscle tissue. These results indicate that muscle tissue is a better source of stem cells than tendon tissue. Achievement of this study is proof that there is vast innate capacity of muscle tissue for enhancement of bone-tendon integration and

  2. Dynamic restraint capacity of the hamstring muscles has important functional implications after anterior cruciate ligament injury and anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Bryant, Adam L; Creaby, Mark W; Newton, Robert U; Steele, Julie R

    2008-12-01

    The purpose of this study was to investigate the relation between knee functionality of anterior cruciate ligament deficient (ACLD) and anterior cruciate ligament reconstruction (ACLR) patients and hamstring antagonist torque generated during resisted knee extension. Cross-sectional. Laboratory based. Male ACLD subjects (n=10) (18-35 y) and 27 matched males who had undergone ACLR (14 patella tendon [PT] grafts and 13 combined semitendinosus/gracilis tendon grafts). Not applicable. Knee functionality was rated (0- to 100-point scale) by using the Cincinnati Knee Rating System. Using electromyography data from the semitendinosus (ST) and biceps femoris muscles, we created a mathematical model to estimate the opposing torque generated by the hamstrings during isokinetic knee extension in 10 degrees intervals from 80 degrees to 10 degrees knee flexion. Pearson product-moment correlations revealed that more functional ACLD subjects generated significantly (Phamstring antagonist torque throughout knee extension. In contrast, more functional PT subjects produced significantly lower hamstring antagonist torque at 80 degrees to 70 degrees knee flexion, whereas no significant associations were found between hamstring antagonist torque and knee functionality for the ST/gracilis tendon subjects. An increased hamstring antagonist torque generated by the more functional ACLD subjects, reflective of increased hamstring contractile force, is thought to represent a protective mechanism to compensate for mechanical instability. The restoration of anterior knee stability through ACLR negates the need for augmented hamstring antagonist torque.

  3. Surgical Techniques for the Reconstruction of Medial Collateral Ligament and Posteromedial Corner Injuries of the Knee: A Systematic Review.

    Science.gov (United States)

    DeLong, Jeffrey M; Waterman, Brian R

    2015-11-01

    To systematically review reconstruction techniques of the medial collateral ligament (MCL) and associated medial structures of the knee (e.g., posterior oblique ligament). A systematic review of Medline/PubMed Database (1966 to November 2013), reference list scanning and citation searches of included articles, and manual searches of high-impact journals (2000 to July 2013) and conference proceedings (2009 to July 2013) were performed to identify publications describing MCL reconstruction techniques of the knee. Exclusion criteria included (1) MCL primary repair techniques or advancement procedures, (2) lack of clear description of MCL reconstruction technique, (3) animal models, (4) nonrelevant study design, (5) and foreign language articles without available translation. After review of 4,600 references, 25 publications with 359 of 388 patients (92.5%) were isolated for analysis, including 18 single-bundle MCL and 10 double-bundle reconstruction techniques. Only 2 techniques were classified as anatomic reconstructions, and clinical and objective outcomes (n = 28; 100% techniques (n = 114; 52.6% techniques have been used in the treatment of isolated and combined medial knee injuries in the existent literature. Many variations exist among reconstruction techniques and may differ by graft choices, method of fixation, number of bundles, tensioning protocol, and degree of anatomic restoration of medial and posteromedial corner knee restraints. Further studies are required to better ascertain the comparative clinical outcomes with anatomic, non-anatomic, and tendon transfer techniques for medial knee reconstruction. Level IV, systematic review of level IV studies and surgical techniques. Published by Elsevier Inc.

  4. Factors related to the need for surgical reconstruction after anterior cruciate ligament rupture: a systematic review of the literature.

    Science.gov (United States)

    Eggerding, Vincent; Meuffels, Duncan E; Bierma-Zeinstra, Sita M A; Verhaar, Jan A; Reijman, Max

    2015-01-01

    Systematic literature review. To summarize and evaluate research on factors predictive of progression to surgery after nonoperative treatment for an anterior cruciate ligament (ACL) rupture. Anterior cruciate ligament rupture is a common injury among young, active individuals. Surgical reconstruction is often required for patients who do not regain satisfactory knee function following nonsurgical rehabilitation. Knowledge of factors that predict the need for surgical reconstruction of the ACL would be helpful to guide the decision-making process in this population. A search was performed for studies predicting the need for surgery after nonoperative treatment for ACL rupture in the Embase, MEDLINE (OvidSP), Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, PubMed, and Google Scholar digital databases from inception to October 2013. Two reviewers independently selected the studies and performed a quality assessment. Best-evidence synthesis was used to summarize the evidence of factors predicting the need for surgical reconstruction after nonoperative treatment for an ACL rupture. Seven studies were included, 3 of which were of high quality. Based on these studies, neither sex (strong evidence) nor the severity of knee joint laxity (moderate evidence) can predict whether, soon after ACL injury, a patient will need ACL reconstruction following nonoperative treatment. All other factors identified in this review either had conflicting or only minimal evidence as to their level of association with the need for surgical reconstruction. Noteworthy is that 1 high-quality study reported that the spherical shape of the femoral condyle was predictive of the need for ACL reconstruction. Sex and knee joint laxity tests do not predict the need for ACL reconstruction soon after an ACL rupture. Independent validation in future research will be necessary to establish whether knee shape is a predictive factor. Prognosis, level 1a-.

  5. Use of platelet-rich plasma for bioplastic processes stimulation after arthroscopic reconstruction of anterior cruciate ligament (review

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    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.

  6. On-Ice Return-to-Hockey Progression After Anterior Cruciate Ligament Reconstruction.

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    Capin, Jacob J; Behrns, William; Thatcher, Karen; Arundale, Amelia; Smith, Angela Hutchinson; Snyder-Mackler, Lynn

    2017-05-01

    Synopsis The literature pertaining to the rehabilitation of ice hockey players seeking to return to sport after anterior cruciate ligament reconstruction (ACLR) is currently limited. The purpose of this clinical commentary was to present a criterion-based progression for return to ice hockey for athletes after ACLR. First, we review pertinent literature and provide previously published guidelines on general rehabilitation after ACLR. Then, we present a 4-phase, on-ice skating progression with objective criteria to initiate each phase. During the early on-ice phase, the athlete is reintroduced to specific demands, including graded exposure to forward, backward, and crossover skating. In the intermediate on-ice phase, the emphasis shifts to developing power and introducing anticipated changes of direction within a controlled environment. During the late on-ice phase, the focus progresses to developing anaerobic endurance and introducing unanticipated changes of direction, but still without other players or contact. Finally, once objective return-to-sport criteria are met, noncontact team drills, outnumbered and even-numbered drills, practices, scrimmages, and games are progressively reintroduced during the return-to-sport phase. Recommendations for off-ice strength and conditioning exercises complement the on-ice progression. Additionally, we apply the return-to-hockey progression framework to a case report of a female collegiate defensive ice hockey player who returned to sport successfully after ACLR. This criterion-based return-to-hockey progression may guide rehabilitation specialists managing athletes returning to ice hockey after ACLR. J Orthop Sports Phys Ther 2017;47(5):324-333. Epub 29 Mar 2017. doi:10.2519/jospt.2017.7245.

  7. The anatomy and isometry of a quasi-anatomical reconstruction of the medial patellofemoral ligament.

    Science.gov (United States)

    Pérez-Prieto, Daniel; Capurro, Bruno; Gelber, Pablo E; Ginovart, Gerard; Reina, Francisco; Sanchis-Alfonso, Vicente; Monllau, Joan C

    2017-08-01

    To describe the anatomy of the medial patellofemoral ligament (MPFL) and its relationship to the Adductor Magnus (AM) tendon as well as the behaviour exhibited in length changes during knee flexion. Ten cadaveric knees were dissected. The length from the superior and inferior patellar origin of the MPFL to its femoral insertion was measured at different degrees of knee flexion (0°, 30°, 60°, 90° and 120°). The same measures were made from both patellar origins of the MPFL up to the femoral insertion of the AM. The distance between the insertion of the AM and the Hunter canal was also measured. In general, isometry up to 90° was seen in all measures of the MPFL and those of the AM. The most isometric behaviour was seen in 2 measures: the length of the AM femoral insertion up to the inferior origin of the MPFL on the patella and the length of the femoral insertion of the MPFL up to the inferior origin of the MPFL on the patella. Similar behaviour was seen regardless of the anatomical or quasi-anatomical femoral point of attachment (n.s.). The distance from the AM tendon to the Hunter canal had a mean value of 78.6 mm (SD 9.4 mm). The behaviour exhibited during the changes in the length of the anatomical femoral footprint of the MPFL and the AM is similar. Neurovascular structures were not seen at risk. This is relevant in the daily clinical practice since the AM tendon might be a suitable point of insertion for MPFL reconstruction.

  8. MRI of broken bioabsorbable crosspin fixation in hamstring graft reconstruction of the anterior cruciate ligament

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    Bakhru, Prashant [Department of Radiology Jacobi Medical Center, Bronx, NY (United States); Park, Brian [Albert Einstein College of Medicine, Bronx, NY (United States); Umans, Hilary [Department of Radiology Jacobi Medical Center, Bronx, NY (United States); Lenox Hill Radiology and Imaging Associates, P.C., New York, NY (United States); DiFelice, Gregory S. [Hospital for Special Surgery, New York, NY (United States); Tobin, Keith [Lenox Hill Radiology and Imaging Associates, P.C., New York, NY (United States)

    2011-06-15

    To report seven cases of broken bioabsorbable femoral crosspins identified by MRI in evaluation of hamstring grafts of the anterior cruciate ligament. Seven cases of broken bioabsorbable crosspins utilized in femoral fixation of ACL hamstring grafts were identified prospectively and retrospectively from our PACs database during a period from 9/1/08 to 8/31/09. All imaging was performed using 1.5 or 3.0 Tesla MRI and were evaluated for T2 signal within and surrounding the crosspin, osteolysis surrounding the fragments, displacement of fragments, and graft integrity. Time from surgery was also recorded. Seven cases of hamstring grafts with broken bioabsorbable crosspins were imaged 4 months to 3 years following grafting. There was osteolysis surrounding the crosspin in all but one case in which the graft was intact but a pin fragment was displaced into the joint. One graft failed due to aseptic foreign-body reaction to the fixation with aggressive osteolysis at 9 months post surgery. In the remaining five, the ACL graft was either completely torn, partially torn, lax, or degenerative and frayed. Of these, the crosspins were broken and angulated with osteolysis surrounding the apex of the angulated fragment or demonstrated lateral extrusion of the peripheral fragment. Bioabsorbable crosspins utilized in femoral fixation of hamstring graft reconstruction of the ACL may become fractured. While the natural history of osteo-integration of these devices as demonstrated by MRI has not been defined, osteolysis surrounding the fragments, extrusion or displacement of the fragments, and graft laxity or failure would suggest that these are abnormal findings that should be reported. (orig.)

  9. Return-to-Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players.

    Science.gov (United States)

    Harris, Joshua D; Erickson, Brandon J; Bach, Bernard R; Abrams, Geoffrey D; Cvetanovich, Gregory L; Forsythe, Brian; McCormick, Frank M; Gupta, Anil K; Cole, Brian J

    2013-11-01

    Anterior cruciate ligament (ACL) rupture is a significant injury in National Basketball Association (NBA) players. NBA players undergoing ACL reconstruction (ACLR) have high rates of return to sport (RTS), with RTS the season following surgery, no difference in performance between pre- and postsurgery, and no difference in RTS rate or performance between cases (ACLR) and controls (no ACL tear). Case-control. NBA players undergoing ACLR were evaluated. Matched controls for age, body mass index (BMI), position, and NBA experience were selected during the same years as those undergoing ACLR. RTS and performance were compared between cases and controls. Paired-sample Student t tests, chi-square, and linear regression analyses were performed for comparison of within- and between-group variables. Fifty-eight NBA players underwent ACLR while in the NBA. Mean player age was 25.7 ± 3.5 years. Forty percent of ACL tears occurred in the fourth quarter. Fifty players (86%) RTS in the NBA, and 7 players (12%) RTS in the International Basketball Federation (FIBA) or D-league. Ninety-eight percent of players RTS in the NBA the season following ACLR (11.6 ± 4.1 months from injury). Two players (3.1%) required revision ACLR. Career length following ACLR was 4.3 ± 3.4 years. Performance upon RTS following surgery declined significantly (P NBA following ACLR. Nearly all players RTS the season following surgery. Performance significantly declined from preinjury level; however, this was not significantly different from controls. ACL re-tear rate was low. There is a high RTS rate in the NBA after ACLR, with no difference in performance upon RTS compared with controls.

  10. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update

    Directory of Open Access Journals (Sweden)

    Nyl

    2016-02-01

    Full Text Available John Nyland,1,2 Alma Mattocks,1 Shane Kibbe,2 Alaa Kalloub,2,3 Joe W Greene,4 David N M Caborn2,3 1Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA; 2Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA; 3Shea Orthopedic Group, Louisville, KY, USA; 4Norton Orthopedic and Sports, Louisville, KY, USA Abstract: Anatomical discoveries and a growing appreciation of the knee as a complex organ are driving innovations in patient care decision-making following anterior cruciate ligament (ACL injury. Surgeons are increasing their efforts to restore combined mechanical-neurosensory ACL function and placing more consideration on when to reconstruct versus repair native anatomical structures. Surgical options now include primary repair with or without reinforcing the injured ACL with suture-based internal bracing, and growing evidence supports biological augmentation using platelet-rich plasma and mesenchymal stem cells to enhance tissue healing. Physical therapists and athletic trainers are increasing their efforts to facilitate greater athlete cognitive engagement during therapeutic exercise performance to better restore nonimpaired neuromuscular control activation amplitude and timing. Knee brace design and use needs to evolve to better match these innovations and their influence on the rehabilitation plan timetable. There is a growing appreciation for the multifaceted characteristics of the rehabilitation process and how they influence neuromuscular, educational, and psychobehavioral treatment goal achievement. Multiple sources may influence the athlete during the return to sports process and clinical outcome measures need to be refined to better evaluate these influences. This update summarizes contemporary ACL surgical, medical, and rehabilitation interventions and future trends. Keywords: arthroscopy, knee, function, outcomes, decision-making 

  11. Comparative Study after Hamstring Anterior Cruciate Ligament Reconstruction with Endobutton and Rigidfix: A Clinical Trial Study

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    Hamid Mousavi

    2017-01-01

    Full Text Available Background: One of the most common orthopedic clinic visits involves direct and indirect knee trauma leading to rupture of anterior cruciate ligament (ACL. Endobutton and Rigidfix are most frequent treating methods that used by orthopedic surgeons. Thus the aim of this study was compare the clinical results of reconstructing arthroscopic ACL of the knee through two methods namely Rigidfix and Endobutton. Materials and Methods: In a clinical trial study, a total of 40 patients with rupture of ACL were selected and randomly divided into two groups. The groups were treated through fixation procedures either Endobutton or Rigidfix. Prior to surgery and then at least 2 years after surgery, the patients were under physical examination in terms of knee range of motion, knee stability, knee pain, ability to perform daily activities and exercises and compared between the two groups. Results: The knee range of motion in Endobutton and Rigidfix were 135.73 ± 2.63 and 129.87 ± 7.14° resprectively (P = 0.06. comparing two groups, during last month in Endobutton and Rigidfix the frequency of knee pain were 2.5 ± 1.4 and 3.4 ± 1.4 respectively (P = 0.08. Moreover, the pain intensity score were 2.9 ± 1.5 and 2.6 ± 1.1 (P = 0.49. But there was a significant difference observed in patients' satisfaction and ability to perform sports activities. Conclusions: The two fixation methods namely Endobutton and Rigidfix are not preferred over one another. But patients' satisfaction and ability to perform sports activities in Endobutton was better than the Rigidfix.

  12. Knee flexor strength recovery following hamstring tendon harvest for anterior cruciate ligament reconstruction: a systematic review

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    Clare Ardern

    2009-07-01

    Full Text Available The hamstring tendons are an increasingly popular graft choice for anterior cruciate ligament reconstruction due to preservation of quadriceps function and the absence of anterior knee pain post-operatively. Two commonly used hamstring grafts are a quadruple strand semitendinosus graft (4ST and a double strand semitendinosus-double strand gracilis graft (2ST-2G. It has been suggested that concurrent harvest of the semitendinsous and gracilis tendons may result in sub-optimal hamstring strength recovery as the gracilis may play a role in reinforcing the semitendinosus particularly in deep knee flexion angles. The objective of this systematic review was to synthesize the findings of available literature and determine whether semitendinosus and gracilis harvest lead to post-operative hamstring strength deficits when compared to semitendinosus harvest alone. Seven studies were identified which compared hamstring strength outcomes between the common hamstring graft types. The methodological quality of each paper was assessed, and where possible effect sizes were calculated to allow comparison of results across studies. No differences were reported between the groups in isokinetic hamstring strength. Deficits in hamstring strength were reported in the 2ST-2G groups when compared to the 4ST groups in isometric strength testing at knee flexion angles ≥70°, and in the standing knee flexion angle. Preliminary evidence exists to support the hypothesis that harvesting the semitendinosus tendon alone is preferable to harvesting in combination with the gracilis tendon for minimizing post-operative hamstring strength deficits at knee flexion angles greater than 70°. However, due to the paucity of research comparing strength outcomes between the common hamstring graft types, further investigation is warranted to fully elucidate the implications for graft harvest.

  13. Repeated bouts of exercise in patients with anterior cruciate ligament reconstruction.

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    Chang, Eunwook; Kim, Kyung-Min; Hertel, Jay; Hart, Joseph M

    2014-04-01

    Reduced quadriceps activation after anterior cruciate ligament reconstructions (ACL-R) has been reported. Patients often return to daily exercise or sport after ACL-R; however, there is little information regarding quadriceps function after exercise in this population. Therefore, the purpose of this study was to compare quadriceps strength and central activation after repeated bouts of exercise between individuals with and without a history of ACL-R. Eighteen recreationally active subjects participated in this study: 8 with unilateral ACL-R at least 6 months earlier and 10 healthy controls. All subjects performed 30 min of continuous exercise on two consecutive days. Exercise included repeated bouts of inclined treadmill walking and jumping exercises. We measured maximal isometric knee extension torque and quadriceps central activation ratio (CAR) using the superimposed burst technique before and after exercise on day 1. Subjects returned 24 h later (day 2) for a repeat testing session. There was a significant group-time interaction for knee extension torque. ACL-R subjects were weaker at baseline on day 1 of testing (P = 0.01) but exhibited no significant reduction in knee extension torque after exercise (P = 0.13), whereas the healthy control subjects did (P = 0.01). Knee extension torque on day 2 remained significantly lower than baseline for the controls (P = 0.03), but not the ACL-R (P = 0.73). On day 2, both groups experienced significantly reduced knee extension torque after exercise. There was no group-time interaction for CAR, but a group main effect indicated that, on average, ACL-R had significantly lower CAR bilaterally compared with healthy controls. The quadriceps in ACL-R knees were weaker and showed less reduction of isometric knee extension torque compared with healthy group in day 1. However, there were no group differences of quadriceps strength on day 2.

  14. Biological fixation in anterior cruciate ligament surgery

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    Chih-Hwa Chen

    2014-04-01

    Full Text Available Successful anterior cruciate ligament (ACL reconstruction with tendon graft requires extensive tendon-to-bone healing in the bone tunnels and progressive graft ligamentization for biological, structural, and functional recovery of the ACL. Improvement in graft-to-bone healing is crucial for facilitating early, aggressive rehabilitation after surgery to ensure an early return to pre-injury activity levels. The use of various biomaterials for enhancing the healing of tendon grafts in bone tunnels has been developed. With the biological enhancement of tendon-to-bone healing, biological fixation of the tendon graft in the tunnel can be achieved in ACL reconstruction.

  15. YouTube provides poor information regarding anterior cruciate ligament injury and reconstruction.

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    Cassidy, J T; Fitzgerald, E; Cassidy, E S; Cleary, M; Byrne, D P; Devitt, B M; Baker, J F

    2018-03-01

    YouTube is a global medium used predominantly by young adults (aged 18-49 years). This study examined the quality of YouTube information regarding ACL injury and reconstruction. YouTube was searched on the 13th of June 2015 for "ACL" and "anterior cruciate ligament" with/without associated terms of "injury", "reconstruction", and "surgery". Videos were evaluated by two independent reviewers [EF (Reviewer 1), (Reviewer 2)] using two recognized information scoring systems (Modified DISCERN (MD) 0-5 and JAMA Benchmark 0-4) and an adaptation of a score designed for written ACL information [ACL Specific Score (ASS) 0-25]. The ASS categorized scores as very good (21-25), good (16-20), moderate (11-15), poor (6-10), and very poor (0-5). Number of views/likes/dislikes, animation, and continent of origin and source (e.g., corporate/educational) were recorded. Correlation of video characteristics with number of views was examined using the analysis of variance (ANOVA) model. Agreement between reviewers was assessed by Interclass Correlation Co-efficient (ICC). Following a filtering process of the 964,770 identified videos, 39 videos were retained. The mean MD score was 2.3 (standard deviation (SD) ±0.9) for Reviewer 1 and 2.2 (SD ±0.9) for Reviewer 2 (ICC = 0.7). The mean JAMA score was 2.5(SD ±0.7) for Reviewer 1 and 2.3 (SD ±0.7) for Reviewer 2 (ICC = 0.8). The mean ASS was 6.3 (SD ±3.5) for Reviewer 1 and 4.6 (SD ±2.9) for Reviewer 2 (ICC = 0.9). Five videos achieved moderate score (13%), while 15 (38%) and 19 (49%) scored as poor and very poor, respectively. There was no correlation between number of views and video quality/video source for any scoring system. The majority of videos viewed on YouTube regarding ACL injury and treatment are of low quality.

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

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    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

  17. Analgesic Effect of Gabapentin on Post-Operative Pain After Arthroscopic Anterior Cruciate Ligament Reconstruction

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    Mario I. Ortiz

    2014-03-01

    Full Text Available To the Editor Mardani-Kivi et al presented results about a triple blinded randomized controlled trial with gabapentin in patients that underwent anterior cruciate ligament (ACL reconstruction (1. In their manuscript, the introduction section is very illustrative about the subject. With respect to methodology, it is well known that the physical diagnosis of ACL injury is particularly difficult in several patients, and partial ACL tears are also difficult to diagnose on physical examination. In this particular case, how did the authors obtain the diagnosis of ACL in the patients? Likewise, ACL reconstruction can be delayed several weeks or months until the swelling has decreased and there is an appropriate range of motion. For this reason, I want to ask: was the cause of the ACL injury homogeneous in all patients?; was the time delay of the surgery the same for everyone; and was the type of damage the same for all participants? Meperidine is an opioid with analgesic effects. The American Pain Society and the Institute for Safe Medication Practice (ISMP do not recommend meperidine use as pain relieving medication or they recommend it only in very special cases and with many precautions during its administration (2, 3. What was the rationale of the authors choosing meperidine as analgesic drug? In this same sense, authors did not indicate in their manuscript whether meperidine was administered by oral, intramuscular or intravenous pathways or patient-controlled analgesia. The time schedule of meperidine administration was not indicate in the manuscript; was meperidine administered q4h or q6h? How many doses were received by patients? I think it was a mistake to publish the demographic data of all patients (n=114. You had to eliminate the patients deleted in the presentation of the demographic characteristics of the patients (n=108, that is more correct. Table 2 and 3 were poorly prepared. Table 2 has missing data about the results at 24 hours in the

  18. Biomechanic analysis of trapeziectomy, ligament reconstruction with tendon interposition, and tie-in trapezium implant arthroplasty for thumb carpometacarpal arthritis: a cadaver study.

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    Luria, Shai; Waitayawinyu, Thanapong; Nemechek, Nicholas; Huber, Philippe; Tencer, Allan F; Trumble, Thomas E

    2007-01-01

    Thumb carpometacarpal joint arthritis has been commonly treated with some combination of resection of the trapezium and interposition of a spacer using either a biologic or artificial material plus tenodesis to reconstruct the volar oblique ligament. The purpose of this study was to evaluate the biomechanic stability of the classic ligament reconstruction with tendon interposition (LRTI) or without tendon interposition compared with a newly developed 1-piece silicone trapezium implant. Twelve cadaver arm specimens had the following procedures: resection of the trapezium, tendon interposition, ligament reconstruction, LRTI, and the silicone implant. Biomechanic testing of joint stability was performed with a physiologic loading protocol before and after each procedure. The implant significantly corrected the axial displacement after trapeziectomy and resulted in less radial displacement than LRTI. It significantly reduced angulation of the thumb metacarpal base but resulted in more rotation of the thumb during simulated pinch. There was no significant difference in stability measures between trapeziectomy and LRTI or ligament reconstruction without tendon interposition. We found several biomechanic advantages to the implant compared with LRTI. Advantages include reduction in axial and radial displacement and maintenance of the trapezial space. We attribute these advantages to the effect of the implant as a spacer. The significant rotation with the implant, however, raises questions concerning implant design and fixation. We found no biomechanic advantage to LRTI or ligament reconstruction without tendon interposition over trapeziectomy alone.

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

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    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.

  20. Evaluation of the resolving potency of a novel reconstruction filter on periodontal ligament space with dental cone-beam CT: a quantitative phantom study

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    Houno, Yuuki; Hishikawa, Toshimitsu; Gotoh, Ken-ichi; Naitoh, Munetaka; Ariji, Eiichiro; Kodera, Yoshie

    2014-03-01

    Diagnosis of the alveolar bone condition is important for the treatment planning of periodontal disease. Especially the determination of periodontal ligament space is the most important remark because it represents the periodontal tissue support for tooth retention. However, owing to the image blur of the current cone-beam CT (CBCT) imaging technique, the periodontal ligament space is difficult to visualize. In this study, we developed an original periodontal ligament phantom (PLP) and evaluated the image quality of simulated periodontal ligament space using a novel reconstruction filter for CBCT that emphasized high frequency component. PLP was composed from two resin blocks of different materials, the bone equivalent block and the dentine equivalent block. They were assembled to make continuously changing space from 0.0 to 1.0 millimeter that mimics periodontal ligament space. PLP was placed in water and the image was obtained by using Alphard-3030 dental cone-beam CT (Asahi Roentgen Industry Co., Ltd.). Then we reconstructed the projection data with a novel reconstruction filter. The axial images were compared with conventional reconstructed images. In novel filter reconstruction images, 0.4 millimeter of the space width was steadily detected by calculation of pixel value, on the other hand 0.6 millimeter was in conventional images. With our method, the resolving potency of conebeam CT images was improved.

  1. Low- Versus High-Intensity Plyometric Exercise During Rehabilitation After Anterior Cruciate Ligament Reconstruction.

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    Chmielewski, Terese L; George, Steven Z; Tillman, Susan M; Moser, Michael W; Lentz, Trevor A; Indelicato, Peter A; Trumble, Troy N; Shuster, Jonathan J; Cicuttini, Flavia M; Leeuwenburgh, Christiaan

    2016-03-01

    Plyometric exercise is used during rehabilitation after anterior cruciate ligament (ACL) reconstruction to facilitate the return to sports participation. However, clinical outcomes have not been examined, and high loads on the lower extremity could be detrimental to knee articular cartilage. To compare the immediate effect of low- and high-intensity plyometric exercise during rehabilitation after ACL reconstruction on knee function, articular cartilage metabolism, and other clinically relevant measures. Randomized controlled trial; Level of evidence, 2. Twenty-four patients who underwent unilateral ACL reconstruction (mean, 14.3 weeks after surgery; range, 12.1-17.7 weeks) were assigned to 8 weeks (16 visits) of low- or high-intensity plyometric exercise consisting of running, jumping, and agility activities. Groups were distinguished by the expected magnitude of vertical ground-reaction forces. Testing was conducted before and after the intervention. Primary outcomes were self-reported knee function (International Knee Documentation Committee [IKDC] subjective knee form) and a biomarker of articular cartilage degradation (urine concentrations of crosslinked C-telopeptide fragments of type II collagen [uCTX-II]). Secondary outcomes included additional biomarkers of articular cartilage metabolism (urinary concentrations of the neoepitope of type II collagen cleavage at the C-terminal three-quarter-length fragment [uC2C], serum concentrations of the C-terminal propeptide of newly formed type II collagen [sCPII]) and inflammation (tumor necrosis factor-α), functional performance (maximal vertical jump and single-legged hop), knee impairments (anterior knee laxity, average knee pain intensity, normalized quadriceps strength, quadriceps symmetry index), and psychosocial status (kinesiophobia, knee activity self-efficacy, pain catastrophizing). The change in each measure was compared between groups. Values before and after the intervention were compared with the groups

  2. Static and dynamic tibial translation before, 5 weeks after, and 5 years after anterior cruciate ligament reconstruction.

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    Tagesson, Sofi; Öberg, Birgitta; Kvist, Joanna

    2015-12-01

    To evaluate static and dynamic tibial translation before, 5 weeks after, and 5 years after anterior cruciate ligament (ACL) reconstruction. To explore whether static and dynamic tibial translation are correlated. Ten patients undergoing quadruple hamstring tendon graft ACL reconstruction were evaluated before, 5 weeks after, and 5 years after ACL reconstruction. Sagittal tibial translation was measured during the Lachman test (static translation) and during gait (dynamic translation) using a CA-4000 electrogoniometer. Five years after ACL reconstruction, static tibial translation did not differ between knees (Lachman test 90 N and 134 N n.s.). In contrast, there was greater maximal anterior tibial translation during gait in ACL-reconstructed knees than in uninjured knees (5.5 ± 1.4 vs. 4.5 ± 1.6 mm, P = 0.028). There were no differences in static or dynamic tibial translation between the 5-year follow-up and before ACL reconstruction or between the 5-year follow-up and the 5-week follow-up. There were no correlations between static and dynamic tibial translation. Although static tibial translation did not differ between knees 5 years after ACL reconstruction, dynamic tibial translation during gait was greater in ACL-reconstructed knees than in uninjured knees. Neither static nor dynamic tibial translation changed 5 years after ACL reconstruction as compared to before surgery and 5 weeks after surgery. Static tibial translation did not correlate with dynamic tibial translation. This study indicates that although the knee is stable during static measurements, kinematics during gait is impaired 5 years after ACL reconstruction. This may affect the return to sport and risk of osteoarthritis. Case series, Level IV.

  3. Landing mechanics during single hop for distance in females following anterior cruciate ligament reconstruction compared to healthy controls.

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    Trigsted, Stephanie M; Post, Eric G; Bell, David R

    2017-05-01

    To determine possible differences in single-hop kinematics and kinetics in females with anterior cruciate ligament reconstruction compared to healthy controls. A second purpose was to make comparisons between the healthy and reconstructed limbs. Subjects were grouped based on surgical status (33 ACLR patients and 31 healthy controls). 3D motion capture synchronized with force plates was used to capture the landing phase of three successful trials of single hop for distance during a single data collection session. Peak values during the loading phase were analysed. Subjects additionally completed three successful trials of the triple hop for distance Tegner activity scale and International Knee Document Committee 2000 (IKDC). Controls demonstrated greater peak knee flexion and greater internal knee extension moment and hip extension moment than ACLR subjects. Within the ACLR group, the healthy limb exhibited greater peak knee flexion, hip flexion, hip extension moment, single hop and triple hops for distance and normalized quadriceps strength. Patients who undergo anterior cruciate ligament reconstruction land in a more extended posture when compared to healthy controls and compared to their healthy limb. III.

  4. FUNCTIONAL OUTCOME OF ACCELERATED REHABILITATION IN ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH BONE PATELLAR TENDON BONE GRAFT A PROSPECTIVE STUDY

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    Hiranyakumar

    2016-03-01

    Full Text Available INTRODUCTION An ideal rehabilitation program post anterior cruciate ligament reconstruction enables an individual to return to pre injury levels at a faster rate with minimal to no risk of reinjury to the graft. Rehabilitation protocols have changed considerably over time in the past. It has become “aggressive”, meaning an intensive rehabilitation which includes greater variety of exercises and sports related training. AIM OF THE STUDY The aim of our study is to assess the outcome of accelerated rehabilitation post anterior cruciate ligament (ACL reconstruction. METHODOLOGY 106 patients were operated by a single surgeon underwent arthroscopic anterior cruciate ligament reconstruction using bone patella tendon bone graft and partial meniscectomy for associated meniscal tear. Patients were put on an accelerated rehabilitation protocol designed in our institute on first post-operative day, under the guidance of a physical therapist in consultation with the operated surgeon. Patients were followed up at 3 weeks, 6 months and 9 months, post onset of rehabilitation, patients were assessed using KT1000 Arthrometer and Lysholm knee scoring system. RESULTS Out of 106 patients, who were selected, 96(91% were males and 10(9% were females. The mean pre-operative Lysholm score was 55.09. Post operatively, while on accelerated rehabilitation program the Lysholm scores were 69.73 at 3 weeks, 89.13 at 6 months and 89.19 at 9 months. In our pre-operative evaluation mean KT 1000 arthrometer score was 10.53 and post-operative at six months was 3.49. At nine months 105 patients had excellent results whereas 1 patient had good result. CONCLUSION Accelerated rehabilitation protocol enables the patient to functionally recover faster to pre injury levels. A rehabilitation protocol for 6 months is sufficient in enabling a patient to get back to pre-injury levels. Functional outcome is the same with or without associated meniscal injuries.

  5. Clinical and arthroscopic outcome of single bundle anterior cruciate ligament reconstruction: Comparison of remnant preservation versus conventional technique.

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    Choi, Sungwook; Kim, Myung-Ku; Kwon, Yong Suk; Kang, Hyunseong

    2017-10-01

    The purpose of this study was to compare the clinical outcomes and second-look arthroscopic findings of remnant preservation technique with those of conventional anterior cruciate ligament (ACL) reconstruction in single bundle ACL reconstructions. One hundred sixty two consecutive patients underwent ACL reconstruction by one surgeon, with 93 patients receiving remnant preservation technique (Group A) and 69 patients receiving conventional ACL reconstruction (Group B). The mean follow-up was 15months. Clinical outcomes were assessed using Lysholm scores and the International Knee Documentation Committee form (IKDC form) evaluation. Post-operative knee stability was evaluated through manual knee laxity evaluation, pivot-shift test, and a Telos device. Differences in post-operative stability (manual knee laxity, pivot shift test and Telos device) were not significant between the groups (p=0.681, p=0.610, p=0.696). And also no significant differences were noted with respect to the IKDC form and the latest Lysholm scores. But in the second-look arthroscopic findings, synovial coverage was confirmed to be excellent in 36% (22/61) of Group A patients and 23% (7/30) of Group B patients. ACL reconstruction with both techniques was found to result in acceptable stability, clinical outcomes and second-look arthroscopic findings. With regard to synovial coverage, the remnant reservation techniques were found to be superior to conventional ACL reconstruction. Level III, retrospective comparative study. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Features of Designing the Criterion-Based Rehabilitation Program for Patients after Arthroscopic Reconstruction of the Anterior Cruciate Ligament

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    I.V. Roy

    2016-04-01

    Full Text Available The article presents an innovative criterion-based rehabilitation program for patients, who underwent arthroscopic reconstruction of the anterior cruciate ligament. The features of the program are described, methodological foundations to perform permissible exercises are presented for each periods of the program, which correspond to a specific motor mode. The degree of preparedness of the patient is determined by the criterion of performance of the test exercises that will permit him to the loads of a new, higher level of trainings. The effectiveness of the developed program is confirmed clinically.

  7. Isokinetic Evaluation of Quadriceps Strength in Open and Closed Kinetic Chains in Patients with Anterior Cruciate Ligament Reconstruction

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    Ali Ashraf-Jamshidi

    2014-06-01

    Full Text Available Background: Strength of knee extension and squat were compared between anterior cruciate ligament reconstructed (ACLR patients and healthy subjects. Materials and Methods: Twenty ACLR and twenty control subjects were participated in this non-exprimental study. Isokinetic peak strength of knee extension and squat in involved and uninvolved side of the ACLR patient and control group were measured. Results: Concentric and eccentric knee extension strength of the involved leg was decreased but squat strength showed no difference. Conclusion: In spite of return to sport activity and normal squat strength weakness of knee extensor muscles in the involved side of the ACLR patient was existed.

  8. Lower Extremity Muscle Strength After Anterior Cruciate Ligament Injury and Reconstruction

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    Thomas, Abbey C.; Villwock, Mark; Wojtys, Edward M.; Palmieri-Smith, Riann M.

    2013-01-01

    Context: Quadriceps and hamstrings weakness occurs frequently after anterior cruciate ligament (ACL) injury and reconstruction. Evidence suggests that knee injury may precipitate hip and ankle muscle weakness, but few data support this contention after ACL injury and reconstruction. Objective: To determine if hip, knee, and ankle muscle weakness present after ACL injury and after rehabilitation for ACL reconstruction. Design: Case-control study. Setting: University research laboratory. Patients or Other Participants: Fifteen individuals with ACL injury (8 males, 7 females; age = 20.27 ± 5.38 years, height = 1.75 ± 0.10 m, mass = 74.39 ± 13.26 kg) and 15 control individuals (7 men, 8 women; age = 24.73 ± 3.37 years, height = 1.75 ± 0.09 m, mass = 73.25 ± 13.48 kg). Intervention(s): Bilateral concentric strength was assessed at 60°/s on an isokinetic dynamometer. The participants with ACL injury were tested preoperatively and 6 months postoperatively. Control participants were tested on 1 occasion. Main Outcome Measures: Hip-flexor, -extensor, -abductor, and -adductor; knee-extensor and -flexor; and ankle–plantar-flexor and -dorsiflexor strength (Nm/kg). Results: The ACL-injured participants demonstrated greater hip-extensor (percentage difference = 19.7, F1,14 = 7.28, P = .02) and -adductor (percentage difference = 16.3, F1,14 = 6.15, P = .03) weakness preoperatively than postoperatively, regardless of limb, and greater postoperative hip-adductor strength (percentage difference = 29.0, F1,28 = 10.66, P = .003) than control participants. Knee-extensor and -flexor strength were lower in the injured than in the uninjured limb preoperatively and postoperatively (extensor percentage difference = 34.6 preoperatively and 32.6 postoperatively, t14 range = −4.59 to −4.23, P ≤ .001; flexor percentage difference = 30.6 preoperatively and 10.6 postoperatively, t14 range = −6.05 to −3.24, P ACL-injured participants. The ACL-injured participants had less

  9. Performance-Based Outcomes After Anterior Cruciate Ligament Reconstruction in Professional Athletes Differ Between Sports.

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    Mai, Harry T; Chun, Danielle S; Schneider, Andrew D; Erickson, Brandon J; Freshman, Ryan D; Kester, Benjamin; Verma, Nikhil N; Hsu, Wellington K

    2017-08-01

    Excellent outcomes have been reported for anterior cruciate ligament (ACL) reconstruction (ACLR) in professional athletes in a number of different sports. However, no study has directly compared these outcomes between sports. To determine if differences in performance-based outcomes exist after ACLR between professional athletes of each sport. Cohort study; Level of evidence, 3. National Football League (NFL), National Basketball Association (NBA), National Hockey League (NHL), and Major League Baseball (MLB) athletes undergoing primary ACLR for an acute rupture were identified through an established protocol of injury reports and public archives. Sport-specific performance statistics were collected before and after surgery for each athlete. Return to play (RTP) was defined as a successful return to the active roster for at least 1 regular-season game after ACLR. Of 344 professional athletes who met the inclusion criteria, a total of 298 (86.6%) returned to play. NHL players had a significantly higher rate of RTP (95.8% vs 83.4%, respectively; P = .04) and a shorter recovery time (258 ± 110 days vs 367 ± 268 days, respectively; P athletes in all the other sports. NFL athletes experienced significantly shorter careers postoperatively than players in all the other sports (2.1 vs 3.2 years, respectively; P athletes played fewer games ( P ≤ .02) 1 season postoperatively, while those in the NFL had the lowest rate of active players 2 and 3 seasons postoperatively (60%; P = .002). NBA and NFL players showed decreased performance at season 1 after ACLR ( P ≤ .001). NFL players continued to have lower performance at seasons 2 and 3 ( P = .002), while NBA players recovered to baseline performance. The data indicate that NFL athletes fare the worst after ACLR with the lowest survival rate, shortest postoperative career length, and sustained decreases in performance. NHL athletes fare the best with the highest rates of RTP, highest survival rates, longest postoperative

  10. Return to Sport-Specific Performance After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review.

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    Mohtadi, Nicholas G; Chan, Denise S

    2017-10-01

    Physicians counseling athletes on the prognosis of sport-specific performance outcomes after anterior cruciate ligament reconstruction (ACLR) depend on the published literature. However, critical appraisal of the validity and biases in these studies is required to understand how ACLR affects an athlete's ability to return to sport, the athlete's sport-specific performance, and his or her ability to achieve preinjury levels of performance. This review identifies the published prognostic studies evaluating sport-specific performance outcomes after ACLR. A risk of bias assessment and summaries of return to sport and career longevity results are provided for each included study. Systematic review. Electronic databases (Ovid MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and PUBMED) were searched via a defined search strategy with no limits, to identify relevant studies for inclusion in the review. A priori defined eligibility criteria included studies measuring sport-specific performance within an athlete's sport, before and after primary ACLR. Reference lists of eligible studies were hand-searched for additional relevant studies. Data extraction was performed by use of a standardized spreadsheet. Each included study was assessed by use of 6 bias domains of the Quality in Prognosis Studies tool to critically appraise study participation, study attrition, prognostic factors, outcome measurement, confounders, and statistical analysis and reporting. Two authors independently performed each stage of the review and reached consensus through discussion. Fifteen pertinent prognostic studies evaluated sport-specific performance outcomes and/or return to play after ACLR for athletes participating in competitive soccer, football, ice hockey, basketball, Alpine ski, X-Games ski and snowboarding, and baseball. Twelve of these studies were considered to have a high level of bias. This review demonstrated that most high

  11. 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

  12. Effect of Transosseous Tunnels on Patella Fracture Risk After Medial Patellofemoral Ligament Reconstruction: A Cadaveric Study.

    Science.gov (United States)

    Bonazza, Nicholas A; Lewis, Gregory S; Lukosius, Eric Z; Roush, Evan P; Black, Kevin P; Dhawan, Aman

    2018-02-01

    To determine whether (1) tunnels that breach the anterior cortex of the patella result in increased fracture risk and (2) transosseous tunnels drilled across the patella significantly reduce the tensile force needed to fracture the patella. Twenty-six fresh-frozen cadaveric human patellas were randomized to 1 of 3 groups: a control group with unmodified patellas, a group with 2 transverse tunnels (TT) that did not breach the anterior cortex, and a group with 2 TT that breached the anterior cortex of the patella (PA). Patellas were connected in series to a load cell via freeze clamp attachments to the quadriceps and patellar tendons. Pull was fixed at 45° with the patella set in the trochlear groove of a synthetic femur. Patellas were loaded cyclically, then to failure. Twenty-six patellas were tested (mean age = 71.4 years; range = 37-95, standard deviation [STD] = 11.5 years). PA patellas were more likely to fracture through the tunnel than TT patellas (100% vs 25%, P = .033). Control, TT, and PA groups failed at 1,915 N (STD = 508 N), 1,901 N (STD = 884 N), and 1,640 N (STD = 625 N), respectively. There was no statistically significant difference in overall load to failure between control and TT (P = .969), control and PA (P = .321), and TT and PA (P = .488) groups. Transosseous patellar tunnels for medial patellofemoral ligament reconstruction that breached the anterior cortex were more likely to fracture during longitudinal load than those that did not breach the anterior cortex. However, we found no statistically significant difference in the tensile load to failure between native patellas and patellas with either type of transosseous tunnel. The results of this study show that breaching the anterior cortex during transosseous drilling increases the risk of a patellar fracture occurring through the transosseous tunnel. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  13. Effect of homeopathy on analgesic intake following knee ligament reconstruction: a phase III monocentre randomized placebo controlled study

    Science.gov (United States)

    Paris, A; Gonnet, N; Chaussard, C; Belon, P; Rocourt, F; Saragaglia, D; Cracowski, J L

    2008-01-01

    Aims The efficacy of homeopathy is still under debate. The objective of this study was to assess the efficacy of homeopathic treatment (Arnica montana 5 CH, Bryonia alba 5 CH, Hypericum perforatum 5 CH and Ruta graveolens 3 DH) on cumulated morphine intake delivered by PCA over 24 h after knee ligament reconstruction. Methods This was an add-on randomized controlled study with three parallel groups: a double-blind homeopathic or placebo arm and an open-label noninterventional control arm. Eligible patients were 18–60 years old candidates for surgery of the anterior cruciate ligament. Treatment was administered the evening before surgery and continued for 3 days. The primary end-point was cumulated morphine intake delivered by PCA during the first 24 h inferior or superior/equal to 10 mg day−1. Results One hundred and fifty-eight patients were randomized (66 in the placebo arm, 67 in the homeopathic arm and 25 in the noninterventional group). There was no difference between the treated and the placebo group for primary end-point (mean (95% CI) 48% (35.8, 56.3), and 56% (43.7, 68.3), required less than 10 mg day−1 of morphine in each group, respectively). The homeopathy treatment had no effect on morphine intake between 24 and 72 h or on the visual analogue pain scale, or on quality of life assessed by the SF-36 questionnaire. In addition, these parameters were not different in patients enrolled in the open-label noninterventional control arm. Conclusions The complex of homeopathy tested in this study was not superior to placebo in reducing 24 h morphine consumption after knee ligament reconstruction. What is already known about this subject The efficacy of homeopathy is still under debate and a recent meta-analysis recommended further randomized double-blind clinical trials to identify any clinical situation in which homeopathy might be effective. What this study adds The complex of homeopathy tested in this study (Arnica montana 5 CH, Bryonia alba 5 CH

  14. Meaningful Change Scores in the Knee Injury and Osteoarthritis Outcome Score in Patients Undergoing Anterior Cruciate Ligament Reconstruction

    DEFF Research Database (Denmark)

    Ingelsrud, Lina Holm; Terwee, Caroline B; Terluin, Berend

    2018-01-01

    BACKGROUND: Meaningful change scores in the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients undergoing anterior cruciate ligament (ACL) reconstruction have not yet been established. PURPOSE: To define the minimal important change (MIC) for the KOOS after ACL reconstruction. STUDY....... Presurgery KOOS scores were retrieved from the registry. The MIC for improvement was calculated with anchor-based approaches using the predictive modeling method adjusted for the proportion of improved patients, the mean change method, and the receiver operating characteristic (ROC) method. RESULTS: Complete......% to 10% of patients reported subscale-specific worsening, MIC deterioration calculations were not possible. The ROC MIC values were associated with high degrees of misclassification. Values obtained by the mean change method were considered less reliable because these estimates are derived from subgroups...

  15. A randomised controlled trial of proprioceptive and balance training after surgical reconstruction of the anterior cruciate ligament.

    Science.gov (United States)

    Cooper, R L; Taylor, N F; Feller, J A

    2005-01-01

    A randomised controlled trial (29 participants) was used to compare a 6-week proprioceptive and balance exercise program with a 6-week strengthening program in the early phases of rehabilitation after anterior cruciate ligament (ACL) reconstruction. Measurements of functional activity were taken by a blinded assessor before the intervention and at the end of the 6 weeks. Results demonstrated that there were no significant differences between groups on hop testing at 6 weeks. For several items in the Cincinnati knee rating system and the patient specific functional scale however, the strengthening group improved more than the proprioceptive and balance group (p exercises was not supported. There was either no difference between the two forms of exercise or strength training may be more beneficial than proprioceptive and balance training in the early phase of rehabilitation after ACL reconstructive surgery.

  16. SHORT COMMUNICATION ON THE INFLUENCE OF POSITION ON ANTERIOR CRUCIATE LIGAMENT INJURY AND RECONSTRUCTION IN RECREATIONAL RUGBY FOOTBALL UNION PARTICIPANTS

    Directory of Open Access Journals (Sweden)

    Helen Dawes

    2003-03-01

    Full Text Available The different player positions in rugby union may place varying demands on a reconstructed anterior cruciate ligament (ACL in regards to 'cutting manoeuvres', this in turn may effect performance. In order to investigate sporting performance post reconstruction, a questionnaire was sent to amateur rugby clubs affiliated to the Oxfordshire Rugby Football Union (R.F.U. From the returned questionnaires player positions were placed into categories based on similar 'cutting manoeuvre' demands. Seventy five percent of Individuals playing in the category 1 (low 'cutting manoeuvre' demands at slow running speeds could play a full game with a damaged ACL and post-reconstruction the majority returned to play at a higher level. Fifty percent of ACL injuries occurred on category 2 (high 'cutting manoeuvre' demands at medium running speeds suggesting they may be more prone to ACL injury than other positions. The majority of individuals playing in category 3 (high 'cutting manoeuvre' demands at fast speeds played at a lower level of rugby post reconstruction. Positional demands may influence ACL injury and post reconstruction sporting performance. However, more research is needed

  17. Runx2-Modified Adipose-Derived Stem Cells Promote Tendon Graft Integration in Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Zhang, Xin; Ma, Yong; Fu, Xin; Liu, Qiang; Shao, Zhenxing; Dai, Linghui; Pi, Yanbin; Hu, Xiaoqing; Zhang, Jiying; Duan, Xiaoning; Chen, Wenqing; Chen, Ping; Zhou, Chunyan; Ao, Yingfang

    2016-01-08

    Runx2 is a powerful osteo-inductive factor and adipose-derived stem cells (ADSCs) are multipotent. However, it is unknown whether Runx2-overexpressing ADSCs (Runx2-ADSCs) could promote anterior cruciate ligament (ACL) reconstruction. We evaluated the effect of Runx2-ADSCs on ACL reconstruction in vitro and in vivo. mRNA expressions of osteocalcin (OCN), bone sialoprotein (BSP) and collagen I (COLI) increased over time in Runx2-ADSCs. Runx2 overexpression inhibited LPL and PPARγ mRNA expressions. Runx2 induced alkaline phosphatase activity markedly. In nude mice injected with Runx2-ADSCs, promoted bone formation was detected by X-rays 8 weeks after injection. The healing of tendon-to-bone in a rabbit model of ACL reconstruction treated with Runx2-ADSCs, fibrin glue only and an RNAi targeting Runx2, was evaluated with CT 3D reconstruction, histological analysis and biomechanical methods. CT showed a greater degree of new bone formation around the bone tunnel in the group treated with Runx2-ADSCs compared with the fibrin glue group and RNAi Runx2 group. Histology showed that treatment with Runx2-ADSCs led to a rapid and significant increase at the tendon-to-bone compared with the control groups. Biomechanical tests demonstrated higher tendon pullout strength in the Runx2-ADSCs group at early time points. The healing of the attachment in ACL reconstruction was enhanced by Runx2-ADSCs.

  18. 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.

  19. Clinical and Functional Outcomes following Primary Repair versus Reconstruction of the Medial Patellofemoral Ligament for Recurrent Patellar Instability

    Directory of Open Access Journals (Sweden)

    Marc Tompkins

    2014-01-01

    Full Text Available Background. The purpose of this study was to compare outcomes of medial patellofemoral ligament (MPFL repair or reconstruction. Methods. Fourteen knees that underwent MPFL repair and nine (F5, M4 knees that underwent reconstruction at our institution were evaluated for objective and subjective outcomes. The mean age at operation was 20.1 years for repair and 19.8 years for reconstruction. All patients had a minimum of 2 years of follow-up (range: 24–75 months. Patient subjective outcomes were obtained using the International Knee Documentation Committee (IKDC and Kujala patellofemoral subjective evaluations, as well as Visual Analog (VAS and Tegner Activity Scales. Bilateral isometric quadriceps strength and vastus medialis obliquus (VMO and vastus lateralis (VL surface EMG were measured during maximal isometric quadriceps contractions at 30° and 60° of flexion. Results. There were no redislocations in either group. There was no difference in IKDC (P=0.16, Kujala (P=0.43, Tegner (P=0.12, or VAS (P=0.05 scores at follow-up. There were no differences between repair and reconstruction in torque generation of the involved side at 30° (P=0.96 and 60° (P=0.99. In addition, there was no side to side difference in torque generation or surface EMG activation of VL or VMO. Conclusions. There were minimal differences found between patients undergoing MPFL repair and MPFL reconstruction for the objective and subjective evaluations in this study.

  20. Is Remnant Preservation Truly Beneficial to Anterior Cruciate Ligament Reconstruction Healing? Clinical and Magnetic Resonance Imaging Evaluations of Remnant-Preserved Reconstruction.

    Science.gov (United States)

    Naraoka, Takuya; Kimura, Yuka; Tsuda, Eiichi; Yamamoto, Yuji; Ishibashi, Yasuyuki

    2017-04-01

    Remnant-preserved anterior cruciate ligament (ACL) reconstruction was introduced to improve clinical outcomes and biological healing. However, the effects of remnant preservation and the influence of the delay from injury until reconstruction on the outcomes of this technique are still uncertain. Purpose/Hypothesis: The purposes of this study were to evaluate whether remnant preservation improved the clinical outcomes and graft incorporation of ACL reconstruction and to examine the influence of the delay between ACL injury and reconstruction on the usefulness of remnant preservation. We hypothesized that remnant preservation improves clinical results and accelerates graft incorporation and that its effect is dependent on the delay between ACL injury and reconstruction. Cohort study; Level of evidence, 2. A total of 151 consecutive patients who underwent double-bundle ACL reconstruction using a semitendinosus graft were enrolled in this study: 74 knees underwent ACL reconstruction without a remnant (or the remnant was reconstruction with remnant preservation (RP group). These were divided into 4 subgroups based on the time from injury to surgery: phase 1 was 20 weeks (n = 25). Clinical measurements, including KT-1000 arthrometer side-to-side anterior tibial translation measurements, were assessed at 3, 6, 12, and 24 months after reconstruction. Magnetic resonance imaging evaluations of graft maturation and graft-tunnel integration of the anteromedial and posterolateral bundles were assessed at 3, 6, and 12 months after reconstruction. There was no difference in side-to-side anterior tibial translation between the NR and RP groups. There was also no difference in graft maturation between the 2 groups. Furthermore, the time from ACL injury until reconstruction did not affect graft maturation, except in the case of very long delays before reconstruction (phase 4). Graft-tunnel integration was significantly increased in both groups in a time-dependent manner. However

  1. Histological Observation of Regions around Bone Tunnels after Compression of the Bone Tunnel Wall in Ligament Reconstruction

    International Nuclear Information System (INIS)

    Maeda, Shintaro; Ishikawa, Hiroki; Tanigawa, Naoaki; Miyazaki, Kyosuke; Shioda, Seiji

    2012-01-01

    The objectives of this study were to investigate the time-course of influence of compression of bone tunnel wall in ligament reconstruction on tissue around the bone tunnel and to histologically examine the mechanism of preventing the complication of bone tunnel dilation, using rabbit tibia. A model in which the femoral origin of the extensor digitorum longus tendon was cut and inserted into a bone tunnel made proximal to the tibia was prepared in the bilateral hind legs of 20 Japanese white rabbits. In each animal, a tunnel was made using a drill only in the right leg, while an undersized bone tunnel was made by drilling and then dilated by compression using a dilator to the same tunnel size as that in the right leg. Animals were sacrificed at 0, 2, 4, 8 and 12 weeks after surgery (4 animals at each time point). Observation of bone tunnels by X-ray radiography showed osteosclerosis in the 2- and 4-week dilation groups. Osteosclerosis appeared as white lines around the bone tunnel on X-ray radiography. This suggests that dilation promotes callus formation in the bone tunnel wall and prevents the complication of bone tunnel enlargement after ligament reconstruction

  2. The use of multimedia as an adjunct to the informed consent process for ankle ligament reconstruction surgery.

    Science.gov (United States)

    Batuyong, Eldridge; Birks, Christopher; Beischer, Andrew D

    2012-06-01

    Obtaining "informed consent" is an integral aspect of surgery that can be fraught with difficulty. This study assessed the efficacy of a multimedia education tool in improving patients' understanding when used as an adjunct to the traditional verbal consent process regarding ankle lateral ligament reconstruction surgery. A total of 56 patients (28 males and 28 females) were recruited with a mean age of 36 years. A standardized verbal discussion regarding surgical treatment was provided to each patient. Understanding was then assessed using a knowledge questionnaire. Subsequently, each patient observed a multimedia educational program following which the knowledge questionnaire was repeated. Additional supplementary questions were then given regarding the ease of understanding and satisfaction with the 2 methods of education delivery. The patients answered 75% of the questions correctly before the multimedia module compared with 88% after it (P multimedia tool performed as well as the treating surgeon. Multimedia tools used in sequence after a verbal consent resulted in improved patient understanding of pertinent information regarding ankle lateral ligament reconstruction surgery. Therapeutic Level II.

  3. 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 stability scores correlated with core stability tests (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.

  4. Anterior cruciate ligament reconstruction in a rabbit model using silk-collagen scaffold and comparison with autograft.

    Directory of Open Access Journals (Sweden)

    Fanggang Bi

    Full Text Available The objective of the present study was to perform an in vivo assessment of a novel silk-collagen scaffold for anterior cruciate ligament (ACL reconstruction. First, a silk-collagen scaffold was fabricated by combining sericin-extracted knitted silk fibroin mesh and type I collagen to mimic the components of the ligament. Scaffolds were electron-beam sterilized and rolled up to replace the ACL in 20 rabbits in the scaffold group, and autologous semitendinosus tendons were used to reconstruct the ACL in the autograft control group. At 4 and 16 weeks after surgery, grafts were retrieved and analyzed for neoligament regeneration and tendon-bone healing. To evaluate neoligament regeneration, H&E and immunohistochemical staining was performed, and to assess tendon-bone healing, micro-CT, biomechanical test, H&E and Russell-Movat pentachrome staining were performed. Cell infiltration increased over time in the scaffold group, and abundant fibroblast-like cells were found in the core of the scaffold graft at 16 weeks postoperatively. Tenascin-C was strongly positive in newly regenerated tissue at 4 and 16 weeks postoperatively in the scaffold group, similar to observations in the autograft group. Compared with the autograft group, tendon-bone healing was better in the scaffold group with trabecular bone growth into the scaffold. The results indicate that the silk-collagen scaffold has considerable potential for clinical application.

  5. [Reconstruction of medial patellofemoral ligament with transposition of great adductor muscular tendon for the treatment of teenagers' recurrent patellar dislocation].

    Science.gov (United States)

    Shao, Chuan-Qiang; Chen, Chang-Chun; Zhao, Chun-Cheng; Yang, Hong-Mei; Kang, Yan-Zhong

    2017-06-25

    To investigate surgical method and clinical curative effects of medial patellofemoral ligament (MPFL) reconstruction with great adductor muscular tendon in treating teenagers' recurrent patellar dislocation. From May 2012 to September 2014, 19 patients with recurrent dislocation of patellar, including 6 males and 13 females with an average of 16 years old (ranged from 13 to 17 years), the courses of disease ranged from 3 to 18 months(averaged 6 months). All patients were underwent great adductor muscular tendon transposition to reconstruct medial patellofemoral ligament. The curative effects were evaluated by preoperative and postoperative with Lysholm scores and Patellofemoral angle and Q angle. All patients were followed up from 12 to 18 months with an average of 16.5 months. Primary healing was achieved at stage I. No pain, swelling and patellar dislocation or subluxation occurred. Patellofemoral angle increased from preoperative (-3.8±4.9)° to (10.3±4.1)° postoperatively. Q angle decreased from preoperative(16.4±3.1)° to(10.5±1.2)° postoperatively; Lysholm scores were improved from preoperative (68.6±8.5) to (93.7±6.5) final follow-up ( P teenagers' recurrent patellar dislocation.

  6. 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

  7. Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique.

    Science.gov (United States)

    Bedi, Asheesh; Musahl, Volker; Steuber, Volker; Kendoff, Daniel; Choi, Dan; Allen, Answorth A; Pearle, Andrew D; Altchek, David W

    2011-03-01

    The purpose of this study was to objectively evaluate the anatomic and biomechanical outcomes of anterior cruciate ligament (ACL) reconstruction with transtibial versus anteromedial portal drilling of the femoral tunnel. Ten human cadaveric knees (5 matched pairs) without ligament injury or pre-existing arthritis underwent ACL reconstruction by either a transtibial or anteromedial portal technique. A medial arthrotomy was created in all cases before reconstruction to determine the center of the native ACL tibial and femoral footprints. A 10-mm tibial tunnel directed toward the center of the tibial footprint was prepared in an identical fashion, starting at the anterior border of the medial collateral ligament in all cases. For transtibial femoral socket preparation (n = 5), a guidewire was placed as close to the center of the femoral footprint as possible. With anteromedial portal reconstruction (n = 5), the guidewire was positioned centrally in the femoral footprint and the tunnel drilled through the medial portal in hyperflexion. An identical graft was fixed and tensioned, and knee stability was assessed with the following standardized examinations: (1) anterior drawer, (2) Lachman, (3) maximal internal rotation at 30°, (4) manual pivot shift, and (5) instrumented pivot shift. Distance from the femoral guidewire to the center of the femoral footprint and dimensions of the tibial tunnel intra-articular aperture were measured for all specimens. Statistical analysis was completed with a repeated-measures analysis of variance and Tukey multiple comparisons test with P ≤ .05 defined as significant. The anteromedial portal ACL reconstruction controlled tibial translation significantly more than the transtibial reconstruction with anterior drawer, Lachman, and pivot-shift examinations of knee stability (P ≤ .05). Anteromedial portal ACL reconstruction restored the Lachman and anterior drawer examinations to those of the intact condition and constrained translation

  8. Early anterior cruciate ligament reconstruction can save meniscus without any complications

    Directory of Open Access Journals (Sweden)

    Chang-Ik Hur

    2017-01-01

    Conclusions: Early ACL reconstruction had excellent clinical results and stability as good as delayed reconstruction without the problem of knee motion, muscle power, and postural control. Moreover, early reconstruction showed the high possibility of meniscal repair. Therefore, early ACL reconstruction should be recommended.

  9. Effects of Remnant Tissue Preservation on Clinical and Arthroscopic Results After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Kondo, Eiji; Yasuda, Kazunori; Onodera, Jun; Kawaguchi, Yasuyuki; Kitamura, Nobuto

    2015-08-01

    Clinical utility of remnant tissue preservation after single-bundle anterior cruciate ligament (ACL) reconstruction has not been established. In addition, no studies have evaluated the clinical utility of remnant preservation after anatomic double-bundle ACL reconstruction. The study hypotheses were as follows: (1) Subjective and functional clinical results may be comparable between anatomic double-bundle reconstructions that preserve the remnant tissue and those that resect the remnant tissue, (2) postoperative knee stability and the second-look arthroscopic evaluation may be significantly more favorable with the remnant-preserving reconstruction, and (3) the degree of the initial graft coverage may significantly affect postoperative knee stability. Cohort study; Level of evidence, 2. A total of 179 patients underwent anatomic double-bundle ACL reconstruction. Based on the Crain classification of ACL remnant tissue, 81 patients underwent the remnant-preserving procedure (group P) and the remaining 98 patients underwent the remnant-resecting procedure (group R). There were no differences between the 2 groups concerning all background factors, including preoperative knee instability and intraoperative tunnel positions. The patients were followed for 2 years or more. The subjective and functional clinical results were comparable between the 2 reconstruction procedures. Side-to-side anterior laxity was significantly less (P = .0277) in group P (0.9 mm) than in group R (1.5 mm). The pivot-shift test was negative in 89% of group P and 78% of group R patients; the result for group R was significantly lower (P = .0460). In the arthroscopic observations, results for group P were significantly better than for group R concerning postoperative laceration and fibrous tissue coverage of the grafts (P = .0479). Remnant preservation in anatomic double-bundle ACL reconstruction did not significantly improve subjective and functional results in the short-term evaluation, but it

  10. Biomechanical comparisons of knee stability after anterior cruciate ligament reconstruction between 2 clinically available transtibial procedures: anatomic double bundle versus single bundle.

    Science.gov (United States)

    Kondo, Eiji; Merican, Azhar M; Yasuda, Kazunori; Amis, Andrew A

    2010-07-01

    Several trials have compared the clinical results between anatomic double-bundle and single-bundle anterior cruciate ligament reconstruction procedures. However, it remains controversial whether the anatomic double-bundle procedure is superior to the single-bundle procedure. The anatomic double-bundle procedure will be better than the single-bundle procedure at resisting anterior laxity, internal rotation laxity, and pivot-shift instability. Controlled laboratory study. Eight cadaveric knees were tested in a 6 degrees of freedom rig using the following loading conditions: 90-N anterior tibialforce, 5-N.m internal and external tibial torques, and a simulated pivot-shift test. Tibiofemoral kinematics during the flexion-extension cycle were recorded with an optical tracking system for (1) intact, (2) anterior cruciate ligament-deficient knee, (3) anatomic double-bundle reconstruction, and (4) single-bundle reconstruction placed at 11 o'clock in the intercondylar notch. There were significant reductions of anterior laxity of 3.5 mm at 20 degrees of flexion, internal rotational laxity of 2.5 degrees at 20 degrees of flexion, and anterior translations (2 mm) and internal rotations (5 degrees ) in the simulated pivot-shift test in the double-bundle reconstruction com-pared with the single-bundle reconstruction. There were no significant differences between the 2 procedures for external rotation laxity. The postoperative anterior translation and internal rotation stability after anatomic double-bundle anterior cruciate ligament reconstruction were significantly better than after single-bundle reconstruction, in both static tests and the pivot shift. Unlike previous laboratory studies, this work used clinical arthroscopic methods for anterior cruciate ligament reconstruction, and found that the anatomic reconstruction was superior to a single graft placed at 11 o'clock.

  11. 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

  12. The effect of anterior cruciate ligament reconstruction on hamstring and quadriceps muscle function outcome ratios in male athletes.

    Science.gov (United States)

    Kadija, Marko; Knezević, Olivera M; Milovanović, Darko; Nedeljković, Aleksandar; Mirkov, Dragan M

    2016-01-01

    Maximal strength ratios such as the limb symmetry index (LSI) and hamstring-to-quadriceps ratio (HQ) may be considered the main outcome measures in the monitoring of recovery after anterior cruciate ligament (ACL) reconstruction. Although explosive strength is much more important than maximal strength, it is generally disregarded in the follow-up of muscle function recovery. The purpose of this study was to compare ratios between maximal (Fmax) and explosive strength (rate of force development--RFD) in individuals with ACL reconstruction. Fifteen male athletes were enrolled and had maximum voluntary isometric quadriceps and hamstring contractions tested (4.0 ± 0.1 months post reconstruction). In addition to Fmax RFD was estimated (RFDmax, as well as RFD at 50, 100, and 200 ms from onset of contraction) and LSI and HQ ratios were calculated. The involved leg demonstrated significant hamstring and quadriceps deficits compared to uninvolved leg (p quadriceps, causing higher HQ ratios (average 0.63), compared to the uninvolved leg (0.44). LSI was significantly lower for RFD variables (average 55%) than for Fmax (66%). The assessment of RFD may be considered an objective recovery parameter for one's readiness to return to sports and should be an integral part of standard follow-up protocol for athletes after ACL reconstruction. Moreover, the combination of indices derived from maximal and explosive strength may provide better insight in muscle strength balance, as well as a clear picture of functional implications.

  13. Assessment of rotatory instability after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft

    International Nuclear Information System (INIS)

    Tashiro, Yasutaka; Okazaki, Ken; Miura, Hiromasa

    2010-01-01

    Anatomically oriented anterior cruciate ligament (ACL) reconstruction has been advocated recently, but its effect on rotatory instability remains to be cleared objectively. The purpose of this study was to quantitatively evaluate rotatory instability in ACL reconstructed knees with a bone-patellar tendon-bone (BTB) graft using an open MRI system. Eighteen subjects underwent arthroscopic ACL reconstruction with a BTB graft. The tibial tunnel was placed in the center of the ACL footprint. The femoral tunnel was drilled transtibially at the 10:00 to 10:30-o'clock position for the right knees. Subjects were examined using a Slocum anterolateral rotatory instability test in open MRI. Anterior tibial translation was measured at the medial and lateral compartments by evaluating sagittal images. Anterior knee stability was evaluated using the KT-2000 arthrometer. The clinical knee function was assessed with the Lysholm and Tegner scoring scales before and after the surgery. Side-to-side differences of anterolateral tibial translation was 0.1 mm. Side-to-side difference on KT-2000 arthrometer measurement was 1.8 mm. The Lysholm score improved to 96 and the latest Tegner score reached substantially the preinjury level. ACL reconstruction with a BTB graft was successful in restoring rotatory stability as well as anterior stability and knee function. (author)

  14. Reconstruction of medial collateral ligament defects with a flexor-pronator fascia patch in complete open release of stiff elbows.

    Science.gov (United States)

    Chen, Shuai; Yan, Hede; Wang, Wei; Zhang, Mei; Hildebrand, Kevin A; Fan, Cun-Yi

    2017-01-01

    Because medial elbow stability is essential for stiff elbow release, surgical techniques have been reported for reconstructing medial elbow stability. However, medial collateral ligament (MCL) defects, caused by inevitable detachment and resection performed for complete release, make the reconstruction more challenging. To our knowledge, no study has evaluated the outcomes after using a flexor-pronator fascia patch in medial elbow reconstruction for open release of stiff elbows. We hypothesized that this technique is effective for repairing MCL defects. We retrospectively reviewed the records of 10 patients. The MCL defects were all reconstructed with a flexor-pronator fascia patch. An external fixator was used in all patients. One patient could not be contacted and was thus excluded from the study. Outcome measures included stability, range of motion, Mayo Elbow Performance Score, ulnar nerve symptoms, power grip, and radiographic findings. The mean follow-up period was 19.6 months; all elbows were stable by the last follow-up. One patient presented with moderate elbow instability and then regained stability 3 months after the external fixator was removed. The Mayo Elbow Performance Score improved from 58 points to 94 points, and the mean flexion arc improved from 40° to 133°. No radiographic manifestations of elbow dislocation or suture anchor looseness were observed. A flexor-pronator fascia patch provides sufficient stability for repairing MCL defects without restricting the range of motion gained during arthrolysis. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

  15. Remnant preservation in anterior cruciate ligament reconstruction versus standard techniques: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Ma, Tianjun; Zeng, Chun; Pan, Jianying; Zhao, Chang; Fang, Hang; Cai, Daozhang

    2017-01-01

    Preserving the remnant during anterior cruciate ligament (ACL) reconstruction is considered beneficial for graft healing, but it might increase the technical difficulties and complications. This study was to compare outcomes of using the technique of remnant preservation during the ACL reconstruction versus the standard procedure with the debridement of remnant. We searched PubMed and EMBASE and the Cochrane Library for randomized controlled trials comparing the outcomes of ACL reconstruction both with and without remnant preservation. The risk of bias was assessed in accordance with the Cochrane Collaboration's risk of bias tool. Meta-analysis was performed to compare results. Six randomized controlled trials with 346 patients were included. Statistically significant differences in favor of using technique of remnant preservation were observed for Lysholm Score, arthrometer measurements, and tibial tunnel enlargement. There was no significant difference between remnant technique of preservation and the standard procedure with respect to the IKDC (International Knee Documentation Committee) grade, IKDC score, Lachman Test, Pivot-shift Test, range of motion (ROM), and the incidence of the cyclops lesion. This meta-analysis of randomized controlled trials showed that ACL reconstruction with technique of remnant preservation cannot provide superior clinical outcomes compared with the standard procedure.

  16. Computed tomography value and tunnel enlargement of round and rounded rectangular femoral bone tunnel for anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Takata, Yasushi; Nakase, Junsuke; Numata, Hitoaki; Oshima, Takeshi; Tsuchiya, Hiroyuki

    2016-11-01

    We developed a novel technique for anatomical single-bundle anterior cruciate ligament (ACL) reconstruction: creation of a rounded rectangular femoral bone tunnel. The purpose of this study was to compare the computed tomography (CT) value and tunnel enlargement ratio of the femoral bone tunnel with those of round tunnel ACL reconstruction. We included 39 knees that underwent round tunnel ACL reconstruction and 42 that underwent rounded rectangular ACL reconstruction. To evaluate the CT value, we compared the CT images approximately 1 week after surgery. Making a parallel slice toward the opening of bone tunnels to a depth of 3 mm, we evaluated the CT value of eight directions in the bone tunnel wall. To evaluate tunnel enlargement, we compared CT images approximately 1 week after surgery with images taken 3 months after surgery. Using a parallel slice toward the opening of the bone tunnel, we measured the bone tunnel area and calculated the tunnel enlargement ratio. The level of significance was P value was significantly increased for the rounded rectangular tunnel in comparison with the round tunnel in almost all directions (P < 0.05). The rounded rectangular tunnel area enlargement ratio was significantly lower (round, 110 ± 38 %; rounded rectangular, 73 ± 37 %; P = 0.001). The rounded rectangular tunnel could have a compression effect on the cancellous bone and reduce enlargement of the bone tunnel.

  17. Patella fracture during rehabilitation after bone-patellar tendon-bone anterior cruciate ligament reconstruction: 2 case reports.

    Science.gov (United States)

    Piva, Sara R; Childs, John D; Klucinec, Brian M; Irrgang, James J; Almeida, Gustavo J M; Fitzgerald, G Kelley

    2009-04-01

    Case report. Patellar fracture is a rare but significant complication following anterior cruciate ligament (ACL) reconstruction when using a bone-patellar tendon-bone (BPTB) autograft. The purpose of these case reports is to describe 2 cases in which patellar fracture occurred during rehabilitation after ACL reconstruction using a BPTB. Both patients were 23-year-old males referred for rehabilitation after ACL reconstruction using a BPTB autograft. They were both progressing satisfactorily in rehabilitation until sustaining a fracture of the patella. One fracture occurred during the performance of the eccentric phase of a knee extension exercise during the sixth week of rehabilitation (7 weeks postsurgery), whereas the other fracture occurred during testing of the patient is quadriceps maximum voluntary isometric contraction in the ninth week of rehabilitation (10 weeks postsurgery). Both patients were subsequently treated with open reduction and internal fixation of the patella. During rehabilitation following ACL reconstruction using BPTB autograft, clinicians should consider the need to balance the sometimes-competing goals of improving quadriceps strength while providing protection to the healing graft, minimization of patellofemoral pain, and protection of the patellar donor site.

  18. Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature

    Directory of Open Access Journals (Sweden)

    Sohrab Keyhani

    2015-04-01

    Full Text Available 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 assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages: first fixation of the fracture and then ACL re-revision after fracture healing was complete. Conclusions: Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction

  19. Skeletal imaging following reconstruction of the posterior cruciate ligament: in vivo comparison of fluoroscopy, radiography, and computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Osti, Michael; Benedetto, Karl Peter [Academic Hospital Feldkirch, Department for Trauma Surgery and Sports Traumatology, Feldkirch (Austria); Krawinkel, Alessa [Academic Hospital Feldkirch, Department for Radiology, Feldkirch (Austria)

    2014-12-15

    Intra- and postoperative validation of anatomic footprint replication in posterior cruciate ligament (PCL) reconstruction can be conducted using fluoroscopy, radiography, or computed tomography (CT) scans. However, effectiveness and exposure to radiation of these imaging modalities are unknown. The objective of this study was to evaluate the comparative effectiveness of fluoroscopy, radiography, and CT in detecting femoral and tibial tunnel positions following an all-inside reconstruction of the PCL ligament in vivo. The study design was a retrospective case series. Intraoperative fluoroscopic images, postoperative radiographs, and CT scans were obtained in 50 consecutive patients following single-bundle PCL reconstruction. The centers of the tibial and femoral tunnel apertures were identified and correlated to measurement grid systems. The results of fluoroscopic, radiographic, and CT measurements were compared to each other and accumulated radiation dosages were calculated. Comparing the imaging groups, no statistically significant difference could be detected for the reference of the femoral tunnel to the intercondylar depth and height, for the reference of the tibial tunnel to the mediolateral diameter of the tibial plateau and for the superoinferior distance of the tibial tunnel entry to the tibial plateau and to the former physis line. Effective doses resulting from fluoroscopic, radiographic, and CT exposure averaged 2.9 mSv, standard deviation (±SD) 4.1 mSv, to 1.3 ± 0.8 mSv and to 3.6 ± 1.0 mSv, respectively. Fluoroscopy, radiography, and CT yield approximately equal effectiveness in detecting parameters used for quality validation intra- and postoperatively. An accumulating exposure to radiation must be considered. (orig.)

  20. Comparison of the operation of arthroscopic tibial inlay and traditional tibial inlay for posterior cruciate ligament reconstruction.

    Science.gov (United States)

    Lu, Daifeng; Xiao, Mochao; Lian, Yongyun; Zhou, Yong; Liu, Xuefeng

    2014-01-01

    To perform dual-bundle reconstruction of posterior cruciate ligament using full arthroscopic tibial inlay technology with self-designed tibia tunnel drilling system and to compare the effect of arthroscopic tibial inlay versus traditional technique for posterior cruciate ligament reconstruction. 32 patients were randomly divided into experiment group (improved tibial inlay, n = 17) and control group (traditional tibial inlay, n = 15). Self-designed tibia tunnel drill system was used to produce intraoperative deep-limited bone tunnel. During follow-up, the location of the bone block and the healing situation were checked by knee X-ray and spiral CT scan. Blood loss, operation time and nerve vascular injuries were evaluated. Mean intraoperative blood loss was 123.53 ± 74.05 ml in the improved tibial inlay group compared with 332 ± 114.26 ml in the traditional tibial inlay group (t = 6.12, P inlay group compared with 346.37 ± 59.67 min in the traditional tibial inlay group (t = 5.19, P inlay technique compared with 14 negative cases and 2 positive cases of traditional tibial Inlay technique. The X-ray and spiral CT scan showed the location of the bone block were perfect and healed well with the patent who received improved tibial inlay technology after 12 weeks postoperatively. Accurate depth-limited bone tunnel can be produced by the tibia tunnel drill system with minor trauma, less bleeding and reducing of nerves or vessels and the recent clinical effects of PCL reconstruction were pretty good.

  1. Hip external rotation strength predicts hop performance after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Kline, Paul W; Burnham, Jeremy; Yonz, Michael; Johnson, Darren; Ireland, Mary Lloyd; Noehren, Brian

    2017-04-04

    Quadriceps strength and single-leg hop performance are commonly evaluated prior to return to sport after anterior cruciate ligament reconstruction (ACLR). However, few studies have documented potential hip strength deficits after ACLR, or ascertained the relative contribution of quadriceps and hip strength to hop performance. Patients cleared for return to sports drills after ACLR were compared to a control group. Participants' peak isometric knee extension, hip abduction, hip extension, and hip external rotation (HER) strength were measured. Participants also performed single-leg hops, timed hops, triple hops, and crossover hops. Between-limb comparisons for the ACLR to control limb and the non-operative limb were made using independent two-sample and paired sample t tests. Pearson's correlations and stepwise multiple linear regression were used to determine the relationships and predictive ability of limb strength, graft type, sex, and limb dominance to hop performance. Sixty-five subjects, 20 ACLR [11F, age 22.8 (15-45) years, 8.3 ± 2 months post-op, mass 70.47 ± 12.95 kg, height 1.71 ± 0.08 m, Tegner 5.5 (3-9)] and 45 controls [22F, age 25.8 (15-45) years, mass 74.0 ± 15.2 kg, height 1.74 ± 0.1 m, Tegner 6 (3-7)], were tested. Knee extension (4.4 ± 1.5 vs 5.4 ± 1.8 N/kg, p = 0.02), HER (1.4 ± 0.4 vs 1.7 ± 0.5 N/kg, p = 0.04), single-leg hop (146 ± 37 vs 182 ± 38% limb length, p hop (417 ± 106 vs 519 ± 102% limb length, p hop (3.3 ± 2.0 vs 2.3 ± 0.6 s, p hop (364 ± 107 vs 446 ± 123% limb length, p = 0.01) were significantly impaired in the operative versus control subject limbs. Similar deficits existed between the operative and non-operative limbs. Knee extension and HER strength were significantly correlated with each of the hop tests, but only HER significantly predicted hop performance. After ACLR, patients have persistent HER strength, knee extension strength, and hop test deficits in the

  2. Unilateral Quadriceps Strengthening With Disinhibitory Cryotherapy and Quadriceps Symmetry After Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Kuenze, Christopher M; Kelly, Adam R; Jun, Hyung-Pil; Eltoukhy, Moataz

    2017-11-01

      The effect of unilateral cryotherapy-facilitated rehabilitation exercise on involved-limb quadriceps function and limb symmetry in individuals with quadriceps dysfunction after anterior cruciate ligament reconstruction (ACLR) remains unclear.   To measure the effect of a 2-week unilateral cryotherapy-facilitated quadriceps-strengthening program on knee-extension strength and quadriceps central activation ratio (CAR) in participants with ACLR.   Controlled laboratory study.   Laboratory.   A total of 10 volunteers with unilateral ACLR (1 man, 9 women; age = 21.0 ± 2.8 years, height = 164.6 ± 5.0 cm, mass = 64.0 ± 6.1 kg, body mass index = 23.7 ± 2.7 kg/m 2 ) and 10 healthy volunteers serving as control participants (1 man, 9 women; age = 20.8 ± 2.5 years, height = 169.1 ± 6.2 cm, mass = 61.1 ± 6.4 kg, body mass index = 21.4 ± 2.3 kg/m 2 ) participated.   Participants with ACLR completed a 2-week unilateral cryotherapy-facilitated quadriceps-strengthening intervention.   Bilateral normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/kg) and quadriceps CAR (%) were assessed preintervention and postintervention. Limb symmetry index (LSI) was calculated at preintervention and postintervention testing. Preintervention between-groups differences in unilateral quadriceps function and LSI were evaluated using independent-samples t tests. Preintervention-to-postintervention differences in quadriceps function were evaluated using paired-samples t tests. Cohen d effect sizes (95% confidence interval [CI]) were calculated for each comparison.   Preintervention between-groups comparisons revealed less knee-extension MVIC torque and quadriceps CAR for the ACLR limb (MVIC: P = .01, Cohen d = -1.31 [95% CI = -2.28, -0.34]; CAR: P = .004, Cohen d = -1.48 [95% CI = -2.47, -0.49]) and uninvolved limb (MVIC: P = .03, Cohen d = -1.05 [95% CI = -1.99, -0.11]; CAR: P = .01, Cohen d = -1.27 [95% CI = -2.23, -0.31]) but not for the

  3. Prevalence of Radiographic Knee Osteoarthritis After Anterior Cruciate Ligament Reconstruction, With or Without Meniscectomy: An Evidence-Based Practice Article.

    Science.gov (United States)

    Ruano, Jennifer S; Sitler, Michael R; Driban, Jeffrey B

    2017-06-02

    Reference:  Claes S, Hermie L, Verdonk R, Bellemans J, Verdonk P. Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21(9):1967-1976.   What is the prevalence of radiographic knee osteoarthritis (OA) at a mean follow-up equal to or greater than 10 years after autologous anterior cruciate ligament (ACL) reconstruction, with or without meniscectomy?   The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were used to conduct this meta-analysis. Studies were identified by searching PubMed, MEDLINE, EMBASE, and Cochrane Library dating from their earliest file until October 2010. Key terms applied for searching were anterior cruciate ligament or ACL, autologous, follow-up, long-term, outcome, reconstruction, results, treatment, and (osteo)arthritis or osteoarthrosis. The reference lists of included studies were also manually checked to ensure that relevant articles were not omitted.   The authors limited their search to English- and French-language journals. Included studies provided radiographic outcomes after autologous ACL reconstruction and had a mean follow-up of ≥10 years. Excluded studies evaluated ACL reconstruction with major concomitant surgical procedures (eg, meniscal allograft transplantation, high tibial osteotomy). In addition, data from 2 studies completed by the same research team with identical patient populations were limited to the article with the longest follow-up. Finally, manuscripts with inaccurate or incomplete data were excluded.   The following key characteristics of each study were extracted: type of study (prospective or retrospective); ACL surgical procedure (eg, open or arthroscopic bone-patellar tendon-bone graft); time frame of surgery; mean follow-up (in years) post-ACL reconstruction; total number of participants with radiographs; total number of participants with radiographic OA

  4. Beneficial and limiting factors for return to work following anterior cruciate ligament reconstruction: a retrospective cohort study.

    Science.gov (United States)

    Groot, Judith A M; Jonkers, Freerk J; Kievit, Arthur J; Kuijer, P Paul F M; Hoozemans, Marco J M

    2017-02-01

    Evidence-based advice for return to work (RTW) after anterior cruciate ligament (ACL) reconstruction is not available. Therefore, the objectives of this study were to determine when patients achieve full RTW, and to explore the beneficial and limiting factors for fully RTW after ACL reconstruction. A retrospective cohort study was performed after ACL reconstruction among 185 patients in one hospital. Data from patient files and a questionnaire were used to explore whether patient-, injury-, surgery-, sports-, work- and rehabilitation-related factors are beneficial or limiting for fully RTW after ACL reconstruction, using a backward stepwise logistic regression analysis. Of the 125 (68%) patients that returned the questionnaire, 36 were not part of the working population. Of the remaining 89 patients, 82 patients (92%) had returned fully to work at follow-up. The median time to fully RTW was 78 days. In the final regression model, which explained 29% of the variance, a significant OR of 5.4 (90% CI 2.2-13.1) for RTW > 78 days was observed for patients performing heavy knee-demanding work compared to patients performing light knee-demanding work. In addition, a significant and positive OR (1.6, 90% CI 1.2-1.9) for the number of weeks walking with the aid of crutches for RTW > 78 days was observed in the final model. After ACL reconstruction, 92% of the patients fully return to work at a median time of 78 days. The significant predictors for fully RTW > 78 days are performing heavy knee-demanding work and a longer period of walking aided with crutches after ACL reconstruction.

  5. Comparison of femur tunnel aperture location in patients undergoing transtibial and anatomical single-bundle anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Lee, Dae-Hee; Kim, Hyun-Jung; Ahn, Hyeong-Sik; Bin, Seong-Il

    2016-12-01

    Although three-dimensional computed tomography (3D-CT) has been used to compare femoral tunnel position following transtibial and anatomical anterior cruciate ligament (ACL) reconstruction, no consensus has been reached on which technique results in a more anatomical position because methods of quantifying femoral tunnel position on 3D-CT have not been consistent. This meta-analysis was therefore performed to compare femoral tunnel location following transtibial and anatomical ACL reconstruction, in both the low-to-high and deep-to-shallow directions. This meta-analysis included all studies that used 3D-CT to compare femoral tunnel location, using quadrant or anatomical coordinate axis methods, following transtibial and anatomical (AM portal or OI) single-bundle ACL reconstruction. Six studies were included in the meta-analysis. Femoral tunnel location was 18 % higher in the low-to-high direction, but was not significant in the deep-to-shallow direction, using the transtibial technique than the anatomical methods, when measured using the anatomical coordinate axis method. When measured using the quadrant method, however, femoral tunnel positions were significantly higher (21 %) and shallower (6 %) with transtibial than anatomical methods of ACL reconstruction. The anatomical ACL reconstruction techniques led to a lower femoral tunnel aperture location than the transtibial technique, suggesting the superiority of anatomical techniques for creating new femoral tunnels during revision ACL reconstruction in femoral tunnel aperture location in the low-to-high direction. However, the mean difference in the deep-to-shallow direction differed by method of measurement. Meta-analysis, Level II.

  6. Association Between Previous Meniscal Surgery and the Incidence of Chondral Lesions at Revision Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Brophy, Robert H.; Wright, Rick W.; David, Tal S.; McCormack, Robert G.; Sekiya, Jon K.; Svoboda, Steven J.; Huston, Laura J.; Haas, Amanda K.; Steger-May, Karen

    2013-01-01

    Background Knees undergoing revision anterior cruciate ligament (ACL) reconstruction typically have more intra-articular injuries than do knees undergoing primary reconstruction. Hypothesis Previous partial meniscectomy (PM) is associated with a higher rate of chondral lesions at revision ACL reconstruction, whereas previous meniscal repair (MR) is not associated with a higher rate of chondral lesions at revision ACL reconstruction, compared with knees undergoing revision ACL with no previous meniscal surgery. Study design Cohort study (Prevalence); Level of evidence, 2. Methods Data from a multicenter cohort was reviewed to determine the history of prior meniscal surgery (PM/MR) and the presence of grade II/III/IV chondral lesions at revision ACL reconstruction. The association between previous meniscal surgery and the incidence of chondral lesions was examined. Patient age was included as a covariate to determine if surgery type contributes predictive information independent of patient age. Results The cohort included 725 ACL revision surgeries. Chondrosis was associated with patient age (P meniscal surgery (P meniscal surgery (P meniscal surgery and knees with previous MR (P = .7). Previous partial meniscectomy was associated with a higher rate of chondrosis in the same compartment compared with knees without previous meniscal surgery (P meniscal surgery independent of the effect of patient age. Previous partial meniscectomy is associated with a higher incidence of articular cartilage lesions, whereas previous meniscal repair is not. Although this association may reflect underlying differences in the knee at the time of prior surgery, it does suggest that meniscal repair is preferable when possible at the time of ACL reconstruction. PMID:22374942

  7. Rate of force development as an adjunctive outcome measure for return-to-sport decisions after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Angelozzi, Massimo; Madama, Marco; Corsica, Cristiana; Calvisi, Vittorio; Properzi, Gianfranco; McCaw, Steven T; Cacchio, Angelo

    2012-09-01

    Descriptive, prospective, longitudinal single-cohort study. To investigate the rate of force development to 30% (RFD(30)), 50% (RFD(50)), and 90% (RFD(90)) of maximal voluntary isometric contraction (MVIC) as an adjunct outcome measure for determining readiness for return to sport following an anterior cruciate ligament (ACL) reconstruction. One criterion of full recovery following an ACL reconstruction is the ability to achieve 85% or 90% of the maximal strength of the contralateral limb. However, the time required to develop muscular strength in many types of daily and sports activities is considerably shorter than that required to achieve maximal strength. Therefore, in addition to maximal strength, neuromuscular functions such as RFD should also be considered in the definition of recovery. Forty-five male professional soccer players who underwent an ACL reconstruction were recruited. Assessment with the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Tegner score, and KT1000 instrumented arthrometer was performed postinjury/prereconstruction and at 6 and 12 months after ACL reconstruction. MVIC, RFD(30), RFD(50), and RFD(90) testing was performed preinjury, as part of standard preseason assessment, and at 6 and 12 months post-ACL reconstruction. The average MVIC value 6 months postreconstruction was 97% of the preinjury average value. In contrast, at 6 months, the RFD(30), RFD(50), and RFD(90) values were 80% (P = .04), 77% (P = .03), and 63% (P = .007), respectively, of the preinjury values. The mean RFD values for the reconstructed knee attained or exceeded 90% of the preinjury mean values only at the 12-month post-ACL reconstruction assessment (RFD(30), P = .86; RFD(50), P = .51; RFD(90), P = .56). Despite the near recovery of MVIC strength to preinjury levels, there were still significant deficits in RFD at 6 months post-ACL reconstruction. An RFD similar to the preinjury RFD was achieved at 12 months post

  8. Anterior Cruciate Ligament Reconstruction: A 2015 global perspective of the Magellan Society

    Directory of Open Access Journals (Sweden)

    Yee Han Dave Lee

    2015-10-01

    Conclusion: Based on the survey, hamstring transportal anatomic single-bundle ACL reconstruction with meniscus preservation is the preferred ACL reconstruction technique of high-volume fellowship-trained sports surgeons.

  9. Comparison of Clinical Outcome of Autograft and Allograft Reconstruction for Anterior Cruciate Ligament Tears

    Directory of Open Access Journals (Sweden)

    Yu-Hua Jia

    2015-01-01

    Conclusions: In the repair of ACL tears, allograft reconstruction is as effective as the autograft reconstruction, but the allograft can lead to more tunnel widening evidently in the tibial tunnel, particularly.

  10. A Novel In Vivo Joint Loading System to Investigate the Effect of Daily Mechanical Load on a Healing Anterior Cruciate Ligament Reconstruction

    OpenAIRE

    Stasiak, Mark; Imhauser, Carl; Packer, Jonathan; Bedi, Asheesh; Brophy, Robert; Kovacevic, David; Jackson, Kent; Deng, Xiang-Hua; Rodeo, Scott; Torzilli, Peter

    2010-01-01

    We designed and validated a novel knee joint fixation/distraction system to study tendon–to-bone healing in an in vivo rat model of anterior cruciate ligament (ACL) reconstruction. The system uses an external fixator to apply a cyclic distraction of the knee joint while monitoring the resultant force developed across the joint, thus providing a temporal indication of structural changes during the healing process of the bone-tendon-bone reconstruction. The validation was performed using an opt...

  11. Reconstruction of the anterior cruciate ligament : a clinical comparison of bone-patellar tendon-bone single bundle versus semitendinosus and gracilis double bundle technique

    NARCIS (Netherlands)

    Sadoghi, Patrick; Mueller, Peter E.; Jansson, Volkmar; van Griensven, Martin; Kroepfl, Albert; Fischmeister, Martin F.

    The study hypothesis was that the outcome of semitendinosus gracilis double bundle (STG-DB) anterior cruciate ligament (ACL) reconstruction is advantageous in terms of clinical results and restoration of anterior-posterior and rotational laxity in comparison to bone-patellar tendon-bone

  12. Feedback Techniques to Target Functional Deficits Following Anterior Cruciate Ligament Reconstruction : Implications for Motor Control and Reduction of Second Injury Risk

    NARCIS (Netherlands)

    Gokeler, Alli; Benjaminse, Anne; Hewett, Timothy E.; Paterno, Mark V.; Ford, Kevin R.; Otten, Egbert; Myer, Gregory D.

    2013-01-01

    Primary anterior cruciate ligament (ACL) injury prevention training has been shown to reduce the risk of injury. Less is known about the effect of prevention on second injury after ACL reconstruction (ACLR). Given recent findings that second injury rates exceed 20 % in only the first year following

  13. Measuring individual hierarchy of anxiety invoking sports related activities: development and validation of the Photographic Series of Sports Activities for Anterior Cruciate Ligament Reconstruction (PHOSA-ACLR)

    NARCIS (Netherlands)

    Lankveld, W. van; Melick, N. van; Habets, B.; Roelofsen, E.; Staal, J.B.; Cingel, R.E. van

    2017-01-01

    BACKGROUND: Fear of harm (FoH) after Anterior Cruciate Ligament Reconstruction (ACLR) should be addressed in physical therapy as it hampers return to sports. However, there are no instruments assessing FoH specific for ACLR. The objective of this study is to describe the development and measurement

  14. Outcomes After Anterior Cruciate Ligament Reconstruction Using the Norwegian Knee Ligament Registry of 4691 Patients: How Does Meniscal Repair or Resection Affect Short-term Outcomes?

    Science.gov (United States)

    LaPrade, Christopher M; Dornan, Grant J; Granan, Lars-Petter; LaPrade, Robert F; Engebretsen, Lars

    2015-07-01

    While the effects of concurrent meniscal resection and anterior cruciate ligament reconstruction (ACLR) are known to decrease patient outcomes and increase the rate of osteoarthritis over the long term, overall short-term patient functional outcomes in a large cohort of patients are not well known. The purpose of this study was to compare the preoperative and 2-year postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale scores after ACLR with and without meniscal injury. The hypothesis was that, in comparison with an isolated ACLR, patients with a medial meniscal (MM) or lateral meniscal (LM) resection with an ACLR would have significantly decreased 2-year postoperative KOOS outcomes, while those with an ACLR with an MM or LM repair would be indistinguishable from isolated ACLR. Cohort study; Level of evidence, 2. The Norwegian Knee Ligament Registry (NKLR) was used to evaluate outcomes for a total of 4691 patients with primary ACLR. The KOOS scoring system was used to evaluate patients on 5 subscales (Pain, Other Symptoms, Activities of Daily Life [ADL], Sport and Recreation Function, and Quality of Life [QoL]) at time of surgery and at 2-year postoperative follow-up. Patients with isolated ACLR and ACLR with LM repair, LM resection, MM repair, or MM resection were compared using multiple linear regression modeling. Preoperatively, in comparison with isolated ACLR, patients who had an ACLR with either an MM repair or MM resection had significantly lower scores for all KOOS subscores, and LM repair had significantly decreased scores on the Other Symptoms, Pain, and ADL subscales. Postoperatively, in comparison with isolated ACLR, 2-year KOOS outcomes were not significantly different between patients with ACLR and LM repair, MM resection, or LM resection; however, those with MM repair had significantly lower scores on the Other Symptoms and QoL subscales. Patients with ACLR with meniscal resections do not exhibit decreased clinical outcomes at 2

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  16. The use of layer by layer self-assembled coatings of hyaluronic acid and cationized gelatin to improve the biocompatibility of poly(ethylene terephthalate) artificial ligaments for reconstruction of the anterior cruciate ligament.

    Science.gov (United States)

    Li, Hong; Chen, Chen; Zhang, Shurong; Jiang, Jia; Tao, Hongyue; Xu, Jialing; Sun, Jianguo; Zhong, Wei; Chen, Shiyi

    2012-11-01

    In this study layer by layer (LBL) self-assembled coatings of hyaluronic acid (HA) and cationized gelatin (CG) were used to modify polyethylene terephthalate (PET) artificial ligament grafts. Changes in the surface properties were characterized by scanning electron microscopy, attenuated total reflection Fourier transform infrared spectroscopy, energy-dispersive X-ray spectroscopy, and contact angle and biomechanical measurements. The cell compatibility of this HA-CG coating was investigated in vitro on PET films seeded with human foreskin dermal fibroblasts over 7days. The results of our in vitro studies demonstrated that the HA-CG coating significantly enhanced cell adhesion, facilitated cell growth, and suppressed the expression of inflammation-related genes relative to a pure PET graft. Furthermore, rabbit and porcine anterior cruciate ligament reconstruction models were used to evaluate the effect of this LBL coating in vivo. The animal experiment results proved that this LBL coating significantly inhibited inflammatory cell infiltration and promoted new ligament tissue regeneration among the graft fibers. In addition, the formation of type I collagen in the HA-CG coating group was much higher than in the control group. Based on these results we conclude that PET grafts coated with HA-CG have considerable potential as substitutes for ligament reconstruction. Copyright © 2012 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  17. A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note.

    Science.gov (United States)

    Sillanpää, Petri J; Mäenpää, Heikki M; Mattila, Ville M; Visuri, Tuomo; Pihlajamäki, Harri

    2009-05-01

    Patellar dislocations are associated with injuries to the medial patellofemoral ligament (MPFL). Several techniques for MPFL reconstruction have been recently published with some disadvantages involved, including large skin incisions and donor site morbidity. Arthroscopic stabilizing techniques carry the potential of inadequate restoration of MPFL function. We present a minimally invasive technique for MPFL reconstruction using adductor magnus tendon autograft. This technique is easily performed, safe, and provides a stabilizing effect equal to current MPFL reconstructions. Skin incision of only 3-4 cm is located at the level of the proximal half of the patella. After identifying the distal insertion of the adductor magnus tendon, a tendon harvester is introduced to harvest the medial two-thirds of the tendon, while the distal insertion is left intact. The adductor magnus tendon is cut at 12-14 cm from its distal insertion and transferred into the patellar medial margin. Two suture anchors are inserted through the same incision at the superomedial aspect of the patella in the anatomic MPFL origin. The graft is tightened at 30 degrees knee flexion. Aftercare includes 4 weeks of brace treatment with restricted range of motion.

  18. Influence of Bundle Diameter and Attachment Point on Kinematic Behavior in Double Bundle Anterior Cruciate Ligament Reconstruction Using Computational Model

    Directory of Open Access Journals (Sweden)

    Oh Soo Kwon

    2014-01-01

    Full Text Available A protocol to choose the graft diameter attachment point of each bundle has not yet been determined since they are usually dependent on a surgeon’s preference. Therefore, the influence of bundle diameters and attachment points on the kinematics of the knee joint needs to be quantitatively analyzed. A three-dimensional knee model was reconstructed with computed tomography images of a 26-year-old man. Based on the model, models of double bundle anterior cruciate ligament (ACL reconstruction were developed. The anterior tibial translations for the anterior drawer test and the internal tibial rotation for the pivot shift test were investigated according to variation of bundle diameters and attachment points. For the model in this study, the knee kinematics after the double bundle ACL reconstruction were dependent on the attachment point and not much influenced by the bundle diameter although larger sized anterior-medial bundles provided increased stability in the knee joint. Therefore, in the clinical setting, the bundle attachment point needs to be considered prior to the bundle diameter, and the current selection method of graft diameters for both bundles appears justified.

  19. 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.

  20. Revision Anterior Cruciate Ligament Reconstruction: Results of a Single-stage Approach Using Allograft Dowel Bone Grafting for Femoral Defects.

    Science.gov (United States)

    Werner, Brian C; Gilmore, Carl J; Hamann, Joshua C; Gaskin, Cree M; Carroll, John J; Hart, Joseph M; Miller, Mark D

    2016-08-01

    The purpose of this study was to present results of single-stage revision anterior cruciate ligament (ACL) reconstruction using an allograft bone dowel for isolated femoral bony deficiency. Sixteen patients underwent single-stage revision ACL reconstruction using an allograft bone dowel for isolated femoral bony deficiency between 2007 and 2012. Twelve patients (75%) completed study visits, which included CT scans as well as completion of validated outcomes measures. The average KT-1000 side-to-side difference was 1.0 mm ± 2.9 mm. The average International Knee Documentation Committee score was 70.2 ± 17.8, the Tegner score was 4.8 ± 2.8, and the visual analog scale pain score was 2.8 ± 2.4. An analysis of CT scans showed that all 12 dowels had excellent (>75%) incorporation. A single-stage approach for revision ACL reconstruction using allograft dowels for isolated femoral bony deficiency yields objective and subjective outcomes comparable to those reported in the literature for two-stage and other single-stage techniques, with good incorporation of the dowels. Retrospective case series, level IV.

  1. Do peak torque angles of muscles change following anterior cruciate ligament reconstruction using hamstring or patellar tendon graft?

    Science.gov (United States)

    Yosmaoğlu, Hayri Baran; Baltacı, Gül; Sönmezer, Emel; Özer, Hamza; Doğan, Deha

    2017-12-01

    This study aims to compare the effects of anterior cruciate ligament (ACL) reconstruction using autogenous hamstring or patellar tendon graft on the peak torque angle. The study included 132 patients (103 males, 29 females; mean age 29±9 year) who were performed ACL reconstruction with autogenous hamstring or patellar tendon graft. The peak torque angles in the quadriceps and hamstring muscles were recorded using an isokinetic dynamometer. Angle of peak knee flexion torque occurred significantly earlier within the range of motion on the operated side than nonoperated side at 180°/second in the hamstring tendon group. Angle of peak knee extension torque occurred significantly earlier within the range of motion on the operated side than nonoperated side at 180°/second in the patellar tendon group. There were no statistically significant differences in the flexion and extension peak torque angles between the operated and nonoperated knees at 60°/second in both groups. The angle of peak torque at relatively high angular velocities is affected after ACL reconstruction in patients with hamstring or patellar tendon grafts. The graft donor site directly influences this parameter. This finding may be important for clinicians in terms of preventing re-injury.

  2. Gait analysis of national athletes after anterior cruciate ligament reconstruction following three stages of rehabilitation program: Symmetrical perspective.

    Science.gov (United States)

    Hadizadeh, Maryam; Amri, Saidon; Mohafez, Hamidreza; Roohi, Sharifah Ahmad; Mokhtar, Abdul Halim

    2016-07-01

    This study aimed to objectively evaluate changes in gait kinematics, kinetics and symmetry among anterior cruciate ligament (ACL) reconstructed athletes during rehabilitation. Twenty-two national athletes with ACL reconstruction and 15 healthy athletes were recruited for the study. Gait data were collected between the weeks 4-5, 8-9, and 12-13 post-operation using three-dimensional motion analysis system. Five separate components, including knee range of motion (ROM), vertical ground reaction force (VGRF), their symmetries and knee extension moment were evaluated. One way and repeated measure multivariate analysis of variance (MANOVA) were used to analyze the knee ROMs. The VGRF and extension moment were tested using repeated measure ANOVA and independent sample t-test. Findings indicated significant alterations in all measured components between patients' Test 1 and control group. Repeated measure analysis revealed significant effect for time in components of knee angular and VGRF (Pgait parameters except knee extension moment by 12-13 weeks post-reconstruction; however, more time is required to normalize single-stance ROM and VGRF asymmetries. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Ankylosis of the knee after septic arthritis following anterior cruciate ligament reconstruction in a 13-year-old male.

    Science.gov (United States)

    Mester, B; Ullerich, F; Ohmann, T; Glombitza, M; Schoepp, C

    2017-06-01

    We present the case of an adolescent male developing an ankylosis of the knee after septic arthritis following anterior cruciate ligament reconstruction (ACLR). The patient was shifted to our institution with postoperative septic arthritis associated with a systemic septic condition. Before, repeated arthroscopic surgery had been conducted without any improvement. MRI showed a concomitant osteomyelitis. The infection (Gächter IV, Staphylococcus aureus) was controlled by an open surgical approach and graft removal. An increasing joint stiffness was documented. X-rays showed an ankylosis at 30° of flexion and early closure of growth plates. Functional knee scores showed significantly worse results. Early diagnosis and a stage-adapted treatment in septic arthritis following ACLR are mandatory. In advanced stages or concomitant osteomyelitis an open approach and graft removal may be appropriate. The antibiotic treatment should be adapted consistently. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  4. Liposomal Bupivacaine for Pain Control After Anterior Cruciate Ligament Reconstruction: A Prospective, Double-Blinded, Randomized, Positive-Controlled Trial.

    Science.gov (United States)

    Premkumar, Ajay; Samady, Heather; Slone, Harris; Hash, Regina; Karas, Spero; Xerogeanes, John

    2016-07-01

    Local anesthetics are commonly administered into surgical sites as a part of multimodal pain control regimens. Liposomal bupivacaine is a novel formulation of bupivacaine designed for slow diffusion of a single dose of local anesthetic over a 72-hour period. While early results are promising in various settings, no studies have compared pain management regimens containing liposomal bupivacaine to traditional regimens in patients undergoing anterior cruciate ligament (ACL) reconstruction. To evaluate liposomal bupivacaine in comparison with 0.25% bupivacaine hydrochloride (HCl) for pain control after ACL reconstruction. Randomized controlled trial; Level of evidence, 1. A total of 32 adult patients undergoing primary ACL reconstruction with a soft tissue quadriceps tendon autograft between July 2014 and March 2015 were enrolled. All patients received a femoral nerve block immediately before surgery. Patients then received either a 40-mL suspension of 20 mL Exparel (1 vial of bupivacaine liposome injectable suspension) and 20 mL 0.9% injectable saline or 20 mL 0.5% bupivacaine HCl and 20 mL 0.9% injectable saline, which was administered into the graft harvest site and portal sites during surgery. Patients were given either a postoperative smartphone application or paper-based journal to record data for 1 week after ACL reconstruction. Of the 32 patients recruited, 29 patients were analyzed (90.6%). Two patients were lost to follow-up, and 1 was excluded because of a postoperative hematoma. There were no statistically significant differences in postoperative pain, medication use, pain location, recovery room time, or mobility between the 2 study groups. There were comparable outcomes with 0.25% bupivacaine HCl at a 200-fold lower cost than liposomal bupivacaine. This study does not support the widespread use of liposomal bupivacaine for pain control after ACL reconstruction in the setting of a femoral nerve block. ClinicalTrials.gov NCT02189317. © 2016 The Author(s).

  5. Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling.

    Science.gov (United States)

    Lacey, Matthew; Lamplot, Joseph; Walley, Kempland C; DeAngelis, Joseph P; Ramappa, Arun J

    2017-05-18

    To describe an approach to anterior cruciate ligament (ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary (IM) femoral nail. Once preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware (locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant and lateral wall soft tissues are removed from the intercondylar, to provide adequate visualization of the ACL footprint. Femoral tunnel placement is performed using a transportal ACL guide with desired offset and the knee flexed to 2.09 rad. The Beath pin is placed through the guide starting at the ACL's anatomic footprint using arthroscopic visualization and/or fluoroscopic guidance. If resistance is met while placing the Beath pin, the arthroscopy should be discontinued and the obstructing hardware should be removed under fluoroscopic guidance. When the Beath pin is successfully placed through the lateral femur, it is overdrilled with a 4.5 mm Endobutton drill. If the Endobutton drill is obstructed, the obstructing hardware should be removed under fluoroscopic guidance. In this case, the obstruction is more likely during Endobutton drilling due to its larger diameter and increased rigidity compared to the Beath pin. The femoral tunnel is then drilled using a best approximation of the graft's outer diameter. We recommend at least 7 mm diameter to minimize the risk of graft failure. Autologous hamstring grafts are generally between 6.8 and 8.6 mm in diameter. After reaming, the knee is flexed to 1.57 rad, the arthroscope placed through the anteromedial portal to confirm the femoral tunnel position, referencing the posterior wall and lateral cortex. For a quadrupled hamstring graft, the gracilis and semitendinosus tendons are then harvested in the standard fashion. The tendons are whip

  6. Evaluation of Polycaprolactone Scaffold with Basic Fibroblast Growth Factor and Fibroblasts in an Athymic Rat Model for Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Kabir, Nima; Arshi, Armin; Nazemi, Azadeh; Wu, Ben; Petrigliano, Frank A.; McAllister, David R.

    2015-01-01

    Anterior cruciate ligament (ACL) rupture is a common ligamentous injury often necessitating surgery. Current surgical treatment options include ligament reconstruction with autograft or allograft, which have their inherent limitations. Thus, there is interest in a tissue-engineered substitute for use in ACL regeneration. However, there have been relatively few in vivo studies to date. In this study, an athymic rat model of ACL reconstruction was used to evaluate electrospun polycaprolactone (PCL) grafts, with and without the addition of basic fibroblast growth factor (bFGF) and human foreskin fibroblasts. We examined the regenerative potential of tissue-engineered ACL grafts using histology, immunohistochemistry, and mechanical testing up to 16 weeks postoperatively. Histology showed infiltration of the grafts with cells, and immunohistochemistry demonstrated aligned collagen deposition with minimal inflammatory reaction. Mechanical testing of the grafts demonstrated significantly higher mechanical properties than immediately postimplantation. Acellular grafts loaded with bFGF achieved 58.8% of the stiffness and 40.7% of the peak load of healthy native ACL. Grafts without bFGF achieved 31.3% of the stiffness and 28.2% of the peak load of healthy native ACL. In this in vivo rodent model study for ACL reconstruction, the histological and mechanical evaluation demonstrated excellent healing and regenerative potential of our electrospun PCL ligament graft. PMID:25744933

  7. Evaluation of polycaprolactone scaffold with basic fibroblast growth factor and fibroblasts in an athymic rat model for anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Leong, Natalie Luanne; Kabir, Nima; Arshi, Armin; Nazemi, Azadeh; Wu, Ben; Petrigliano, Frank A; McAllister, David R

    2015-06-01

    Anterior cruciate ligament (ACL) rupture is a common ligamentous injury often necessitating surgery. Current surgical treatment options include ligament reconstruction with autograft or allograft, which have their inherent limitations. Thus, there is interest in a tissue-engineered substitute for use in ACL regeneration. However, there have been relatively few in vivo studies to date. In this study, an athymic rat model of ACL reconstruction was used to evaluate electrospun polycaprolactone (PCL) grafts, with and without the addition of basic fibroblast growth factor (bFGF) and human foreskin fibroblasts. We examined the regenerative potential of tissue-engineered ACL grafts using histology, immunohistochemistry, and mechanical testing up to 16 weeks postoperatively. Histology showed infiltration of the grafts with cells, and immunohistochemistry demonstrated aligned collagen deposition with minimal inflammatory reaction. Mechanical testing of the grafts demonstrated significantly higher mechanical properties than immediately postimplantation. Acellular grafts loaded with bFGF achieved 58.8% of the stiffness and 40.7% of the peak load of healthy native ACL. Grafts without bFGF achieved 31.3% of the stiffness and 28.2% of the peak load of healthy native ACL. In this in vivo rodent model study for ACL reconstruction, the histological and mechanical evaluation demonstrated excellent healing and regenerative potential of our electrospun PCL ligament graft.

  8. Return to sport and knee functional scores after anterior cruciate ligament reconstruction: 2 to 10 years' follow-up

    Directory of Open Access Journals (Sweden)

    Sukrom Cheecharern

    2018-04-01

    Full Text Available Background: Anterior cruciate ligament (ACL reconstruction is one of the most common knee ligament reconstruction sustained by sports players. Previous studies have revealed different rates of returning to play sports depending on study sites, subjects, and time to follow-up; however, this subject has not been adequately investigated in Thailand. Objectives: This study aimed to assess the percentage of ACL reconstruction patients who successfully returned to sport activities. Factors associated with being able to return to sport were also determined. Materials and methods: A cross-sectional study was conducted to assess the rates of return to sport of patients who underwent ACL reconstruction between 2005 and 2015. All potential patients were initially contacted via letter or mobile phone and asked to report their long-term follow-up outcomes. Collected data from the interview, including return to sport status, performance following ACL, and reasons for not returning to play (if applicable were then combined with the initial surgical findings and enrollment/follow-up cohort data for analysis. This study was reviewed and approved by the ethics committee of Rajavithi Hospital. Results: A total of 110 participants were recruited, with a mean age of 35.05 ± 9.16 years. Most of the patients were male, single, with bachelor degree education, engaged in “other” occupations, had income up to 10,000 baht/month, were in the social security scheme (54.5%, and had no underlying diseases (85.5%. The mean ± SD of BMI was 25.58 ± 4.30 kg/m2. When classified by whether or not they returned to sports, it was found that sex, education, income and underlying disease of those who returned to sport were significantly different from those of subjects who did not (p < 0.05. At follow-up, 36.4% had returned to sport. The main reasons stated for not returning to sport following ACL were fear of injury, concern about possible long-term effects

  9. The effect of anterior cruciate ligament reconstruction on hamstring and quadriceps muscle function outcome ratios in male athletes

    Directory of Open Access Journals (Sweden)

    Kadija Marko

    2016-01-01

    Full Text Available Introduction. Maximal strength ratios such as the limb symmetry index (LSI and hamstring-to-quadriceps ratio (HQ may be considered the main outcome measures in the monitoring of recovery after anterior cruciate ligament (ACL reconstruction. Although explosive strength is much more important than maximal strength, it is generally disregarded in the follow-up of muscle function recovery. Objective. The purpose of this study was to compare ratios between maximal (Fmax and explosive strength (rate of force development - RFD in individuals with ACL reconstruction. Methods. Fifteen male athletes were enrolled and had maximum voluntary isometric quadriceps and hamstring contractions tested (4.0 ± 0.1 months post reconstruction. In addition to Fmax, RFD was estimated (RFDmax, as well as RFD at 50, 100, and 200 ms from onset of contraction and LSI and HQ ratios were calculated. Results. The involved leg demonstrated significant hamstring and quadriceps deficits compared to uninvolved leg (p < 0.01. Deficits were particularly significant in the involved quadriceps, causing higher HQ ratios (average 0.63, compared to the uninvolved leg (0.44. LSI was significantly lower for RFD variables (average 55% than for Fmax (66%. Conclusion. The assessment of RFD may be considered an objective recovery parameter for one’s readiness to return to sports and should be an integral part of standard follow-up protocol for athletes after ACL reconstruction. Moreover, the combination of indices derived from maximal and explosive strength may provide better insight in muscle strength balance, as well as a clear picture of functional implications. [Projekat Ministarstva nauke Republike Srbije, br. 175012 i br. 175037

  10. Double-bundle anterior cruciate ligament reconstruction with and without remnant preservation - Comparison of early postoperative outcomes and complications.

    Science.gov (United States)

    Nakayama, Hiroshi; Kambara, Syunichiro; Iseki, Tomoya; Kanto, Ryo; Kurosaka, Kenji; Yoshiya, Shinichi

    2017-10-01

    To compare the early postoperative outcomes and complications of double-bundle anterior cruciate ligament (ACL) reconstruction with and without remnant preservation. The study population comprised 125 consecutive knees that underwent double-bundle ACL reconstruction using hamstring autograft. Among the 125 knees, remnant preservation was indicated for 50 knees, while standard double-bundle reconstruction was performed in the remaining 75 knees. Postoperative evaluations included heel-height difference (HHD) at periodical follow-ups, number of knees requiring arthroscopic debridement due to problematic extension loss within six months, re-injury within one year, graft status upon second-look arthroscopy, and clinical examinations by Lysholm score and KT measurement at one year. All patients could be followed up for a minimum of one year after surgery. When the results obtained from both groups were compared, HHD values were significantly larger in the preservation group at three and six months, and the rate of knees requiring arthroscopic debridement was also higher in this group (12% versus 4.0%). Graft status on second-look arthroscopy was considered to be good for 92% of the knees in the preservation group versus 59% in the non-preservation group. Re-injury rates within one year were 2.0% in the preservation group and 5.3% in the non-preservation group. No significant differences in clinical examinations were found between the groups at one year. Remnant preservation in double-bundle hamstring autograft ACL reconstruction may enhance tissue healing; however, retention of the remnant with its full volume resulted in an increased incidence of postoperative problematic extension loss. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. The Effect of Femoral Nerve Block on Quadriceps Strength in Anterior Cruciate Ligament Reconstruction: A Systematic Review.

    Science.gov (United States)

    Swank, Katherine R; DiBartola, Alex C; Everhart, Joshua S; Kaeding, Christopher C; Magnussen, Robert A; Flanigan, David C

    2017-05-01

    To assess the isokinetic, functional, and patient-reported outcomes of femoral nerve block (FNB) compared with traditional multimodal anesthesia for FNB in anterior cruciate ligament (ACL) reconstruction. A systematic search of PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Reviews, and Google Scholar was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Effects of FNB on quadriceps function were evaluated by isokinetic testing, functional scoring systems, range of motion, and patient self-report questionnaires. Heterogeneous reporting of outcomes precluded a formal meta-analysis. The methodologic merit of all studies included was evaluated by the Coleman Methodology Score. Six studies were identified with outcome measures reported between 7 days and 6 months postoperatively. At 6 months, 2 of 4 studies that reported isokinetic testing found significantly greater deficits among patients who received a nerve block; one of the remaining studies showed a deficit at 6 weeks but not 6 months. Limited data showed no significant differences in functional or patient-reported outcomes at 6 months after reconstruction, and data regarding the impact of FNB on return to sport were inconclusive. The mean Coleman Methodology Score for the included studies was 53, indicating poor overall methodologic quality of the available literature. The limited data available suggest that FNB causes a measurable deficit in quadriceps isokinetic strength during the early postoperative period but has no effect on functional outcomes or return to sport at 6 months after ACL reconstruction. However, current clinical evidence is not sufficient to draw any valid or definitive conclusions regarding the effect of FNB on postoperative outcomes after ACL reconstruction. Level IV, systemic review of Level I through IV studies. Copyright © 2017 Arthroscopy Association of North America. Published by

  12. The influence of electromyographic biofeedback therapy on knee extension following anterior cruciate ligament reconstruction: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Christanell Franz

    2012-11-01

    Full Text Available Abstract Background Loss of knee extension and a deficit in quadriceps strength are frequently found following anterior cruciate ligament (ACL reconstruction. The aim of this study was to investigate whether the addition of Eletromyographic Biofeedback (EMG BFB therapy for the vastus medialis muscle to the in the early phase of the standard rehabilitation programme could improve the range of knee extension and strength after ACL reconstruction more than a standard rehabilitation programme. The correlation between EMG measurement and passive knee extension was also investigated. Method Sixteen patients, all of whom underwent endoscopic ACL reconstruction using patellar tendon autograft, were randomly assigned to two groups: • Control group (8 patients: standard rehabilitation protocol; with full weight-bearing postoperative, knee brace (0° extension, 90° flexion, electrical stimulation, aquatics and proprioceptive training. • The EMG BFB group (8 patients: EMG BFB was added to the standard rehabilitation protocol within the first postoperative week and during each session for the next 6 weeks. Each patent attended a total of 16 outpatient physiotherapy sessions following surgery. High-Heel-Distance (HHD Test, range of motion (ROM and integrated EMG (iEMG for vastus medialis were measured preoperatively, and at the 1, 2, 4 and 6-week follow ups. Additionally, knee function, swelling and pain were evaluated using standardized scoring scales. Results At 6 weeks, passive knee extension (p  0.01 differences were found between the two groups for the assessment of knee function, swelling and pain. Conclusion The results indicate that EMG BFB therapy, in the early phase of rehabilitation after ACL reconstruction, is useful in enhancing knee extension. Improved innervation of the vastus medialis can play a key role in the development of postoperative knee extension. EMG BFB therapy is a simple, inexpensive and valuable adjunct to conventional

  13. Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance Imaging in Patients With Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    DePhillipo, Nicholas N; Cinque, Mark E; Chahla, Jorge; Geeslin, Andrew G; Engebretsen, Lars; LaPrade, Robert F

    2017-08-01

    Meniscal ramp lesions have been reported to be present in 9% to 17% of patients undergoing anterior cruciate ligament (ACL) reconstruction. Detection at the time of arthroscopy can be accomplished based on clinical suspicion and careful evaluation. Preoperative assessment via magnetic resonance imaging (MRI) has been reported to have a low sensitivity in identifying meniscal ramp lesions. To investigate the incidence of meniscal ramp lesions in patients with ACL tears and the sensitivity of preoperative MRI for the detection of ramp lesions. Case series; Level of evidence, 4. All patients who underwent ACL reconstruction by a single surgeon between 2010 and 2016 were included in this study, and patients with medial meniscal ramp lesions found at the time of arthroscopy were identified. The sensitivity of MRI compared with the gold standard of arthroscopic evaluation was determined by review of the preoperative MRI musculoskeletal radiologist report, mimicking the clinical scenario. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. In a consecutive series of 301 ACL reconstructions, 50 patients (33 male, 17 female) with a mean age of 29.6 years (range, 14-61 years) were diagnosed with a medial meniscal ramp lesion at arthroscopic evaluation (16.6% incidence). The sensitivity of MRI for ramp lesions was 48% based on the preoperative MRI report. A secondary finding of a posteromedial tibial bone bruise was identified on preoperative MRI in 36 of the 50 patients with ramp lesions in a retrospective MRI review by 2 orthopaedic surgeons. Medial meniscal ramp lesions were present in approximately 17% of 301 patients undergoing ACL reconstruction, and less than one-half were diagnosed on the preoperative MRI. A posteromedial tibial bone bruise was found to be a secondary sign of a ramp lesion in 72% of patients. Increased awareness of this potentially combined injury pattern is

  14. Reconstruction of the medial patellofemoral ligament by means of the anatomical double-bundle technique using metal anchors

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    David Sadigursky

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate double-bundle reconstruction of the medial patellofemoral ligament (MPFL using a graft from the semitendinosus tendon and fixation with metal anchors over the medium term. METHODS: This was a prospective cross-sectional study. After approval from the research ethics committee, 31 patients with patellofemoral instability who underwent MPFL reconstruction by means of the anatomical double-bundle technique, with fixation using metal anchors, were analyzed between May 2010 and January 2015. To evaluate the effectiveness of the MPFL reconstruction surgery, the Kujala scale and the Tegner-Lysholm score were assessed before the procedure and one year afterwards, along with clinical data such as pain levels, range of motion and J sign. The data were tabulated in the Excel(r software and were analyzed using the SPSS Statistics(r software, version 21. The statistical analysis was performed using the Wilcoxon T test and the McNemar test. RESULTS: The mean preoperative score from the Kujala test was 45.64 ± 1.24 and the postoperative score was 94.03 ± 0.79 (p < 0.001. The preoperative Tegner-Lysholm score was 40.51 ± 1.61 and the postoperative score was 91.64 ± 0.79 (p < 0.001. The preoperative range of motion was 125.96 ± 2.11 and the postoperative range was 138.38 ± 1.49 (p < 0.05. CONCLUSION: MPFL reconstruction by means of the anatomical double-bundle technique is easily reproducible, without episodes of recurrence, with satisfactory results regarding restoration of stability and function of the patellofemoral joint.

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

    Science.gov (United States)

    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

    2016-09-23

    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. This is a prospective study of 177 patients with anterior cruciate ligament injury, who underwent surgery and physical therapy guideline conducted in an orthopedic clinic in São Paulo, southeastern Brazil. The clinical evolution of patients was made according to Lysholm and IKDC questionnaire on the 1st day after surgery with 30, 90 and 180 days of treatment. There was statistically significant increase in the gross values of Lysholm and IKDC questionnaires during the treatment (p postoperative anterior cruciate ligament.

  16. Can joint contact dynamics be restored by anterior cruciate ligament reconstruction?

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    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.

  17. A LONGITUDINAL STUDY TO ASSESS THE TREATMENT OUTCOME FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING BONE – PATELLAR TENDON – BONE GRAFT [BTB

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    Tummala Venkata Suresh

    2016-03-01

    Full Text Available BACKGROUND Reconstruction of ACL and restoration of musculoskeletal function is a fundamental goal of orthopaedic treatment. OBJECTIVES To assess the outcome of knee function after anterior cruciate Ligament reconstruction. MATERIALS AND METHODS This prospective study included 28 patients who underwent ACL reconstruction for two years. The clinical follow-up evaluation was done following the surgery and postoperative rehabilitation. International Knee Documentation Committee (IKDC and Lysholm Score was used to assess the functional outcome. Results were expressed in terms of percentage, proportion and chi-square test. RESULTS According to the IKDC rating scale, 80% of the patients had normal or nearly normal final outcome. The mean Lysholm score was 82. About half of the patients had anterior knee pain, as classified by the IKDC. Patients with early reconstruction had less degenerative changes in the tibiofemoral joint, were subjectively more satisfied to the result, and could return to the pre-injury level of activities. CONCLUSION Our results showed that an ACL reconstruction using BTB autograft leads to good ligamentous stability and function of the knee. Those who underwent early reconstruction had better results. Mild anterior knee pain and osteoarthritis after reconstruction was a common finding.

  18. Two-bundle reconstruction of the anterior cruciate ligament using semitendinosus tendon with endobuttons: operative technique and preliminary results.

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    Muneta, T; Sekiya, I; Yagishita, K; Ogiuchi, T; Yamamoto, H; Shinomiya, K

    1999-09-01

    We carried out two-bundle reconstruction of the anterior cruciate ligament (ACL) using multi-strand semitendinosus tendon for the purpose of getting better stability under aggressive rehabilitation by putting the graft in the normal anatomy with minimized notch-plasty. The drill guide position was determined using two-directional radiography in hyperextension. The two-bundle procedure was performed using the inside-out technique for grafting and two Endobuttons (Acufex Microsurgical, Mansfield, MA) for femoral graft fixation. The clinical outcomes 2 years postoperatively of 54 of 62 consecutive patients were reported. The preliminary results suggested that the two-bundle procedure showed a better trend with respect to anterior stability compared with those of our previous experience using the single-bundle technique under the same aggressive rehabilitation. The two-bundle procedures have several theoretical advantages over single-bundle with multi-strand tendon graft. The present two-bundle reconstruction is recommended to result in better anterior stability with minimized notch-plasty and with no serious complications.

  19. Videofluoroscopy Instrument to Identify the Tibiofemoral Contact Point Migration for Anterior Cruciate Ligament Reconstruction Follow-up: CINARTRO

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    Simini, F.; Santos, D.; Francescoli, L.

    2016-04-01

    We measure the Tibiofemoral contact point migration to offer clinicians a tool to evaluate Anterior Cruciate Ligament reconstruction. The design of the tool includes a C arm with fluoroscopy, image acquisition and processing system, interactive software and report generation for the clinical record. The procedure samples 30 images from the videofluoroscopy describing 2 seconds movements of hanging-to-full-extension of the knee articulation. A geometrical routine implemented in the original equipment (CINARTRO) helps capture tibial plateau and femoral condile profile by interaction with the user. The tightness or looseness of the knee is expressed by the migration given in terms of movement of the femur along the tibial plateau, as a percentage. We automatically create clinical reports in standard Clinical Document Architecture or CDA format. A special phantom was developed to correct the “pin cushion effect” in Rx images. Five cases of broken ACL patients were measured giving meaningful results for clinical follow up. Tibiofemoral contact point migration was measured as 60% of the tibial plateau, with standard deviation of 6% for healthy knees, 4% when injured and 1% after reconstruction.

  20. Effectiveness and safety of cryotherapy after arthroscopic anterior cruciate ligament reconstruction. A systematic review of the literature.

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    Martimbianco, Ana Luiza Cabrera; Gomes da Silva, Brenda Nazaré; de Carvalho, Alan Pedrosa Viegas; Silva, Valter; Torloni, Maria Regina; Peccin, Maria Stella

    2014-11-01

    Cryotherapy is widely used in rehabilitation; however, its effectiveness after anterior cruciate ligament (ACL) reconstruction remains uncertain. To investigate the effectiveness and safety of cryotherapy following ACL reconstruction through a systematic review, randomized and quasi-randomized clinical trials were searched in the databases: MEDLINE, EMBASE, CENTRAL, PEDro, SportDiscus, CINAHL, LILACS (June 2013). The primary outcomes measures were pain, edema and adverse events; the secondary outcomes were knee function, analgesic medication use, range of motion, blood loss, hospital stay, quality of life and patient satisfaction. The methodological quality of studies was evaluated using the Cochrane Collaboration risk-of-bias tool. Ten trials (a total of 573 patients) were included. Results of meta-analysis showed that the use of cold compression devices produced a significant reduction in pain scores 48 h after surgery (p cryotherapy. The risk for adverse events did not differ between patients receiving cryotherapy versus no treatment (p = 1.00). The limited evidence currently available is insufficient to draw definitive conclusions on the effectiveness of cryotherapy for other outcomes. There is a need for well designed, good quality randomized trials to answer other questions related to this intervention and increase the precision of future systematic reviews. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. 3-T MRI assessment of osteophyte formation in patients with unilateral anterior cruciate ligament injury and reconstruction

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    Panzer, Stephanie [Department of Radiology, Trauma Center Murnau, Murnau (Germany); Augat, Peter [Trauma Center Murnau and Paracelsus Medical University, Institute of Biomechanics, Murnau (Germany); Atzwanger, Joerg; Hergan, Klaus [University Hospital Salzburg, Paracelsus Medical University, Department of Radiology, Salzburg (Austria)

    2012-12-15

    To define the number and distribution of osteophytes (OPs) in bilateral knee MRI (magnetic resonance imaging) of patients with unilateral anterior cruciate ligament (ACL) rupture. Bilateral knee MRIs of 20 patients with unilateral ACL rupture and reconstruction were retrospectively analyzed for OPs. OPs were graded following the KOSS (knee OA scoring system) classification and their compartmental distribution was assessed following the WORMS (Whole-Organ Magnetic Resonance Imaging Score) classification. All examined knees revealed OPs. Knees with ACL rupture showed significant (p < 0.001) higher total numbers of OPs (mean 11.6; SD {+-} 4.4) than knees with intact ACL (mean 5.1; SD {+-} 2.3). Knees with ACL rupture showed increased OP formation in all knee compartments with predominance of marginal OPs in the lateral femorotibial compartment especially on the tibia. Our results show that after knee injury with ACL rupture and reconstruction, all knee compartments were involved in post-traumatic increase of OP formation. The most affected compartment was the lateral femorotibial compartment on the tibial side. (orig.)

  2. Do Knee Bracing and Delayed Weight Bearing Affect Mid-Term Functional Outcome after Anterior Cruciate Ligament Reconstruction?

    Science.gov (United States)

    Di Miceli, Riccardo; Marambio, Carlotta Bustos; Zati, Alessandro; Monesi, Roberta; Benedetti, Maria Grazia

    2017-12-01

    Purpose  The aim of this study was to assess the effect of knee bracing and timing of full weight bearing after anterior cruciate ligament reconstruction (ACLR) on functional outcomes at mid-term follow-up. Methods  We performed a retrospective study on 41 patients with ACLR. Patients were divided in two groups: ACLR group, who received isolated ACL reconstruction and ACLR-OI group who received ACL reconstruction and adjunctive surgery. Information about age at surgery, bracing, full or progressive weight bearing permission after surgery were collected for the two groups. Subjective IKDC score was obtained at follow-up. Statistical analysis was performed to compare the two groups for IKDC score. Subgroup analysis was performed to assess the effect of postoperative regimen (knee bracing and weight bearing) on functional outcomes. Results  The mean age of patients was 30.8 ± 10.6 years. Mean IKDC score was 87.4 ± 13.9. The mean follow-up was 3.5 ± 1.8 years. Twenty-two (53.7%) patients underwent ACLR only, while 19 (46.3%) also received other interventions, such as meniscal repair and/or collateral ligament suture. Analysis of overall data showed no differences between the groups for IKDC score. Patients in the ACLR group exhibited a significantly better IKDC score when no brace and full weight bearing after 4 weeks from surgery was prescribed in comparison with patients who worn a brace and had delayed full weight bearing. No differences were found with respect to the use of brace and postoperative weight bearing regimen in the ACLR-OI group. Conclusion  Brace and delayed weight bearing after ACLR have a negative influence on long-term functional outcomes. Further research is required to explore possible differences in the patients operated on ACLR and other intervention with respect to the use of a brace and the timing of full weight bearing to identify optimal recovery strategies. Level of Evidence  Level III, retrospective observational

  3. Intermittent blood flow restriction does not reduce atrophy following anterior cruciate ligament reconstruction

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    Erik Iversen

    2016-03-01

    Conclusion: In conflict with other studies using a similar protocol, application of blood flow restriction the first 14 days after ACL reconstruction did not reduce quadriceps ACSA muscle atrophy measured by MR in a population of athletes.

  4. Evaluating the center of gravity of dislocations in soccer players with and without reconstruction of the anterior cruciate ligament using a balance platform

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    Angelica Castilho Alonso

    2009-03-01

    Full Text Available OBJECTIVE: The objective of this study was to compare the dislocation of the center of gravity and postural balance in sedentary and recreational soccer players with and withoutanterior cruciate ligament (ACL reconstruction using the Biodex Balance System (BBS. METHOD: Sixty-four subjects were divided into three groups: a soccer players who were post- anterior cruciate ligament reconstruction; b soccer players with no anterior cruciate ligament injuries; and c sedentary subjects. The subjects were submitted to functional stability tests using the Biodex Balance System. The instability protocols used were level eight (more stable and level two (less stable. Three stability indexes were calculated: the anteroposterior stability index, the mediolateral stability index, and the general stability index. RESULTS: Postural balance (dislocation on the reconstructed side of the athletes was worse than on the side that had not undergone reconstruction. The postural balance of the sedentary group was dislocated less on both sides than the reconstructed knees of the athletes without anterior cruciate ligament injuries. There were no differences in postural balance with relation to left/right dominance for the uninjured athletes and the sedentary individuals. CONCLUSION: The dislocation of the center of gravity and change in postural balance in sedentary individuals and on the operated limb of Surgery Group are less marked than in the soccer players from the Non Surgery Group and on the non-operated limbs. The dislocation of the center of gravity and the change in postural balance from the operated limb of the soccer players is less marked than in their non-operated limbs.

  5. Septic Arthritis After Arthroscopic Anterior Cruciate Ligament Reconstruction: Evaluation of an Arthroscopic Graft-Retaining Treatment Protocol.

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    Schuster, Philipp; Schulz, Martin; Immendoerfer, Micha; Mayer, Philipp; Schlumberger, Michael; Richter, Joerg

    2015-12-01

    Septic arthritis after anterior cruciate ligament (ACL) reconstruction is a rare but severe complication. Treatment regimens differ, and optimal management has not been established. To determine the incidence of postoperative infections after ACL reconstruction, to identify the microbiological spectrum, and to evaluate a standardized graft-retaining treatment protocol consisting of sequential arthroscopic irrigation and debridement (I&D) procedures and antibiotic therapy until C-reactive protein levels are within normal range. Case series; Level of evidence, 4. From January 2004 to June 2014, a total of 7096 consecutive arthroscopic ACL reconstructions were performed at a single institution (5907 primary and 1189 revision reconstructions). Thirty-six cases with postoperative septic arthritis were identified and retrospectively analyzed with regard to incidence, clinical presentation, time to and number of arthroscopic reoperations, and microbiological findings. The follow-up examination consisted of a clinical examination, instrumeted measurement of laxity (KT-1000 arthrometer), classification according to objective and subjective International Knee Documentation Committee (IKDC) scores, and radiological evaluation. The incidence of septic arthritis was 0.51% (n = 36), with 0.41% (n = 24) in primary and 1.01% (n = 12) in revision reconstructions (odds ratio, 2.5; P = .008). The first I&D was performed a mean (± SD) of 19.6 ± 10.6 days after the index procedure. Eradication was achieved in all patients after a mean of 2.25 ± 1.22 procedures, with graft retention in all but 1 patient (97.2%). The mean duration of antibiotic treatment was 5.4 ± 2.3 weeks (range, 2.1-12.9 weeks) and ≤ 4 weeks in 13 patients (36%). No recurrence of infections was seen. Coagulase-negative staphylococci (62.5%) and Staphylococcus aureus (21.9%) were the most frequent pathogens. Twenty-nine patients were available for follow-up (80.6%) after a mean 4.7 ± 3.2 years (range, 0

  6. Efficacy of quadriceps vastus medialis dry needling in a rehabilitation protocol after surgical reconstruction of complete anterior cruciate ligament rupture.

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    Velázquez-Saornil, Jorge; Ruíz-Ruíz, Beatriz; Rodríguez-Sanz, David; Romero-Morales, Carlos; López-López, Daniel; Calvo-Lobo, Cesar

    2017-04-01

    Several new rehabilitation modalities have been proposed after anterior cruciate ligament (ACL) reconstruction. Among these, trigger point dry needling (TrP-DN) might be useful in the treatment of myofascial pain syndrome associated with ACL reconstruction to reduce pain intensity, increase knee flexion range and modify the mechanical properties of the quadriceps muscle during late-stage rehabilitation. To date, this is the first randomized clinical trial to support the use of TrP-DN in the early rehabilitation process after ACL reconstruction. The aim of this study was to determine the pain intensity, range of motion (ROM), stability, and functionality improvements by adding quadriceps vastus medialis TrP-DN to the rehabilitation protocol (Rh) provided to subacute ACL reconstructed patients. This randomized, single-blinded, clinical trial (NCT02699411) included 44 subacute patients with surgical reconstruction of complete ACL rupture. The patients were randomized into 2 intervention groups: Rh (n = 22) or Rh + TrP-DN (n = 22). Pain intensity, ROM, stability, and functionality were measured at baseline (A0) and immediately (A1), 24 hours (A2), 1 week (A3), and 5 weeks (A4) after the first treatment. Comparing statistically significant differences (P ≤ .001; Eta = 0.198-0.360) between both groups, pain intensity (at A1), ROM (at A1, A2, and A3), and functionality (at A2, A3, and A4) were increased. Nevertheless, the rest of measurements did not show significant differences (P > .05). Quadriceps vastus medialis TrP-DN in conjunction with a rehabilitation protocol in subacute patients with surgical reconstruction of complete ACL rupture increases ROM (short-term) and functionality (short- to mid-term). Although there was an increase in pain intensity with the addition of TrP-DN, this was not detected beyond immediately after the first treatment. Furthermore, stability does not seem to be modified after TrP-DN.

  7. No significant difference in clinical outcome and knee stability between patellar tendon and semitendinosus tendon in anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Konrads, Christian; Reppenhagen, Stephan; Plumhoff, Piet; Hoberg, Maik; Rudert, Maximilian; Barthel, Thomas

    2016-04-01

    ACL reconstruction with either patellar tendon or semitendinosus tendon autografts are standard procedures. Between these two grafts might be differences in stability, morbidity, or long-term changes. This study investigates outcomes of ACL reconstruction with patellar tendon versus semitendinosus tendon autografts. We hypothesize no significant differences in clinical outcome and knee stability between both groups. In a randomized prospective trial, we operated 62 ACL-deficient patients, 45 males and 17 females with a mean age of 29.8 years (min. 18, max. 44). We reconstructed the ligament using either autologous patellar tendon (n = 31) or semitendinosus tendon (n = 31). After 10 years of follow-up, we investigated 47 patients of the study. For evaluation we used a standard clinical examination including one-leg jump test and KT-1000 instrumental translation measure, visual analog pain scale, IKDC subjective knee form, Lysholm score, Tegner activity scale, and standard X-rays of the knee. The data did not show any significant differences between the two groups. Between 5 and 10 years after ACL reconstruction both groups started to develop degenerative arthritic changes, which were detectable in standard radiographs of the knee. At 10-year follow-up mean IKDC for the BPTB group was 1.8 (min. 1, max. 3) and for the ST group it was 2.2 (min 1, max. 4), p = 0.35. Regarding Tegner activity scale after 10 years, the BPTB group showed a mean score of 5.9 (min. 4, max. 9) versus 5.1 (min. 3, max. 7) in the ST group, p = 0.53. For the Lysholm score the BPTB group reached a mean of 92.0 (min. 63, max. 98) and the ST group 91.8 (min. 62, max. 98) points, p = 0.66. There is a tendency for higher donor site morbidity in the BPTB group than in the ST group, p = 0.07. Both, patellar tendon and semitendinosus tendon are safe autografts for ACL reconstruction. Regarding graft selection, individual patient-dependent factors should be considered. ACL reconstruction

  8. Predictive parameters for return to pre-injury level of sport 6 months following anterior cruciate ligament reconstruction surgery.

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    Müller, Ulrike; Krüger-Franke, Michael; Schmidt, Michael; Rosemeyer, Bernd

    2015-12-01

    The aim of the study was to find predictive parameters for a successful resumption of pre-injury level of sport 6 months post anterior cruciate ligament (ACL) reconstruction. In a prospective study, 40 patients with a ruptured ACL were surgically treated with semitendinosus tendon autograft. Six months after surgery, strength of knee extensors and flexors, four single-leg hop tests, Anterior Cruciate Ligament-Return to Sport after Injury Scale (ACL-RSI), subjective International Knee Documentation Committee (IKDC) 2000 and the Tampa Scale of Kinesiophobia-11 (TSK-11) were assessed. Seven months post-operatively, a standardized interview was conducted to identify "return to sport" (RS) and "non-return to sport" (nRS) patients. Logistic regression and "Receiver Operating Characteristic" (ROC) analyses were used to determine predictive parameters. No significant differences could be detected between RS and nRS patients concerning socio-demographic data, muscle tests, square hop and TSK-11. In nRS patients, the Limb Symmetry Index (LSI) of single hop for distance (p = 0.005), crossover hop (p = 0.008) and triple hop (p = 0.001) were significantly lower, in addition to the ACL-RSI (p = 0.013) and IKDC 2000 (p = 0.037). The cut-off points for LSI single hop for distance were 75.4 % (sensitivity 0.74; specificity 0.88), and for ACL-RSI 51.3 points (sensitivity 0.97; specificity 0.63). Logistic regression distinguished between RS and nRS subjects (sensitivity 0.97; specificity 0.63). The single hop for distance and ACL-RSI were found to be the strongest predictive parameters, assessing both the objective functional and the subjective psychological aspects of returning to sport. Both tests may help to identify patients at risk of not returning to pre-injury sport. II.

  9. Magnetic resonance imaging analysis of the bioabsorbable Milagro interference screw for graft fixation in anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Frosch, K-H; Sawallich, T; Schütze, G; Losch, A; Walde, T; Balcarek, P; Konietschke, F; Stürmer, K M

    2009-10-01

    Ligament graft fixation with bioabsorbable interference screws is a standard procedure in cruciate ligament replacement. Previous screw designs may resorb incompletely, and can cause osteolysis and sterile cysts despite being implanted for several years. The aim of this study was to examine the in vivo degradation and biocompatibility of the new Milagro interference screw (Mitek, Norderstedt, Germany). The Milagro interference screw is made of 30% ss-TCP (TriCalcium phosphate) and 70% PLGA (Poly-lactic-co-glycolic acid). In the period between June 2005 and February 2006, 38 patients underwent graft fixation with Milagro screws in our hospital. Arthroscopic ACL reconstruction was performed using hamstring tendon grafts in all the patients. MR imaging was performed on 12 randomly selected patients out of the total of 38 at 3, 6 and 12 months after surgery. During the examination, the volume loss of the screw, tunnel enlargement, presence of osteolysis, fluid lines, edema and postoperative screw replacement by bone tissue were evaluated. There was no edema or signs of inflammation around the bone tunnels. At 3, 6 and 12 months, the tibial screws showed an average volume loss of 0, 8.1% (+/-7.9%) and 82.6% (+/-17.2%, P Milagro screw is closely linked to the graft healing process. The screws were rapidly resorbed after 6 months and, at 12 months, only the screw remnants were detectable. Moreover, the Milagro screw is biocompatible and osteoconductive, promoting bone ingrowth during resorption. Tunnel enlargement is not prevented in the first months but is reduced by bone ingrowth after 12 months.

  10. Importance of anatomically locating the infrapatellar branch of the saphenous nerve in reconstructing the anterior cruciate ligament using flexor tendons,

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    Julio Cesar Gali

    2014-12-01

    Full Text Available Objective:To describe the path of the infrapatellar branch of the saphenous nerve (IBSN using the medial joint line, anterior tibial tuberosity (ATT, tibial collateral ligament and a horizontal line parallel to the medial joint line that passes over the ATT, as reference points, in order to help surgeons to diminish the likelihood of injuring this nerve branch during reconstruction of the anterior cruciate ligament (ACL using flexor tendons.Methods:Ten frozen knees that originated from amputations were examined. Through anatomical dissection performed with the specimens flexed, we sought to find the IBSN, from its most medial and proximal portion to its most lateral and distal portion. Following this, the anatomical specimens were photographed and, using the ImageJ software, we determined the distance from the IBSN to the medial joint line and to a lower horizontal line going through the ATT and parallel to the first line. We also measured the angle of the direction of the path of the nerve branch in relation to this lower line.Results:The mean angle of the path of the nerve branch in relation to the lower horizontal line was 17.50 ±6.17°. The mean distance from the IBSN to the medial joint line was 2.61 ± 0.59 cm and from the IBSN to the lower horizontal line, 1.44 ±0.51 cm.Conclusion:The IBSN was found in all the knees studied. In three knees, we found a second branch proximal to the first one. The direction of its path was always from proximal and medial to distal and lateral. The IBSN was always proximal and medial to the ATT and distal to the medial joint line. The medial angle between its direction and a horizontal line going through the ATT was 17.50 ± 6.17°.

  11. Sex-specific gait adaptations prior to and up to 6 months after anterior cruciate ligament reconstruction.

    Science.gov (United States)

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

    2015-03-01

    Controlled longitudinal laboratory study. To compare sagittal plane gait mechanics of men and women before and up to 6 months after anterior cruciate ligament reconstruction (ACLR). Aberrant gait patterns are ubiquitous after anterior cruciate ligament (ACL) rupture and persist after ACLR despite skilled physical therapy. Sex influences postoperative function and second-ACL injury risk, but its influence on gait adaptations after injury has not been investigated. Sagittal plane knee and hip joint excursions during midstance and internal knee and hip extension moments at peak knee flexion were collected in 12 women and 27 men using 3-D gait analysis before (screening) and after preoperative physical therapy (presurgery), and 6 months after ACLR (6 months postsurgery). Repeated-measures analysis-of-variance models were used to determine whether limb asymmetries changed differently over time in men and women. Significant time-by-limb-by-sex interactions were identified for hip and knee excursions and internal knee extension moments (P ≤.007). Both sexes demonstrated smaller knee excursions on the involved limb compared to the uninvolved limb at each time point (P ≤.007), but only women demonstrated a decrease in the involved knee excursion from presurgery to 6 months postsurgery (P = .03). Women also demonstrated smaller hip excursions (P<.001) and internal knee extension moments (P = .005) on the involved limb compared to the uninvolved limb at 6 months postsurgery. Men demonstrated smaller hip excursions and knee moments on the involved limb compared to the uninvolved limb (P<.001) regardless of time. The persistence of limb asymmetries in men and women 6 months after ACLR indicates that current postoperative rehabilitation efforts are inadequate for some individuals following ACLR.

  12. The Effect of Limited Perioperative Nonsteroidal Anti-inflammatory Drugs on Patients Undergoing Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Soreide, Endre; Granan, Lars-Petter; Hjorthaug, Geir A; Espehaug, Birgitte; Dimmen, Sigbjørn; Nordsletten, Lars

    2016-12-01

    The administration of nonsteroidal anti-inflammatory drugs (NSAIDs) to patients undergoing anterior cruciate ligament reconstruction (ACLR) is controversial because it may impair tissue healing and clinical outcomes. To assess the effect of NSAID administration on patients undergoing ACLR. Cohort study; Level of evidence, 3. Included patients were aged >15 years and were registered in the Norwegian Knee Ligament Registry from 2008 until 2013 after the primary ACLR. Patients with insufficient data regarding administration of NSAIDs and those with associated knee ligament injuries requiring surgical treatment were excluded from this study. Graft survival was estimated using Kaplan-Meier survival curves, and hazard ratios (HRs) for revision were evaluated using Cox regression analysis. Logistic regression analysis was used to calculate the odds ratio (OR) for a Knee Injury and Osteoarthritis Outcome Score (KOOS)-quality of life (QOL) subscale score <44 at 2-year follow-up. A total of 7822 patients were included in the analysis for graft survival and assessment for risk of revision. Of these, 4144 patients were administered NSAIDs postoperatively. The mean duration of follow-up was 2.8 years (range, 0-5.9 years). Administration of NSAIDs did not influence graft survival (P = .568). Adjusted Cox regression analyses demonstrated the same finding regarding risk of revision (HR, 1.0; 95% CI, 0.8-1.3). ACLR using a bone-patellar tendon-bone autograft showed a reduced risk of revision (HR, 0.3; 95% CI, 0.1-0.8) among patients administered NSAIDs. In subgroup analyses of 3144 patients, administration of NSAIDs demonstrated a beneficial effect on the risk of a KOOS-QOL score <44 at 2-year follow-up (OR, 0.8; 95% CI, 0.6-0.9). Administration of NSAIDs to patients after ACLR does not have a negative effect on graft survival, risk of revision, or risk of a KOOS-QOL score <44 at 2-year follow-up. We emphasize using caution when administering NSAIDs by keeping the duration and

  13. Evaluation of information available on the Internet regarding anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Duncan, Ian C; Kane, Patrick W; Lawson, Kevin A; Cohen, Steven B; Ciccotti, Michael G; Dodson, Christopher C

    2013-06-01

    Searching the Internet is one of the most popular methods for acquiring information related to health. The Internet offers physicians and patients easy access to a wide range of medical material from anywhere in the world. For many patients, this information helps formulate decisions related to their health and health care. An important caveat is that virtually anything can be published on the Internet. Although academic publications require rigorous peer review, Internet websites have no regulatory body monitoring quality and content. With a lack of external regulation, the information retrieved may be incorrect or outdated. The Internet can be a valuable asset for educating patients, but because of significant variability physicians should be familiar with the quality of information available. This article discusses both the strengths and weaknesses of information available on the Internet regarding anterior cruciate ligament repair. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  14. Gold and Hydroxyapatite Nano-Composite Scaffolds for Anterior Cruciate Ligament Reconstruction: In Vitro Characterization.

    Science.gov (United States)

    Smith, S E; White, R A; Grant, D A; Grant, S A

    2016-01-01

    Current anterior cruciate ligament (ACL) graft replacement materials often fail due to the lack of biological integration. While many newly developed extracellular matrix based scaffolds show good biocompatibility they often do not entice cellular remodeling and the rebuilding of a functional ligament. We have proposed the conjugation of gold nanoparticles (AuNP) and hydroxyapatite nanoparticles (nano-HAp) to acellular tissue to enhance cell attachment and proliferation while maintaining an improved degradation resistance and open microstructure. We are the first to investigate the double conjugation of AuNP and nano-HAp onto decellularized tissue to improve the tissue remodeling response. Decellularized porcine diaphragm was crosslinked with two types of nano-HAp and amine-functionalized AuNP with 1-ethyl-3-(3-dimethlaminopropyl) carbodiimide (EDC) crosslinker. Scaffolds were characterized using electron microscopy, differential scanning calorimetry, and fibroblast assays. Results demonstrated that scaffolds with nano-HAp have increased thermal stability at low levels of crosslinking. The open microstructure of the scaffold was not compromised allowing for cell migration while still providing increased degradation resistance. The addition of < 200 nm nano-HAp decreased cell viability compared to scaffolds without nanoparticles, but the addition of AuNP to scaffolds showed enhanced cell viability in the presence of < 200 nm nano-HAp. The addition of < 40 nm nano-HAp showed an increase in cell viability compared to scaffolds crosslinked without nanoparticles. It is concluded that attaching AuNP and < 40nm nano-HAp to extracellular matrices may improve overall properties.

  15. Influence of screw length and diameter on tibial strain energy density distribution after anterior cruciate ligament reconstruction

    Science.gov (United States)

    Yao, Jie; Kuang, Guan-Ming; Wong, Duo Wai-Chi; Niu, Wen-Xin; Zhang, Ming; Fan, Yu-Bo

    2014-04-01

    Postoperative tunnel enlargement has been frequently reported after anterior cruciate ligament (ACL) reconstruction. Interference screw, as a surgical implant in ACL reconstruction, may influence natural loading transmission and contribute to tunnel enlargement. The aims of this study are (1) to quantify the alteration of strain energy den sity (SED) distribution after the anatomic single-bundle ACL reconstruction; and (2) to characterize the influence of screw length and diameter on the degree of the SED alteration. A validated finite element model of human knee joint was used. The screw length ranging from 20 to 30mm with screw diameter ranging from 7 to 9 mm were investigated. In the post-operative knee, the SED increased steeply at the extra-articular tunnel aperture under compressive and complex loadings, whereas the SED decreased beneath the screw shaft and nearby the intra-articular tunnel aperture. Increasing the screw length could lower the SED deprivation in the proximal part of the bone tunnel; whereas increasing either screw length or diameter could aggravate the SED deprivation in the distal part of the bone tunnel. Decreasing the elastic modulus of the screw could lower the bone SED deprivation around the screw. In consideration of both graft stability and SED alteration, a biodegradable interference screw with a long length is recommended, which could provide a beneficial mechanical environment at the distal part of the tunnel, and meanwhile decrease the bone-graft motion and synovial fluid propagation at the proximal part of the tunnel. These findings together with the clinical and histological factors could help to improve surgical outcome, and serve as a preliminary knowledge for the following study of biodegradable interference screw. [Figure not available: see fulltext.

  16. 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.

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    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

  17. Postoperative septic arthritis with Eikenella corrodens and Streptococcus mitis following arthroscopic anterior cruciate ligament reconstruction in an adolescent: A case report and review of the literature

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    Richard K. Hurley, Jr.

    2016-12-01

    Full Text Available We present a case of postoperative septic arthritis with Eikenella corrodens and Streptococcus mitis following an arthroscopic anterior cruciate ligament reconstruction in an adolescent male with no pertinent medical history. The patient presented to the emergency department nine days after the operation with fever, an elevated white blood cell count, knee pain, and effusion. Arthrocentesis of the knee yielded purulent fluid that tested positive for S. mitis. Repeat intraoperative cultures revealed E. corrodens. In addition to antibiotics, the patient's treatment course included arthroscopic irrigation and debridement in the operating room as well as removal of graft material and fixation devices. To our knowledge, this is the first case of a polymicrobial infection of E. corrodens and S. mitis causing septic arthritis in a teenager following arthroscopic anterior cruciate ligament reconstruction.

  18. A Novel Percutaneous Screw Fixation of Postero-lateral Tibial Plateau Fracture using Posterior Cruciate Ligament Reconstruction Femoral Template: Technical Note

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    Angus Chao Kun Chan

    2017-06-01

    Full Text Available Percutaneous fixation method has been applied in Schatzker type III joint depressed-type lateral tibial plateau fracture. We report a 76-year-old man suffering from a small joint depressed-type posterolateral tibial plateau fracture with surgical reduction and fixation with a novel guidance of posterior cruciate ligament (PCL reconstruction femoral template under X-ray and arthroscopic assistance. The concept of sequential tunnel drilling in ligament reconstruction has been applied in bone impaction tunnel creation beneath the articular step with the PCL jig. Avoidance of multiple bone guide pin drilling and accurate guide pin insertion and hence screw fixation was also achieved by use of the PCL template. As illustrated, we believe that the PCL jig is a good armamentarium and adjunct equipment to achieve a more precise minimally invasive operation in special anatomical positions such as the postero-lateral tibial plateau under careful surgical planning.

  19. Landing mechanics during side hopping and crossover hopping maneuvers in noninjured women and women with anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Ortiz, Alexis; Olson, Sharon; Trudelle-Jackson, Elaine; Rosario, Martin; Venegas, Heidi L

    2011-01-01

    To compare, landing mechanics and electromyographic activity of the lower extremities during side hopping and crossover hopping maneuvers, in noninjured women and women with anterior cruciate ligament (ACL) reconstruction. A case-control study. A 3-dimensional motion analysis laboratory. Twenty-eight young women (range, 21-35 years) (15 control subjects and 13 subjects with ACL reconstruction). All participants performed a side-to-side hopping task that consisted of hopping single-legged 10 times consecutively from side to side across 2 lines marked 30 cm apart on 2 individual force plates. The task was designated as a side hopping when the hop was to the opposite side of the stance leg and as crossover hopping when the hop was toward the side of the stance leg. Peak hip-/knee-joint angles; peak knee extension/abduction joint moments; electromyographic studies of the gluteus maximus, gluteus medius, rectus femoris, and hamstring muscles; and quadriceps/hamstring co-contraction ratio were compared between the groups by means of 2 × 2 multivariate analysis of variance tests (group × maneuver). Noninjured women and women with ACL reconstruction exhibited similar hip- and knee-joint angles during both types of hopping. Hip-joint angles were greater during the crossover hopping in both groups, and knee-joint angles did not differ between the groups or hops. Knee-joint moments demonstrated a significant group × maneuver interaction. Greater knee extension and valgus moments were noted in the control group during crossover hopping, and greater knee abduction moments were noted in the ACL group during side hopping. Electromyographic data revealed no statistically significantly differences between the groups. Women with ACL reconstruction exhibited the restoration of functional biomechanical movements such as hip-/knee-joint angles and lower extremity neuromuscular activation during side-to-side athletic tasks. However, not all biomechanical strategies are restored years

  20. Outcomes of the patellar tendon and hamstring graft anterior cruciate ligament reconstructions in patients aged above 50 years

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    Tarun Bali

    2015-01-01

    Full Text Available Background: The treatment of anterior cruciate ligament (ACL injury consists of arthroscopic ACL reconstruction with patellar tendon or hamstring graft. Satisfactory results have been reported so far in the younger age group. Dilemma arises regarding the suitability of ACL reconstruction in the patients aged 50 years and above. This retrospective analyses the outcome of ACL reconstruction in patients aged 50 years and above at the time of presentation. Materials and Methods: 55 patients aged 50 years and above presented to our institution with symptomatic ACL tear and were managed with arthroscopic reconstruction with patellar tendon/hamstring graft. 22 patients underwent ACL reconstruction with bone- patellar tendon-bone graft and the remaining 33 with a hamstring graft. Evaluation of functional outcome was performed using International Knee Documentation Committee (IKDC and Lysholm scoring in the preoperative period, at the end of 1 year and at the final followup. Radiographic evaluation was performed using the Kellgren–Lawrence grading system. Results: The mean preoperative IKDC score was 39.7 ± 3.3. At the end of 1-year following the operation, the mean IKDC score was 73.6 ± 4.9 and at the final followup was 67.8 ± 7.7. The mean preoperative Lysholm score was 40.4 ± 10.3. At the end of 1-year following the intervention, the mean Lysholm score was 89.7 ± 2.1 and at final followup was 85.3 ± 2.5. Overall, 14 out of 42 patients who underwent radiographic assessment showed progression of osteoarthritis changes at the final followup after the intervention. Conclusion: In our study, there was a statistically significant improvement in the IKDC and Lysholm scores following the intervention. There was a slight deterioration in the scores at the final followup but