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Sample records for cruciate ligament allograft

  1. Anterior cruciate ligament allograft transplantation for intraarticular ligamentous reconstruction.

    Science.gov (United States)

    Goertzen, M; Dellmann, A; Gruber, J; Clahsen, H; Bürrig, K F

    1992-01-01

    A multiplicity of surgical operations have been developed in an attempt to achieve satisfactory function after anterior cruciate ligament (ACL) repair. None of these procedures have been able to reproduce the fiber organization anatomy of attachment site, vascularity, or function of the ACL. Twenty-nine foxhounds received a deep-frozen bone-ACL-bone allograft and a ligament augmentation device (LAD). Biomechanical, microvascular, and histological changes were evaluated 3, 6, and 12 months following implantation. The maximum loads of the allograft/LADs were 34.3% (387.2 N) after 3 months, 49.3% (556.6 N) after 6 months, and 61.1% (698.8 N) after a year. The maximum load was 69.1% (780 N). In general, after 6 months the allografts showed normal collagen orientation. The allografts demonstrated no evidence of infection or immune reaction. No bone ingrowth into the LAD was observed. Polarized light microscopy and periodic acid-schiff staining showed that the new bone-ligament substance interface had intact fiber orientation at the area of the ligament insertion. Microvascular examination using the Spalteholtz technique revealed revascularization and the importance of an infrapatellar fat pad for the nourishment of ACL allografts.

  2. Anterior cruciate ligament reconstruction using the bone-posterior cruciate ligament-bone allograft

    Institute of Scientific and Technical Information of China (English)

    JIAO Chen; AO Ying-fang; LIU Ping; XIE Xing; LIU Chen; MA Yong

    2013-01-01

    Background AIIografts were widely used in anterior cruciate ligament (ACL) reconstruction for patients with ACL rupture of the knee.This study was to approve the feasibility of bone-posterior cruciate ligament-bone (BPCLB) allograft transplantation in ACL reconstruction.Methods Eight patients underwent ACL reconstructions with BPCLB allografts and were followed up for an average period of 32 months after operation.Results Subjective parameters including Intemational Knee Documentation Committee (IKDC),modified Larson knee ligament,Lysholm,and Tegner rating scales were much improved and side to side KT-2000 arthrometer difference was much less postoperatively.Pivot shift test was negative in all patients.The reconstructed ACL had satisfactory shape and tension.Conclusions BPCLB allograft is an optional choice forACL reconstruction.

  3. Anterior cruciate ligament reconstruction with allograft tendons.

    Science.gov (United States)

    Strickland, Sabrina M; MacGillivray, John D; Warren, Russell F

    2003-01-01

    Allograft tissue allows reconstruction of the ACL without the donor site morbidity that can be caused by autograft harvesting. Patients who must kneel as a part of their occupation or chosen sport are particularly good candidates for allograft reconstruction. Patients over 45 years of age and those requiring revision ACL surgery can also benefit from the use and availability of allograft tendons. In some cases, patients or surgeons may opt for allograft tendons to maximize the result or morbidity ratio. Despite advances in cadaver screening and graft preparation, there remain risks of disease transmission and joint infection after allograft implantation. Detailed explanation and informed consent is vitally important in cases in which allograft tissue is used.

  4. Allograft safety in anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Cohen, Steven B; Sekiya, Jon K

    2007-10-01

    Allograft tissue seems to provide an excellent option for reconstruction of the ACL in the primary and revision setting. Although in general the risks of using allograft tissue in ACL reconstruction are low, the consequences of complications associated with disease or infection transmission or of recurrent instability secondary to graft failure are large. Surgeons should provide patients with the information available regarding allograft risks and should have thorough knowledge of the source and preparation of the grafts by their tissue bank before implantation for ACL reconstruction.

  5. Autograft versus allograft in anterior cruciate ligament reconstruction

    Science.gov (United States)

    Kan, Shun-Li; Yuan, Zhi-Fang; Ning, Guang-Zhi; Yang, Bo; Li, Hai-Liang; Sun, Jing-Cheng; Feng, Shi-Qing

    2016-01-01

    Abstract Background: Anterior cruciate ligament (ACL) reconstruction is considered as the standard surgical procedure for the treatment of ACL tear. However, there is a crucial controversy in terms of whether to use autograft or allograft in ACL reconstruction. The purpose of this meta-analysis is to compare autograft with allograft for patients undergoing ACL reconstruction. Methods: PubMed, EMBASE, and the Cochrane Library were searched for randomized controlled trials that compared autograft with allograft in ACL reconstruction up to January 31, 2016. The relative risk or mean difference with 95% confidence interval was calculated using either a fixed- or random-effects model. The risk of bias for individual studies according to the Cochrane Handbook. The trial sequential analysis was used to test the robustness of our findings and get more conservative estimates. Results: Thirteen trials were included, involving 1636 participants. The results of this meta-analysis indicated that autograft brought about lower clinical failure, better overall International Knee Documentation Committee (IKDC) level, better pivot-shift test, better Lachman test, greater Tegner score, and better instrumented laxity test (P allograft. Autograft was not statistically different from allograft in Lysholm score, subjective IKDC score, and Daniel 1-leg hop test (P > 0.05). Subgroup analyses demonstrated that autograft was superior to irradiated allograft for patients undergoing ACL reconstruction in clinical failure, Lysholm score, pivot-shift test, Lachman test, Tegner score, instrumented laxity test, and subjective IKDC score (P allograft. Conclusions: Autograft is superior to irradiated allograft for patients undergoing ACL reconstruction concerning knee function and laxity, but there are no significant differences between autograft and nonirradiated allograft. However, our results should be interpreted with caution, because the blinding methods were not well used. PMID

  6. Septic arthritis following anterior cruciate ligament reconstruction using tendon allografts--Florida and Louisiana, 2000.

    Science.gov (United States)

    2001-12-01

    In the United States, approximately 50,000 knee surgeries are performed each year for repairing anterior cruciate ligament (ACL) injuries. Tissue allografts frequently are used for ACL reconstruction, and septic arthritis is a rare complication of such procedures. This report describes four patients who acquired postsurgical septic arthritis probably associated with contaminated bone-tendon-bone allografts used for ACL reconstruction. Effective sterilization methods that do not functionally alter musculoskeletal tissue are needed to prevent allograft-related infections.

  7. Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts.

    Science.gov (United States)

    Valenti, J R; Sala, D; Schweitzer, D

    1994-01-01

    A prospective study was performed on 30 patients who underwent an anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allograft. An arthroscopic technique alone was used in 10 patients, and in the other 20 patients this was combined with a miniarthrotomy. After a mean follow up of 35 months, the overall functional results were satisfactory in 85%. There were no cases of infection, disease transmission or tissue rejection. Fresh-frozen patellar tendon allografts are a good method of anterior cruciate reconstruction.

  8. Long-term outcomes of allograft reconstruction of the anterior cruciate ligament.

    Science.gov (United States)

    Lenehan, Eric A; Payne, W Barrett; Askam, Brad M; Grana, William A; Farrow, Lutul D

    2015-05-01

    Recent studies have found higher rates of failed reconstruction of the anterior cruciate ligament (ACL) with use of allograft when compared with autograft reconstruction. To evaluate the long-term outcomes of allograft ACL reconstruction, we retrospectively reviewed the cases of all patients who underwent allograft (n=99) or autograft (n=24) ACL reconstruction by 2 senior surgeons at a single institution over an 8-year period. Seventeen (17%) of the 99 allograft reconstructions required additional surgery. Reoperation and revision ACL reconstruction rates (30.8% and 20.5%, respectively) were much higher for patients 25 years of age or younger than for patients older than 25 years. In our cohort of NCAA (National Collegiate Athletic Association) Division I athletes, the revision ACL reconstruction rate was 62% for allograft ACL reconstruction and 0% for autograft reconstruction. Our study found that reoperation and revision rates for irradiated soft-tissue allograft ACL reconstruction were higher than generally quoted for autograft reconstruction. Given the extremely high graft failure rates in patients younger than 25 years, we recommend against routine use of irradiated soft-tissue allograft for ACL reconstruction in younger patients.

  9. The modified bone-patellar tendon-bone allograft in single-bundle anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Kang, Huijun; Wang, Fei

    2011-06-01

    Bone-patellar tendon-bone graft has been an attractive option for single-bundle anterior cruciate ligament reconstruction in clinical practice. However, the graft-tunnel mismatch in the proximal part of the tibial tunnel and the ultimate strength after postoperative ligamentization process have been potential problems for the traditional 10-mm wide graft. We modified the traditional bone-patellar tendon-bone allograft to make it double-layer, as an ideal substitute graft for single-bundle anterior cruciate ligament reconstruction with better graft-tunnel match and higher initial graft strength.

  10. A long-term study of anterior cruciate ligament allograft reconstruction.

    Science.gov (United States)

    Almqvist, K F; Willaert, Pieter; De Brabandere, S; Criel, K; Verdonk, R

    2009-07-01

    We retrospectively reviewed the long-term clinical outcome of unilateral arthroscopic anterior cruciate ligament (ACL) allograft reconstruction. From October 1995 to December 1997, 64 arthroscopic ACL reconstructions were performed. Multiligamentous knee injuries and ACL injuries in polytrauma patients were excluded and out of the remaining 60 patients 55 were available for follow-up. Three patients had suffered a rerupture caused by major trauma. One patient had a rerupture without significant trauma and one failure was caused by deep infection. These five patients were revised. Fifty patients (36 males, 14 females) were included in the final follow-up. At the time of evaluation, the mean duration of follow-up was 10 years and 6 months. All patients were examined by an independent examiner. Seven patients had an extension lag (anterior or tibialis posterior tendon allograft ACL reconstruction produced good clinical results in the majority of patients at long-term follow-up.

  11. Revision anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft and extra-articular iliotibial band tenodesis.

    Science.gov (United States)

    Mascarenhas, Randy; McConkey, Mark O; Forsythe, Brian; Harner, Christopher D

    2015-04-01

    Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding procedure with outcomes that generally fail to reach those seen with primary ACL reconstruction. With most index procedures using autograft tissue, it is not uncommon for allograft tissue to be required for revision ACL reconstruction. Compared with autografts, allografts take longer to incorporate and lead to more episodes of instability. In this article, we describe ipsilateral iliotibial band tenodesis performed to augment use of bone-patellar tendon-bone allograft in revision ACL reconstruction. This technique adds rotational stability to protect the allograft tissue while it incorporates.

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

    Institute of Scientific and Technical Information of China (English)

    Yu-Hua Jia; Peng-Fei Sun

    2015-01-01

    Background: Hamstring (HS) autograft and bone-patellar tendon-bone allograft are the most common choice for reconstruction of anterior cruciate ligament (ACL).There was a little report about the clinical outcome and difference of arthroscopic ACL reconstruction using allograft and autograft.This study aimed to compare the clinical outcome of autograft and allograft reconstruction for ACL tears.Methods: A total of 106 patients who underwent surgery because of ACL tear were included in this study.The patients were randomly divided into two groups, including 53 patients in each group.The patients in group Ⅰ underwent standard ACL reconstruction with HS tendon autografts, while others in group Ⅱ underwent reconstruction with bone-patellar tendon-bone allograft.All the patients were followed up and analyzed;the mean follow-up was 81 months (range: 28-86 months).Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC), Lysholm scores, physical instability tests, and patient satisfaction questionnaires.The complication rates of both groups were compared.Tibial and femoral tunnel widening were assessed using lateral and anteroposterior radiographs.Results: At the end of follow-up, no significant differences were found between the groups in terms of IKDC, Lysholm scores, physical instability tests, patient satisfaction questionnaires, and incidences of arthrofibrosis.Tibial and femoral tunnel widening was less in the HS tendon autografts.This difference was more significant on the tibial side.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.

  13. Histological comparison of fate of ligamentous insertion after reconstruction of anterior cruciate ligament:autograft vs allograft

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective: To analyze the histological results and the biological remodeling of ligamentous insertion after the reconstruction of anterior cruciate ligament ( ACL ) with autograft or allograft tendon.Methods: Extensor digitorum tendon was harvested from hind limb as graft material and transplanted to reconstruct the resected ACL in 12 mongrel dogs. Each free tendon end was secured by holding sutures and then the sutures were tied to the post screw at the femoral and tibial bony tunnel outlet after transplantation respectively.Autograft was randomly performed on one side of knee while allograft on the other side of knee. After transplantation, the histological analysis was undertaken at the 6th, 12th weeks and the 6th month using hematoxylineosin (HE) stain under light microscope.Results: The insertion structure of normal ACL typically consisted of four layers, I. E., dense connective tissue, fibrocartilage, mineralized fibrocartilage and bone.There was a distinct regular tidemark line between fibrocartilage and mineralized fibrocartilage. At the 6th week postoperatively, loose connective tissue presented in the interspace between graft and bony tunnel wall in both autograft and allograft groups. At the 12th week postoperatively, the collagenous fibers between autograft and tunnel wall became well organized and the four layers of insertion with discontinuous tidemark line were demonstrated indistinctly in autograft group but not in allograft group. At the 6th month postoperatively, both of a clear and continuous tidemark line and distinct four layers could be seen in autograft group. In allograft group, only a waved discontinuous tidemark line was shown and either the anatomic morphology or the maturity of insertion was inferior to that of autograft group.Conclusions: At the 6th month postoperatively,although the ligament-cartilage insertion is primarily formed after ACL reconstruction with autograft or allograft tendon, the histological morphology and the

  14. Transphyseal anterior cruciate ligament reconstruction in a skeletally immature knee using anterior tibialis allograft.

    Science.gov (United States)

    Cho, Yool; Jang, Soo-Jin; Son, Jung-Hwan

    2011-05-18

    Anterior cruciate ligament (ACL) injury in the skeletally immature individual is being recognized with increasing frequency. Nonoperative treatment of ACL injuries in skeletally immature patients have not been favorable. Surgical treatment options for complete ACL tears include primary ligament repair, extraarticular tenodesis, transphyseal reconstruction, partial transphyseal reconstruction, and physeal-sparing reconstruction. The advantage of transphyseal reconstruction is placement of the graft tissue in an isometric position, which provides better results, according to the literature. The potential disadvantage is angular or limb-length discrepancy caused by physeal violation. Controversy exists in allograft selection about whether bone or soft tissue passes into physes. The use of standard tunnels provides reliable results, but carries the risk of iatrogenic growth disturbance from physeal injury.This article presents 4 cases of transphyseal ACL reconstruction using anterior tibialis allograft in skeletally immature patients that had satisfactory functional outcomes with no growth disturbances. This is the first report of transphyseal ACL reconstruction using anterior tibialis allograft in skeletally immature patients in the English-speaking literature. All patients underwent transphyseal ACL reconstruction using anterior tibialis tendon allograft. None of the patients had angular deformities. No early physeal arrest was measured between the preoperative and postoperative radiographs. At last follow-up, the results of the Lachman test were normal for 3 patients and nearly normal for 1 patient. All patients demonstrated full range of knee motion (comparing the reconstructed knee to the contralateral knee). The results of the pivot-shift test were normal for 3 patients and nearly normal for 1 patient. No patients reported giving way.

  15. Two-Stage Revision Anterior Cruciate Ligament Reconstruction: Bone Grafting Technique Using an Allograft Bone Matrix.

    Science.gov (United States)

    Chahla, Jorge; Dean, Chase S; Cram, Tyler R; Civitarese, David; O'Brien, Luke; Moulton, Samuel G; LaPrade, Robert F

    2016-02-01

    Outcomes of primary anterior cruciate ligament (ACL) reconstruction have been reported to be far superior to those of revision reconstruction. However, as the incidence of ACL reconstruction is rapidly increasing, so is the number of failures. The subsequent need for revision ACL reconstruction is estimated to occur in up to 13,000 patients each year in the United States. Revision ACL reconstruction can be performed in one or two stages. A two-stage approach is recommended in cases of improper placement of the original tunnels or in cases of unacceptable tunnel enlargement. The aim of this study was to describe the technique for allograft ACL tunnel bone grafting in patients requiring a two-stage revision ACL reconstruction.

  16. Allograft Anterior Cruciate Ligament Reconstruction in Patients Younger than 25 Years.

    Science.gov (United States)

    Carter, Thomas R; Rabago, Michael T

    2016-05-01

    Purpose The purpose of this study was to evaluate the outcomes for patients younger than 25 years who had anterior cruciate ligament (ACL) reconstructions with allograft tissue. Methods A total of 52 ACL reconstructions performed with fresh-frozen, nonirradiated tibialis or Achilles allografts in active patients younger than 25 years. Outcome evaluations included the International Knee Documentation Committee (IKDC) objective and subjective forms, KT-1000 arthrometry and Lysholm. Results Forty-two patients were available for follow-up at an average follow-up of 65 months (range, 33-99 months). The average age at surgery was 17 years and 7 months (range, 11 years 10 months-24 years 8 months). Objective and subjective data were obtained from 37 patients with 1 requiring revision, and 5 patients had only subjective data. IKDC objective results were 29-A and 5-B. KT-1000 differences were 0 mm for 4 patients, 1 mm for 23, 2 mm for 8, 3 mm for 1, and > 5 mm for 1 patient. The average IKDC subjective score was 90.2 ± 15.0 and average Lysholm score was 90.0 ± 11. Conclusion The result of our study found that using nonirradiated Achilles or tibialis tendon allografts for ACL reconstructions in active patients younger than 25 years can achieve good outcomes, with a low rate of failure.

  17. Anterior cruciate ligament reconstruction with Achilles tendon allografts in revisions and in patients older than 30.

    Science.gov (United States)

    Grafe, Michael W; Kurzweil, Peter R

    2008-06-01

    We evaluated the results of anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft in revisions and in patients older than 30. Results from 23 consecutive patients (mean age, 43 years) who underwent ACL reconstruction with fresh-frozen, irradiated (22/23) Achilles allografts were retrospectively reviewed. Seven cases were revisions. Patients were evaluated with physical examination, questionnaires, and x-rays. Twenty of the 23 patients were evaluated a mean of 28 months after surgery. There were 5 failures (21%); 3 acute failures were not evaluated at follow-up. One patient had an infection that required graft removal, 2 patients had mechanical failure of the grafts, and 2 had displacements of more than 5.5 mm as measured with a KT-1000 arthrometer. The 18 clinically successful cases had full motion, no thigh atrophy, and no effusion. Pivot shift scores were 55% A and 45% B on the International Knee Documentation Committee (IKDC) scale. Lachman scores were 40% A, 55% B, and 5% C on the IKDC scale. The KT-1000 difference was a mean of 2.9 mm at final follow-up. However, knees loosened a mean of 4.5 mm from the immediate postoperative measurements (Preconstructions with Achilles tendon allografts failed. Grafts deemed successful still had significant loosening at final follow-up. Allografts from donors older than 40 may have played a role in these failures. From the data in this study, it appears that surgeons should scrutinize the source of the allograft tissue and the age of the donor.

  18. Mechanoreceptor Reinnervation of Autografts Versus Allografts After Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Young, Simon W.; Valladares, Roberto D.; Loi, Florence; Dragoo, Jason L.

    2016-01-01

    Background: Loss of proprioceptive function occurs after anterior cruciate ligament (ACL) rupture. Clinical, motor, and proprioceptive function is known to improve after ACL reconstruction but does not return to normal. While histological studies of human ACL allografts have been unable to demonstrate mechanoreceptor reinnervation, animal data suggest that reinnervation may occur when an autograft is used. Purpose: To compare the presence or absence of mechanoreceptors between allograft versus autograft after ACL reconstruction in humans. Study Design: Cohort study; Level of evidence, 3. Methods: Ten patients with previous ACL reconstruction presenting for either revision ACL surgery or knee arthroscopy for other reasons were enrolled in a prospective, comparative study. Five patients had a previous autograft ACL and 5 patients had an allograft. Biopsies, either from intact or ruptured grafts, were taken from identical locations as close to the femoral and tibial insertions as possible. Specimens were stained with hematoxylin-eosin (H-E) and monoclonal antibodies against neurofilament protein (NFP), known to be present in mechanoreceptor tissue. Immunohistochemical examination was carried out, and the number of NFP+ neural tissue analogs was counted and compared with that of native ACL tissue. Results: The mean time between original graft and biopsy was 6.9 years (range, 0.5-15 years). Histological examination showed significantly less NFP+ neural analogs in allograft and autograft patients than control tissue (mean number of NFP+ analogs per high-power field, 0.7 ± 0.9 [allograft] and 0.5 ± 0.8 [autograft] vs 4.7 ± 0.9 [controls]; P proprioceptive deficits seen clinically after ACL reconstruction. PMID:27803939

  19. Outcome of hamstring ligament harvest for Anterior Cruciate Ligament reconstruction with allograft versus autograft: a clinical trial

    Directory of Open Access Journals (Sweden)

    Mehdi Moghtadaei

    2013-11-01

    Full Text Available Background: The goal of this study was to evaluate, functional capacity of the knee in flexion and internal rotation after hamstring ligament harvest for Anterior Cruciate Ligament (ACL reconstruction.Methods: Fifty patients (male and 18-45 years old with isolated ACL injury, randomly allocated in two equal groups (in one group, ACL reconstruction was performed with Tibialis Posterior allograft and in another group with quadruple hamstring ligament auto graft and before and 6 months after surgery in both groups isokinetic flexion strength and isometric internal rotation strength of knee evaluated with Biodex System 4 dynamometer and rotational torque recorder, in order. Isokinetic flexion strength evaluated in sitting and prone position; the later position was performed for deep flexion strength evaluation. Also subjective and objective assessment of all patients pre operatively and 6 months post operatively was documented with International Knee Documentation Committee (IKDC questionnaire. In this study for first time, rotational torque strength of knee was recorded with new design measure, from isometric aspect and not isokinetic.Results: Although significant improvements in IKDC scores, flexion and internal rotation capacity of the knee were observed in both groups, post operatively in respect to pre operatively; there was no significant difference between 2 groups. (P<0.05 or more than 95% confidence Interval of the differenceConclusion: This study demonstrates that ACL reconstruction surgery, improves knee performance in flexion and internal rotation, regardless of hamstring tendon harvesting. Considering potential complications of allograft (for example: transfer of harmful diseases from donor to recipient, it is logical to use hamstring auto graft ligament for ACL reconstruction surgery. Because result of this study is not longstanding follow up and limited to male sex, for more worthfull conclusion, we suggest future study in both sex

  20. Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries.

    Science.gov (United States)

    Fanelli, Gregory C; Fanelli, David G; Edson, Craig J; Fanelli, Matthew G

    2014-10-01

    Combined anterior cruciate ligament (ACL) and posterolateral injury of the knee can result in significant functional instability for the affected individual. Both components of the instability must be treated to maximize the probability of success for the surgical procedure. Higher failure rates of the ACL reconstruction have been reported when the posterolateral instability has been left untreated. The purpose of this article is to describe our surgical technique, and present the results of 34 chronic combined ACL posterolateral reconstructions in 34 knees using allograft tissue, and evaluating these patient outcomes with KT 1000 knee ligament arthrometer, Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales. In addition, observations regarding patient demographics with combined ACL posterolateral instability, postoperative range of motion loss, postinjury degenerative joint disease, infection rate, return to function, and the use of radiated and nonirradiated allograft tissues will be presented.

  1. Anterior Cruciate Ligament Reconstruction Using a Combination of Autograft and Allograft Tendon

    Science.gov (United States)

    Darnley, James E.; Léger-St-Jean, Benjamin; Pedroza, Angela D.; Flanigan, David C.; Kaeding, Christopher C.; Magnussen, Robert A.

    2016-01-01

    Background: Anterior cruciate ligament (ACL) reconstruction with hamstring autografts less than 8.5 mm in diameter is associated with worse patient-reported outcome scores and increased risk of revision surgery compared with reconstructions performed with larger grafts. One proposed solution to small autograft harvest is to create a hybrid graft by augmenting autografts with allograft tissue to increase graft diameter. Purpose: To compare hybrid autograft/allograft ACL reconstruction to autograft ACL reconstruction, specifically analyzing the patient-reported outcome scores and the risk of revision surgery at 2 years postoperative. Study Design: Cohort study; Level of evidence, 3. Methods: From the years 2002 to 2009, a total of 34 patients were identified from a prospectively collected database as having undergone hybrid ACL reconstruction. Twenty-seven of 34 (79.4%) patients had a 2-year follow-up. These 27 patients were matched by age (within 1 year) and sex to 27 patients who underwent hamstring autograft ACL reconstruction during the same period. At the 2-year mark, revision surgery risk and patient-reported outcome scores were compared between the 2 groups. Results: The mean age for the hybrid and matched groups (±SD) was 20.9 ± 7.0 years. Both the hybrid and control groups had 17 males and 10 females. There was no significant difference in preoperative patient-reported outcome scores, meniscus tears, or cartilage lesions between the 2 groups. Graft size was larger in the hybrid group (9.5 ± 0.6 mm) than in the autograft group (8.4 ± 0.9 mm) (P reconstruction compared with 2 (7.4%) of those who underwent autograft reconstruction (P = .26). Conclusion: Patients who undergo ACL reconstruction with hybrid hamstring grafts and hamstring autografts report similar patient-reported outcome scores at 2 years postoperative but may be at increased risk for revision ACL reconstruction. PMID:27517057

  2. Anterior cruciate ligament reconstruction with BPTB autograft, irradiated versus non-irradiated allograft: a prospective randomized clinical study.

    Science.gov (United States)

    Sun, Kang; Tian, Shaoqi; Zhang, Jihua; Xia, Changsuo; Zhang, Cailong; Yu, Tengbo

    2009-05-01

    The effect of using gamma irradiation to sterilize bone-patellar tendon-bone (BPTB) allograft on the clinical outcomes of anterior cruciate ligament (ACL) reconstruction with irradiated allograft remains controversial. Our study was aimed to analyze the clinical outcomes of arthroscopic ACL reconstruction with irradiated BPTB allograft compared with non-irradiated allograft and autograft. All BPTB allografts were obtained from a single tissue bank and the irradiated allografts were sterilized with 2.5 Mrad of irradiation prior to distribution. A total of 102 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into three groups. The same surgical technique was used in all operations done by the same senior surgeon. Before surgery and at the average of 31 months follow-up (range 24-47 months) patients were evaluated by the same observer according to objective and subjective clinical evaluations. Of these patients, 99 (autograft 33, non-irradiated allograft 34, irradiated allograft 32) were available for full evaluation. When compared the irradiated allograft group to non-irradiated allograft group or autograft group at 31 months follow-up by the Lachman test, ADT, pivot shift test and KT-2000 arthrometer testing, statistically significant differences were found. Most importantly, 87.8% of patients in the Auto group, 85.3% in the Non-Ir-Auto group and just only 31.3% in the Ir-Allo group had a side-to-side difference of less than 3 mm according to KT-2000. The failure rate of the ACL reconstruction with irradiated allograft (34.4%) was higher than that with autograft (6.1%) and non-irradiated allograft (8.8%). The anterior and rotational stability decreased significantly in the irradiated allograft group. According to the overall IKDC, functional, subjective evaluations and activity level testing, no statistically significant differences were found between the three groups. However, there was a trend that the functional and

  3. Replacement of the anterior cruciate ligament of the knee with deep frozen bone-tendon-bone allografts.

    Science.gov (United States)

    Than, P; Bálint, L; Domán, I; Szabó, G

    1999-01-01

    Surgical treatment of the torn anterior cruciate ligament (ACL) and consequent knee instability showed great development over the last decade. Arthroscopic techniques and the use of different allogenic tissues became a routine. Between 1995 and 1998, 31 knees in 30 patients underwent ACL reconstruction of the knee with fresh-frozen allografts at the Department of Orthopedics, Medical University of Pécs, Hungary. The operations were performed with arthroscopic technique. This paper retrospectively assesses the outcomes with an average follow up of 28 months, which showed good results in most of the cases. The authors reviewed the literature emphasizing advantages and disadvantages of the method with special interest to possible complications resulting from the use of allografts: graft rejection, graft re-rupture, transmission of infection and synovitis evoked by immune response.

  4. Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts: sixty cases with 2 years' minimum follow-up.

    Science.gov (United States)

    Nín, J R; Leyes, M; Schweitzer, D

    1996-01-01

    A prospective study was performed on 101 patients who underwent an arthroscopic anterior cruciate ligament (ACL) reconstruction with fresh-frozen patellar tendon allograft (bone-patellar tendon-bone). We present the results of the first 60 patients with a minimum follow-up of 2 years. Thirty-four were men and 26 women with a mean age of 23. In 45 patients, a postoperative arthroscopy was performed, and tissue biopsies of the reconstructed ACL were obtained. Patients were evaluated according to the International Knee Documentation Committee evaluation form. After a mean follow-up of 47 months, the overall results were normal or nearly normal in 85%. Under postoperative arthroscopy, the macroscopic appearance of the implant was similar to that of a normal ligament. The ACL allograft was covered with a normal, well-vascularized synovium. There were no cases of infection, disease transmission or tissue rejection. We conclude that the use of fresh-frozen patellar tendon allografts is a good method of ACL reconstruction.

  5. Comparison of tendon-bone healing between autografts and allografts after anterior cruciate ligament reconstruction using magnetic resonance imaging.

    Science.gov (United States)

    Ge, Yunshen; Li, Hong; Tao, Hongyue; Hua, Yinghui; Chen, Jiwu; Chen, Shiyi

    2015-04-01

    The purpose of the study is to compare tendon-bone healing between autograft tendons and allograft tendons after anterior cruciate ligament (ACL) reconstruction using 3.0T magnetic resonance imaging. A total of 36 participants (18 with autograft and 18 with allograft reconstruction) underwent MRI scans at least 2 years after the ACL reconstruction operation. Oblique axial images were obtained on three-dimensional dual-echo steady-state images and imported into solid modelling software for three-dimensional model reconstruction of the bone tunnel. The graft signal intensity in the tunnel, tendon-bone interface, tunnel morphology, and tunnel area was analysed using the Siemens software packages to determine the tendon-bone healing between the groups. For the tunnel morphology, both groups exhibited bone tunnel enlargement either at the femoral or tibial tunnel aperture. For the tendon-bone interface, one patient in the autograft group and two patients in the allograft group exhibited a significant fibrous scar tissue bands at the tendon-bone interface. The graft signal/noise quotient values of the allograft group were higher than the autograft group. However, there was no significant difference in the tunnel area between the allograft group and the autograft group. Although the autograft tendons exhibited a better remodelling effect than did the allograft tendons in the bone tunnel, there was no significant difference in the tendon-bone healing between the autograft tendons and the allograft tendons postoperatively. These findings indicate that the biomechanical effect of graft motion may play a significant role in the tunnel aperture. III.

  6. Effect of extraction protocols and epidermal growth factor on the cellular repopulation of decellularized anterior cruciate ligament allografts.

    Science.gov (United States)

    Harrison, Robert D; Gratzer, Paul F

    2005-12-15

    We are developing a decellularized bone-anterior cruciate ligament (ACL)-bone allograft for treatment of ACL disruption in young or active patients. This study demonstrates the feasibility of seeding decellularized ACL tissue with primary ligament fibroblasts. Porcine ACLs were decellularized by one of three protocols, each differing only by the detergent/solvent used during the second wash (SDS, Triton-X, or TnBP). Porcine ACL fibroblasts were obtained by explant and seeded onto tissue samples of decellularized ACL. Culture conditions were varied to compare the relative effect of three different decellularization protocols on cellular repopulation. Culture condition variables included (1) the number of cells used for seeding, (2) the addition of epidermal growth factor (EGF), and (3) culture duration. Cellular ingrowth was assessed by metabolic activity (MTT assay), DNA quantification (Hoescht dye), and histology (H&E staining). Cell counting on histological sections demonstrated that Triton-X-and TnBP-treated ligaments were more receptive to cellular ingrowth than SDS-treated samples. The addition of EGF to culture medium did not significantly increase cellular ingrowth. Both the Triton-X and TnBP decellularization treatments provide suitable, naturally derived scaffolds for the ingrowth of primary ACL fibroblasts, and should be further investigated in the development of an allograft-derived bone-ACL-bone graft.

  7. A follow-up study of arthroscopic combined reconstruction of anterior and posterior cruciate ligaments with allograft patellar tendon

    Institute of Scientific and Technical Information of China (English)

    XIE Feng; YANG Liu; GUO Lin; DAI Can; HAN Xue-song

    2007-01-01

    Objective: To evaluate the therapeutic effect of combined reconstruction of anterior cruciate ligament( ACL ) and posterior cruciate ligament ( PCL )simultaneously by using allograft patellar tendon under arthroscopy.Methods: From May 2003 to November 2005, 10 cases of ruptured ACL and PCL were fixated with compressed screws and reconstructed under arthroscopy with allograft patellar tendon simultaneously. The clinical results were evaluated according to IKDC, Lysholm, and Tegner clinical rating scales.Results: All patients were followed up for 12-30 months (mean: 18 months). At the last follow-up, there was no knee extension limitation and knee flexion was between 120° and 135°, with an average of 128.38°. The Lysholm score of the 10 cases was 66. 5 ± 5. 6 before operation and 89.8 ± 3.4 at last follow up. The difference was statistically significant (P < 0.01 ). The average Tegner activity score decreased from 6.9 ± 1.7 ( range: 4-9 ) before injury to 5.5 ± 1. 6 (rang: 2-9 ) at the follow-up(P =0.53 ). At the end of follow-up, IKDC score was graded as A in 4 cases (40.0%), B in 5 (50.0 % ), and C in 1 (10.0%). Of the 10 patients, 8 returned to the same sports level as before injury and 2 were under the level.Conclusion: Arthroscopic combined reconstruction of ACL and PCL with allograft patellar tendon has the advantages of minimal trauma in surgery and reliable satisfactory outcome.

  8. Biomechanical Evaluation of Human Allograft Compression in Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Lord, Breck; Yasen, Sam; Amis, Andrew; Wilson, Adrian

    2016-01-01

    Introduction: A common problem encountered during ACL reconstruction is asymmetry of proximal-distal graft diameter leading to tunnel upsizing and potential graft-tunnel mismatch. Human allografts are often oedematous, compounding this issue in the context of multi-ligament reconstructions. Tunnel upsizing reduces bone stock, increases the complexity of multi-bundle surgery and may compromise graft-osseous integration if cortical suspensory fixation is used. Graft compression provides uniform size, allowing easy passage into a smaller tunnel, potentially improving the ‘press-fit’ graft-osseous interaction whilst preserving bone stock. To our knowledge, no biomechanical evaluation of this increasing popular technique has been reported. Hypotheses: Graft compression would not cause any significant changes in the biomechanical properties of human allograft tendon that would be detrimental to the function of an ACL reconstruction. Compressed Bioclense® allograft will increase in size when soaked in Ringer’s solution at 36° improving the ‘press-fit’ within the bone socket, decreasing micro-motion at the graft-osseous interface following ACL reconstruction. Method: In-vitro laboratory study. Sixteen samples of Bioclense® treated peroneus longus allograft were quadrupled into GraftLink constructs randomly divided into control and compressed groups. Cross-sectional area (CSA) was determined using alginate moulds and specimens immersed, under tension, in Ringer’s solution at 36.5°. CSA was measured at 8 hours. A further 32 samples were randomised and evaluated under cyclic loading of 70N-220N (1020 cycles) followed by test to failure. A further 30 samples were quadrupled into GraftLink constructs and mounted within porcine femurs using suspensory fixation. High resolution videometer recorded motion at the graft-osseous interface under the same cyclic loading protocol. An independent samples t-test was used to compare changes in CSA whilst a one-way ANOVA was

  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. Reconstruction of the Anterior Cruciate Ligament : Alternative Strategies

    NARCIS (Netherlands)

    van Eijk, F.

    2009-01-01

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

  11. Superior return to sports rate after patellar tendon autograft over patellar tendon allograft in revision anterior cruciate ligament reconstruction.

    NARCIS (Netherlands)

    Keizer, Michèle N. J.; Hoogeslag, Roy A. G.; van Raay, Jos J. A. M.; Otten, Bert; Brouwer, Reinoud

    2017-01-01

    PURPOSE: After revision anterior cruciate ligament reconstruction (ACLR), the rate of return to the pre-injury type of sport (RTS type) is low and graft choice might be an important factor. The aim of this study was to determine whether there is a difference in outcome after revision ACLR using a

  12. Cruciate ligament reflexes

    DEFF Research Database (Denmark)

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

    2002-01-01

    The idea of muscular reflexes elicited from sensory nerves of the cruciate ligaments is more than 100 years old, but the existence of such reflexes has not been proven until the recent two decades. First in animal experiments, a muscular excitation could be elicited in the hamstrings when the ant...

  13. Sterilization with electron beam irradiation influences the biomechanical properties and the early remodeling of tendon allografts for reconstruction of the anterior cruciate ligament (ACL).

    Science.gov (United States)

    Schmidt, Tanja; Hoburg, Arnd; Broziat, Christine; Smith, Mark D; Gohs, Uwe; Pruss, Axel; Scheffler, Sven

    2012-08-01

    Although allografts for anterior cruciate ligament (ACL) replacement have shown advantages compared to autografts, their use is limited due to the risk of disease transmission and the limitations of available sterilization methods. Gamma sterilization has shown detrimental effects on graft properties at the high doses required for sufficient pathogen inactivation. In our previous in vitro study on human patellar tendon allografts, Electron beam (Ebeam) irradiation showed less detrimental effects compared to gamma sterilization (Hoburg et al. in Am J Sports Med 38(6):1134-1140, 2010). To investigate the biological healing and restoration of the mechanical properties of a 34 kGy Ebeam treated tendon allograft twenty-four sheep underwent ACL replacement with either a 34 kGy Ebeam treated allograft or a non-sterilized fresh frozen allograft. Biomechanical testing of stiffness, ultimate failure load and AP-laxity as well as histological analysis to investigate cell, vessel and myofibroblast-density were performed after 6 and 12 weeks. Native sheep ACL and hamstring tendons (HAT, each n = 9) served as controls. The results of a previous study analyzing the remodeling of fresh frozen allografts (n = 12) and autografts (Auto, n = 18) with the same study design were also included in the analysis. Statistics were performed using Mann-Whitney U test followed by Bonferroni-Holm correction. Results showed significantly decreased biomechanical properties during the early remodeling period in Ebeam treated grafts and this was accompanied with an increased remodeling activity. There was no recovery of biomechanical function from 6 to 12 weeks in this group in contrast to the results observed in fresh frozen allografts and autografts. Therefore, high dose Ebeam irradiation investigated in this paper cannot be recommended for soft tissue allograft sterilization.

  14. Twenty-year results of combined meniscal allograft transplantation, anterior cruciate ligament reconstruction and advancement of the medial collateral ligament.

    Science.gov (United States)

    von Lewinski, Gabriela; Milachowski, Klaus A; Weismeier, Karl; Kohn, Dieter; Wirth, Carl Joachim

    2007-09-01

    The purpose of this study was to determine the objective and subjective long-term outcomes of the first free meniscal allograft transplantations in five patients with complete absence or non-repairable lesion of the medial meniscus after 20 years. Between 1984 and 1986 five patients underwent concomitant medial meniscal transplantation with a deep frozen meniscal allograft, ACL reconstruction and femoral advancement or temporary detachment of the MCL. The clinical outcome of the patients was evaluated 20 years postoperatively using clinical assessment, Lysholm-score, KOOS, IKDC-score, radiographs and magnetic resonance imaging. The Lysholm-score ranged between 21 and 97 points of 100 maximal available points. Corresponding to this the total KOOS ranged between 28.4 and 91.1%. The results of the IKDC-score were evaluated as nearly normal (B) (n = 2), abnormal (C) (n = 2) and severely abnormal (D) (n = 1). The radiological evaluation according to the Kellgren-Lawrence classification showed an increase of the degenerative changes between one and four grades. The radiological results revealed clear degenerative changes with long-term follow-up after meniscal allograft transplantation even though some patients did relatively well regarding the subjective and clinical results in the 20-year follow-up examination in comparison with the literature. Despite these relative clear results the question if medial meniscal transplantation can protect against development of arthritis cannot definitely be answered because in this first case series some aspects of meniscus transplantation that have not been considered which turned out to be of importance during the last 20 years. Furthermore, it has to be taken into account that all patients revealed a cartilage damage at the time of surgery and an ACL reconstruction was performed in addition. Nevertheless from biomechanical point of view it might be taken into consideration to combine the medial meniscus transplantation at least

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

    Science.gov (United States)

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

    2015-08-01

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

  16. Allograft anterior cruciate ligament reconstruction in patients younger than 30 years: a matched-pair comparison of bone-patellar tendon-bone and tibialis anterior.

    Science.gov (United States)

    O'Brien, Daniel F; Kraeutler, Matthew J; Koyonos, Loukas; Flato, Russell R; Ciccotti, Michael G; Cohen, Steven B

    2014-03-01

    We conducted a study to compare patient-reported outcomes and graft-rupture rates of bone-patellar tendon-bone (BPTB) and tibialis anterior (TA) allograft primary anterior cruciate ligament (ACL) reconstruction in patients younger than 30 years. Patients were retrospectively identified as having undergone ACL reconstruction with either a BPTB (n = 20) or a TA (n = 20) allograft. Each patient in the BPTB group was matched to a patient in the TA group based on sex, age at time of surgery, height, weight, and preoperative activity level. The Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form were administered at a minimum of 1 year after surgery. Mean Lysholm scores were 92.9 (BPTB) and 93.0 (TA), and mean IKDC scores were 92.6 (BPTB) and 90.3 (TA). The differences were not statistically significant. Overall graft-rupture rates for the study period were 4.7% (BPTB) and 1.9% (TA) (P = .18). There was no statistically significant difference in patient-rated outcomes and graft-rupture rates between BPTB and TA allografts for ACL reconstruction at a minimum of 1 year after surgery. Future research efforts should focus on mid- and long-term follow-up and objective outcomes.

  17. Incidental Anterior Cruciate Ligament Calcification: Case Report.

    Science.gov (United States)

    Hayashi, Hisami; Fischer, Hans

    2016-03-01

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

  18. Current concepts review: the posterior cruciate ligament.

    Science.gov (United States)

    Fanelli, Gregory C; Beck, John D; Edson, Craig J

    2010-06-01

    Injuries to the posterior cruciate ligament (PCL) and methods of treatment of the injured PCL have historically been surrounded by controversy in the orthopedic community. The infrequent occurrence of PCL injuries and PCL-based, multiple ligament knee injuries has led to limitations in clinical studies and a subsequent lag in basic science and clinical research compared with that for other ligamentous injuries. In recent years, new studies have elucidated the biomechanical function and complex anatomy of the PCL leading to an increased interest in research, understanding, and treatment of these complex injuries. In addition to improved understanding of knee ligament structure and biomechanics, technical advancements in allograft tissue, surgical instrumentation, and graft tensioning and fixation methods and improved surgical techniques and postoperative rehabilitation methods have enhanced the results in PCL reconstruction and PCL-based, multiple ligament knee surgical outcomes.

  19. Anterior cruciate ligament - updating article

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Malheiros Luzo

    2016-08-01

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

  20. Anterior cruciate ligament - updating article.

    Science.gov (United States)

    Luzo, Marcus Vinicius Malheiros; Franciozi, Carlos Eduardo da Silveira; Rezende, Fernando Cury; Gracitelli, Guilherme Conforto; Debieux, Pedro; Cohen, Moisés

    2016-01-01

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

  1. Editorial Commentary: Anterior Cruciate Ligament Reconstruction: Auto or Allo?

    Science.gov (United States)

    Verma, Nikhil N

    2016-01-01

    Considerable controversy exists regarding appropriate graft choice for patients undergoing anterior cruciate ligament reconstruction. Allografts pretreated with high-dose irradiation should be avoided. Otherwise, multiple factors should be considered to individualize patient decision making, including patient age and activity level, graft type, and fixation type.

  2. Arthroscopic anterior and posterior cruciate ligament reconstruction: Autograft versus allograft%关节镜下自体肌腱及同种异体肌腱重建膝关节前后交叉韧带

    Institute of Scientific and Technical Information of China (English)

    马业涛; 宋世锋; 曾凡; 陈世强; 肖海涛; 刘福存; 张熙民; 许世忠; 姚理阳

    2011-01-01

    背景:自体肌腱移植重建膝关节前后交叉韧带已广泛应用,但是供区容易出现并发症,同种异体肌腱移植越来越多应用于重建膝关节前后交叉韧带,是一种重要的替代材料.目的:比较关节镜下自体肌腱及同种异体肌腱移植重建膝关节前后交叉韧带的临床疗效差异.方法:40 例前后交叉韧带损伤患者分为2组:自体肌腱组为自体半腱肌及股薄肌重建膝关节前后交叉韧带,异体肌腱组为应用由山西骨组织库提供的同种异体肌腱重建膝关节前后交叉韧带.结果与结论:全部病例均获得6个月以上随访,最长随访时间36个月.重建前后两组大腿周径患健侧差值、Lachman 试验、中立位前抽屉试验(ADT)和国际膝关节评分委员会(IKDC)、Lysholm 及Tegner 评分差异均有显著性意义(P 0.05).结果表明,自体肌腱与单纯深低温冷冻同种异体肌腱移植在重建膝关节前后交叉韧带疗效无明显差异.%BACKGROUND: Using autologous tendon graft to reconstruct the knee cruciate ligament has been widely applied, but the technique has shortages such as donor site prone to complications, relatively longer operation time and greater trauma. So allogeneic tendon grafts have been applied as an important alternative materials in reconstructing knee cruciate ligament more and more frequently.OBJECTIVE: To compare the clinical efficacy difference between using autologous tendon and allograft tendon to reconstruct knee cruciate ligament under arthroscopy.METHODS: We had divided 40 cases of cruciate ligament injury into two groups: Group autologous tendon of 21 cases in which autogenous semitendinosus and gracilis muscle was used to reconstruct knee anterior and posterior cruciate ligament, while Group allograft tendon of 19 cases receiving allograft tendon provided by the Shanxi Province Bone Allograft Tendon Tissue Bank.RESULTS AND CONCLUSION: All the patients were followed up for 6 to 36 months. There

  3. PROSPECTIVE STUDY ON ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH PRESERVING REMNANT ANTERIOR CRUCIATE LIGAMENT BY ALLOGRAFT LIGAMENT%应用异体肌腱鞘内重建前交叉韧带的前瞻性研究

    Institute of Scientific and Technical Information of China (English)

    祁洁; 陈疾忤; 陈世益; 李云霞; 华英江; 李宏云; 董宇

    2010-01-01

    目的 通过前瞻性研究,了解异体肌腱重建前交叉韧带(anterior cruciate ligament,ACL)时,保留ACL对术后膝关节功能的影响.方法 2008年1月-7月,收治97例自愿选用异体肌腱作为移植物的ACL断裂患者,其中38例保留ACL残端行鞘内重建(试验组),59例未保留ACL残端(对照组).试验组:男27例,女11例;年龄16~43岁,平均24.3岁.合并半月板损伤8例,Outbridge Ⅰ度软骨损伤13例.损伤至手术时间3~20周,平均8.6周.对照组:男35例,女24例;年龄18~48岁,平均27.8岁.合并半月板损伤16例,Outbridge Ⅰ度软骨损伤23例.损伤至手术时间4~44周,平均12.7周.两组患者均为运动损伤,前抽屉试验及Lackman试验均为阳性.术前及术后3、6、9、15个月通过Lysholm评分及国际膝关节文献委员会膝关节评估表(IKDC)评分比较膝关节功能改善情况,KT-2000关节测量仪评价关节松弛度.结果 术后切口均Ⅰ期愈合,无关节内感染等并发症发生.试验组37例、对照组57例获15个月完整随访.术后膝关节不稳症状均消失,前抽屉试验及Lackman试验为阴性.术后3、6个月两组患者关节错动均2 mm;术后15个月试验组关节错动无进一步变化,对照组6例关节错动2.5~4.0 mm,平均3.4 mm.术后3个月,试验组Lysholm评分及IKDC评分均高于对照组,但差异无统计学意义(P>0.05);6、9个月,试验组均明显高于对照组(P0.05).结论 ACL重建术时尽可能保留韧带残端,能减少关节液向骨道渗漏,有助于腱骨愈合,并提高术后膝关节功能.

  4. Posterior cruciate ligament: focus on conflicting issues.

    Science.gov (United States)

    Lee, Yong Seuk; Jung, Young Bok

    2013-12-01

    There is little consensus on how to optimally reconstruct the posterior cruciate ligament (PCL) and the natural history of injured PCL is also unclear. The graft material (autograft vs. allograft), the type of tibial fixation (tibial inlay vs. transtibial tunnel), the femoral tunnel position within the femoral footprint (isometric, central, or eccentric), and the number of bundles in the reconstruction (1 bundle vs. 2 bundles) are among the many decisions that a surgeon must make in a PCL reconstruction. In addition, there is a paucity of information on rehabilitation after reconstruction of the PCL and posterolateral structures. This article focused on the conflicting issues regarding the PCL, and the scientific rationales behind some critical points are discussed.

  5. Postoperative rehabilitation of the posterior cruciate ligament.

    Science.gov (United States)

    Edson, Craig J; Fanelli, Gregory C; Beck, John D

    2010-12-01

    Diagnosis and management of posterior cruciate ligament injuries has evolved, and now the treatment often includes surgical intervention. The purpose of this paper is to define the current approach to postsurgical management after the posterior cruciate ligament reconstruction, review conservative management, and discuss surgical outcomes using a specified program.

  6. 关节镜下异体肌腱修复重建前后交叉韧带断裂的临床观察%Clinical Observation of Arthroscopic Reconstruction of Anterior Cruciate Ligament Rupture with Tendon Allograft

    Institute of Scientific and Technical Information of China (English)

    孙强; 才林; 艾光禹

    2016-01-01

    目的:探讨关节镜下异体肌腱修复重建前后交叉韧带断裂的临床效果。方法选取我院2013年9月-2014年9月经影像学、临床诊断为前后交叉韧带断裂患者18例,均采用深低温冷冻同种异体腱于关节镜下同期重建前后交叉韧带。记录Lachman试验、Lysholm评分结果进行治疗效果的评定。结果术后切口均I期愈合,术前存在的症状、阳性体征基本消失,患膝稳定性正常。其中Lachman试验测试均为阴性或I度阳性。关节活动度:17例达0°-130°,仅有1例0°-120°,手术前后的Lysholm、IKDC评分对比具有统计学意义(P<0.05)。结论关节镜下采用异体肌腱修复重建前后交叉韧带断裂能够恢复膝关节的稳定性及功能,疗效显著,值得临床推广应用。%Objective To investigate the clinical effect of arthroscopic reconstruction of anterior cruciate ligament.Methods 9 cases of -2014 in our hospital from September 2013 to 18 were diagnosed as anterior and anterior cruciate ligament rupture. The anterior and anterior cruciate ligaments were reconstructed with the same time of deep hypothermia and frozen allograft. Evaluation of therapeutic effect of Lachman test and Lysholm score.Results All the incisions healed by I, the symptoms and positive signs of the patients were disappeared, and the stability of the knee was normal. The Lachman test was negative or I positive. Joint mobility: 17 cases reached 0 degrees-130 degrees, only 0 cases of 1 degrees -120 degrees, Lysholm, IKDC before and after surgery, score compared with statistical significance (P<0.05).Conclusion Arthroscopic reconstruction of anterior cruciate ligament with allograft tendon repair can restore the stability and function of the knee joint, and the effect is remarkable. It is worth to be popularized.

  7. Posterior cruciate ligament and posterolateral corner reconstruction.

    Science.gov (United States)

    Fanelli, Gregory C; Edson, Craig J; Reinheimer, Kristin N; Garofalo, Raffaele

    2007-12-01

    The keys to successful posterior cruciate ligament reconstruction are to identify and treat all pathology, use strong graft material, accurately place tunnels in anatomic insertion sites, minimize graft bending, use a mechanical graft-tensioning device, use primary and backup graft fixation, and employ the appropriate postoperative rehabilitation program. Adherence to these technical points results in successful single and double bundle arthroscopic transtibial tunnel posterior cruciate ligament reconstruction documented with stress radiography, arthrometer, knee ligament rating scales, and patient satisfaction measurements.

  8. Anterior Cruciate Ligament: Structure, Injuries and Regenerative Treatments.

    Science.gov (United States)

    Negahi Shirazi, Ali; Chrzanowski, Wojciech; Khademhosseini, Ali; Dehghani, Fariba

    2015-01-01

    Anterior cruciate ligament (ACL) is one of the most vulnerable ligaments of the knee. ACL impairment results in episodic instability, chondral and meniscal injury and early osteoarthritis. The poor self-healing capacity of ACL makes surgical treatment inevitable. Current ACL reconstructions include a substitution of torn ACL via biological grafts such as autograft, allograft. This review provides an insight of ACL structure, orientation and properties followed by comparing the performance of various constructs that have been used for ACL replacement. New approaches, undertaken to induce ACL regeneration and fabricate biomimetic scaffolds, are also discussed.

  9. [Anterior cruciate ligament-plasty using the "U-dos" technique].

    Science.gov (United States)

    Morales-Trevizo, C; Paz-García, M; Leal-Berumen, I; Leal-Contreras, C; Berumen-Nafarrate, E

    2013-01-01

    The knee is a compound diarthrodial joint, vulnerable to serious injuries such as ligament injuries of: medial collateral ligament, lateral collateral ligament, anterior cruciate ligament and posterior cruciate ligament, as cruciate ligaments limit rotation movement in the joint. The purpose of our study was to create a new technique to treat injuries of the anterior cruciate ligament, which is composed of two bundles--anteromedial and posterolateral--trying to achieve an anatomical reconstruction that allows for a normal biomechanical recovery. This technique reduces the use of fixation material and costs. The diagnosis of anterior cruciate ligament injuries was made with the pivot shift test. There are currently two repair methods for anterior cruciate ligament injuries: single bundle or double bundle repair; none of these techniques is considered as the gold standard, as their results are very similar. This paper describes a technique used for the treatment of anterior cruciate ligament injuries, known as "U-dos", and its clinical results. Cross-sectional, observational study that enrolled 20 patients with total anterior cruciate ligament injuries who underwent anterior cruciate ligament plasty using the "U-dos" technique between June 2009 and June 2010. The technique requires the use of bone bank allograft, in this case of the anterior tibial ligament. Patients were assessed using the Lysholm scale and the pivot shift test. Our results show that all the pivot shift tests were negative and assessments according to the Lysholm scale were from normal to excellent in 95% of cases (19/20). Only one failure was reported, with avulsion of the graft attachment which required a surgical intervention.

  10. One-stage arthroscopic reconstruction of both cruciate ligaments using Achilles tendon-bone allografts%关节镜下同种异体跟腱骨一期重建膝关节前后交叉韧带

    Institute of Scientific and Technical Information of China (English)

    史德海; 李东会; 刘斌; 金文涛; 蔡道章

    2009-01-01

    Objective To evaluate one-stage arthroscopic reconstruction of anterior crueiate ligament (ACL)and posterior cruciate ligament(PCL)using Achilles tendon-bone allografts. Methods From July 2000 to February 2005.we treated 15 patients(11 males and 4 females)whose ACL and PCL were ruptured at one knee but the eontralateral knee was intact.Their associated meniscus injuries were treated arthroscopically according to established procedures prior to ligament reconstruction.Thirty Achilles tendon-bone allografts were used to reconstruct torn ACL and PCL in 15 knees at one stage.Reconstruction of both ligaments was performed at subacute or chronic phase(>3 to 8 weeks)in 12 casses,and at acute phase in 3 cases(3周)重建12例,急性期(<3周)重建3例.手术前后采用IKDC和Lysholm评分系统对患膝关节功能进行评估,随访结果与对侧健康膝火节进行比较.结果 所有患者均获得36~40个月(平均38个月)随访.根据IKDC评分,术前所有患膝关节功能都严重异常,术后9例患膝功能改善为止常,5例接近正常,1例异常.Lysholm评分由术前平均(56±5)分改善为术后(90±4)分,差异有统汁学意义(t=15.660,P<0.05.结论同种异体跟腱骨可用于关节镜下重建膝关节前后交叉韧带,疗效满意.

  11. Guideline on anterior cruciate ligament injury

    NARCIS (Netherlands)

    D.E. Meuffels (Duncan); M.T. Poldervaart (Michelle T.); R.L. Diercks (Ron L.); A.W.F.M. Fievez (Alex W.F.M.); T.W. Patt (Thomas W.); C.P. van der Hart (Cor P.); E.R. Hammacher (Eric); F. van der Meer (Fred); E.A. Goedhart (Edwin A.); A.F. Lenssen (Anton F); S.B. Muller-Ploeger (Sabrina B); M.A. Pols (Margreet); D.B.F. Saris (Daniel)

    2012-01-01

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

  12. Endoscopic posterior cruciate ligament reconstruction using achilles tendon allografts: single-bundle versus double-bundle%关节镜下异体跟腱单双束重建后交叉韧带的随机对照

    Institute of Scientific and Technical Information of China (English)

    张其亮; 滕学仁

    2011-01-01

    BACKGROUND: Endoscopic posterior cruciate ligament reconstruction using achilles tendon allografts has been primarily performed by single-bundle and dou ble-bundle types.OBJECTIVE: To compare the clinical outcome of single-bundle and dou ble-bundle endoscopic posterior cruciate ligament reconstruction using achilles tendon allograft.METHODS: A total of 70 patients with single posterior cruciate ligament injury who received treatment at the Department of Orthopedics, Qingdao Municipal Hospital between January 2006 and January 2009 were included in this study. Allpatients were randomly divided into two groups: single-bundle group and double-bundle group. The single-bundle group had single-bundle reconstruction using achilles tendon allograft, and the double-bundle group had double-bundle reconstruction.RESULTS AND CONCLUSION: After surgery, 52 patients were successfully healed and followed up. The surgery time and the number of patients who need joint puncture were greater in the dou ble-bundle group than in the single-bundle group (P < 0.05).At 18 months after surgery, the stability and range of motion of the knee joint, Lysholm and IKDC scores were improved in each group compared with prior to surgery (P < 0.05). The tibial backward distance tested by KNEELAX3 when the knee joint flexed at 30° and 90° was significantly improved compared with prior to surgery (P < 0.05). There was no significant difference in the range of motion of the knee joint, Lysholm and IKDC scores, and the tibial backward distance tested by KNEELAX3 when the knee joint flexed at 30° and 90° between the single-bundle and double-bundle groups (P > 0.05). Compared with single-bundle reconstruction , double-bundle reconstruction resulted in poor improvement in early clinical curative effects and greater surgical trauma, required long surgery time, and lead to swelling of the knee joint. Therefore, double-bundle reconstruction should not be the preferred protocol for posterior cruciate

  13. Hamstring tendon autograft versus tendon allograft for reconstruction of anterior cruciate ligament%自体与同种异体肌腱重建膝关节前交叉韧带的比较

    Institute of Scientific and Technical Information of China (English)

    张义龙; 李宁; 李志怀; 宋有鑫; 刘建丰; 李哲; 孙志杰

    2011-01-01

    BACKGROUND: There are mostly three kinds of grafts used in ansterior cruciate ligament reconstruction, such as autografts,allograft and artificial ligaments, each of which has its own advantages and disadvantages. There are a lot of debates on selections of grafts.OBJECTIVE: To evaluate the therapeutic effects of hamstring tendon autograft and tendon allograft used in reconstruction of anterior cruciate ligament (ACL).METHODS: Seventy knees with ACL tear in 70 patients, verified by arthroscopy at the Department of Orthopedics in the Affiiliated Hospital of Chengde Medical College from January 2007 to January 2009, were divided into two groups, and all the damaged ansterior cruciate ligaments were reconstructed under arthroscopy with hamstring tendon autograft or tendon allograft respectively. The value of KT -1000 and the Lysholm scores were recorded before operations and during follow-ups.RESULTS AND CONCLUSION: All of them were followed up for 18 to 24 months with an average of 20.1 months except two were missing. No severe complication, such as vascular nerve injury, infection and rupture of graft occurred in early stage after operations in the patients followed. Wound around canal orifice of d rainage tube exuded continuely in two cases of allograft group,which were cured successfully by changing dressings after half a month. Lysholm scores of both groups increased, side-side difference of the postoperative anterior laxity decreased significantly, and there was no statistical significance in the above -mentioned data between these two group (P > 0.05). These findings suggest that the therapeutic effects in the two groups are satisfactory equally.%背景:关节镜辅助下重建前交叉韧带的移植物主要有自体移植物、同种异体移植物和人工韧带3种,关于移植物的选择,存在较多争议.目的:评估自体健侧腘绳肌腱和同种异体肌腱两种移植物在膝关节前交叉韧带重建中的效果.方法:纳入2007-01/2009-01

  14. 关节镜下异体韧带移植重建膝前交叉韧带%Allograft anterior cruciate ligament reconstruction under arthroscope

    Institute of Scientific and Technical Information of China (English)

    张春礼; 李明全; 朱庆生; 李丹; 李立文

    2000-01-01

    @@ 0 引言膝前交叉韧带(anterior cruciate ligament, ACL )断裂是较常见的运动伤,目前国内多采用开放手术或关节镜下自体韧带、肌腱移植重建ACL. 自体组织取材不仅增加了创伤 ,影响到取材组织原有的功能,而且会带来一系列的并发症,为了克服上述缺点,参考国外成功经验,我们自2000-02以来,采用异体韧带关节镜下移植重建ACL 4例,发现该方法创伤小,康复快,早期疗效满意.

  15. Surgical treatment of anterior cruciate ligament injury in adults.

    Science.gov (United States)

    Alazzawi, Sulaiman; Sukeik, Mohamed; Ibrahim, Mazin; Haddad, Fares S

    2016-04-01

    Anterior cruciate ligament injury is among the most common soft tissue injuries of the knee joint and reconstruction of the anterior cruciate ligament is the gold standard treatment for young active symptomatic patients. This review summarizes the surgical treatment of anterior cruciate ligament injury.

  16. 关节镜下异体韧带移植重建断裂前交叉韧带10例%Arthroscopically assisted allograft reconstruction of anterior cruciate ligament rupture: A primary report of ten cases

    Institute of Scientific and Technical Information of China (English)

    张春礼; 李明全; 朱庆生

    2001-01-01

    目的回顾性总结采用异体韧带重建膝关节前交叉韧带的临床初步疗效. 方法对10例采用关节镜技术移植异体韧带重建损伤前交叉韧带进行了5~11 mo,平均8 mo的随访评估. 结果所有患者症状均有缓解,关节稳定性恢复,取得了满意的临床疗效. 临床观察免疫排斥反应轻微甚至无法觉察. 部分移植韧带,特别是在术后6 mo,逐渐略有松弛,但并未影响近期疗效. 结论异体韧带移植是一种可行的重建损伤前交叉韧带的一种选择,但远期结果需要进一步观察.%AIM To evaluate the early result of allograft reconstruction of anterior cruciate ligament for ACL deficiency knee. METHODS Ten cases of ACL reconstruction operated upon with allografts assisted with arthroscopic technique were followed-up for 5 to 11 mo, mean 8 mo. RESULTS All patients had a quite satisfactory result with relief of symptoms and restoration of knee stability, immunologic rejective reaction was minimal, even invisible, but some grafts were gradually becoming a little laxity, particularly when 6 months postoperation, whereas it has not affected the primary results. All of them have gone back to their preinjury job. CONCLUSION Allograft is one of acceptable alternatives of reconstruction of torn ACL, but the long-term results still needs a further observation.

  17. Evaluation and treatment of posterior cruciate ligament injuries: revisited.

    Science.gov (United States)

    Wind, William M; Bergfeld, John A; Parker, Richard D

    2004-01-01

    Current knowledge and treatment of posterior cruciate ligament injuries continue to lag behind that of anterior cruciate ligament injuries. This is the result of the relative infrequency of posterior cruciate ligament injuries and the lack of consensus with respect to its natural history, surgical indications, technique, and postoperative rehabilitation. Recent anatomical and biomechanical studies have improved our understanding of the posterior cruciate ligament in an attempt to reproduce its anatomy and function during reconstruction. The following is a comprehensive review on the evaluation and treatment of posterior cruciate ligament injuries with special focus on the current surgical techniques.

  18. Cruciate ligament loading during common knee rehabilitation exercises.

    Science.gov (United States)

    Escamilla, Rafael F; Macleod, Toran D; Wilk, Kevin E; Paulos, Lonnie; Andrews, James R

    2012-09-01

    Cruciate ligament injuries are common and may lead to dysfunction if not rehabilitated. Understanding how to progress anterior cruciate ligament and posterior cruciate ligament loading, early after injury or reconstruction, helps clinicians prescribe rehabilitation exercises in a safe manner to enhance recovery. Commonly prescribed therapeutic exercises include both weight-bearing exercise and non-weight-bearing exercise. This review was written to summarize and provide an update on the available literature on cruciate ligament loading during commonly used therapeutic exercises. In general, weight-bearing exercise produces smaller loads on the anterior cruciate ligament and posterior cruciate ligament compared with non-weight-bearing exercise. The anterior cruciate ligament is loaded less at higher knee angles (i.e. 50-100 degrees). Squatting and lunging with a more forward trunk tilt and moving the resistance pad proximally on the leg during the seated knee extension unloads the anterior cruciate ligament. The posterior cruciate ligament is less loaded at lower knee angles (i.e. 0-50 degrees), and may be progressed from level ground walking to a one-leg squat, lunges, wall squat, leg press, and the two-leg squat (from smallest to greatest). Exercise type and technique variation affect cruciate ligament loading, such that the clinician may prescribe therapeutic exercises to progress ligament loading safely, while ensuring optimal recovery of the musculoskeletal system.

  19. Causes of anterior cruciate ligament injuries

    Directory of Open Access Journals (Sweden)

    Ristić Vladimir

    2010-01-01

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

  20. Treatment for acute anterior cruciate ligament tear

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  1. Treatment for acute anterior cruciate ligament tear

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  2. Guideline on anterior cruciate ligament injury

    NARCIS (Netherlands)

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

    2012-01-01

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

  3. Novel Insights into Anterior Cruciate Ligament Injury

    NARCIS (Netherlands)

    D.E. Meuffels (Duncan)

    2011-01-01

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

  4. A Brief History of Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Nikolaos Davarinos

    2014-01-01

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

  5. Reconstruction of anterior cruciate ligament of knee joint with single bundle allograft under arthroscopic%关节镜下应用单束同种异体肌腱重建膝关节前交叉韧带

    Institute of Scientific and Technical Information of China (English)

    罗绍伟; 张平; 李文胜; 郑创义; 邱开封

    2016-01-01

    目的 探讨关节镜下采用同种异体肌腱解剖单束重建膝关节前交叉韧带(ACL)损伤的治疗效果.方法 对62例ACL断裂患者在关节镜下进行重建,采用同种异体肌腱作为移植物,在胫骨近端及股骨远端建立骨隧道,利用挤压钉对移植物进行固定.术后应用支具固定膝关节12周,按照Lysholm和Larson膝关节评分标准进行主观评估;对患者行Lachman试验进行客观评估,了解重建韧带的稳定性和膝关节的功能恢复情况.结果 Lysholm术前评分平均(43.1±2.1)分,术后韧带重建后随访时评分平均(91.0±2.3)分,术前与术后对比,差异有统计学意义(t=3.460,P=0.001).Larson术前评分平均(41.0±2.9)分,韧带重建后最终评分平均(90.1±3.5)分,术前与术后对比,差异有统计学意义(t=3.232,P=0.001).62例患者在最后复查时Lachman试验结果均为阴性.所有患者术后无膝关节感染、深静脉血栓及僵硬.在术后1年均能完全伸直,屈膝达到120度.随访期间未发生韧带再断裂.结论 关节镜下采用同种异体单束解剖重建前交叉韧带可以获得满意的临床疗效.%Objective To introduce the treatment efficacy of using allograft muscle ligament anatomical to rebuild anterior cruciate ligament (ACL) of knee joint under the arthroscopy.Methods Sixty-two cases patients with ACL rupture in anterior cruciate ligament reconstruction under arthroscopy.Allograft ligaments were used as graft,a bone tunnel was established in the proximal tibia and distal femur,and the graft was fixed by the extrusion screw.After the operation,the knee joint was fixed for 12 weeks,and the subjective evaluation was carried out according to the Lysholm and Larson knee score standards;in order to assess the stability of the ligament and the functional recovery of the knee joint,objective evaluation was carried out according to Lachman test in patients.Results The preoperative average Lysholm scale was (43.1±2.1) points,the final

  6. Posterior cruciate ligament rehabilitation: how slow should we go?

    Science.gov (United States)

    Fanelli, Gregory C

    2008-02-01

    Outcomes after posterior cruciate ligament (PCL) reconstructive surgery have historically been inferior to outcomes after reconstruction of the anterior cruciate ligament (ACL). As such, some surgeons may be reluctant to recommend reconstruction of the PCL. However, recent technologic advances have substantially improved PCL reconstructive surgical outcomes. These advances include better understanding of PCL diagnosis and surgical indications; recognition of the need for repair or reconstruction of associated injuries, especially injuries to the posterolateral and posteromedial corners of the knee; PCL-specific surgical instruments including mechanical tensioning devices to restore anatomic tibial step-off; improved graft fixation techniques including primary and backup methods of fixation; use of strong graft material including advances in the procurement, processing, and usage of allograft tissue; improved surgical techniques; and advances in the understanding of knee ligament structure and biomechanics, resulting in more accurate surgical tunnel placement, achieving anatomic graft insertion sites while minimizing graft bending. Today, PCL reconstructive surgery often results in excellent function with a return to the patient's preinjury level of activity. In contrast to accelerated rehabilitation after ACL reconstructive surgery, slow and deliberate postoperative rehabilitation is recommended to allow early healing to occur after PCL reconstructive surgery.

  7. Early postoperation research of autograft tendon versus allograft tendon in anterior cruciate ligament reconstruction%自体肌腱与同种异体肌腱重建前交叉韧带早期对比研究

    Institute of Scientific and Technical Information of China (English)

    关和宇

    2014-01-01

    目的:比较自体肌腱与同种异体肌腱重建前交叉韧带术后早期疗效差异。方法自2011年10月~2012年10月行前交叉韧带重建患者163例。根据采用移植物的不同将患者分为自体组85例,异体组78例。术后随访1个月,比较两组患者的手术时间、引流量、发热天数、术后第7天患肢肿胀程度、患肢肌力恢复程度、术后第3天及第7天CRP值。结果异体组的手术时间(39.2±1.3)min显著低于自体组(52.6±1.7)min,术后异体组引流量(106.7±2.6)ml与自体组(102.6±4.3)ml无明显差异,异体组发热天数(4.6±0.5)d显著长于自体组(1.3±0.2)d,异体组术后患肢早期肌力恢复程度显著高于自体组,异体组的患肢肿胀程度显著低于异体组,异体组术后第3天CRP值(32.9±1.2)mg/L与自体组(31.5±0.8) mg/L无显著差异,异体组术后第7天CRP值(91.7±9.6)mg/L显著高于自体组(12.8±6.1)mg/L。结论异体组术后早期临床疗效优于自体组。%Objective To campare the early clinical efficacy of autograft and allograft tendon in anterior cruciate ligament reconstruction. Methods From October 2011 to October 2012, 163 patients of injured Anterior Cruciate Ligament were reconstructed. According to different graft was used in anterior cruciate ligament reconstruction, they were divided into two groups. 85 cases of patients were reconstructed by autograft is Group A, 78 cases of patients were reconstructed by allograft is Group B.After 1 month follow up, to compare the operation time, the drainage amount, postoperative fever days, the degree of limb myodynamia recovery, the seventh day of postoperative limb swelling degree, the CRP value about the third and seventh day of postoperative. Results The time of operation in Group B(39.2±1.3)min was significant shorter than that in Group A(52.6±1.7 )min, the drainage amount was no significant difference between Group B(106.7±2.6)mland Group A(102.6±4.3)ml, the postoperative fever days in

  8. Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS)

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  9. 关节镜下同种异体跟腱四骨道双束解剖重建前交叉韧带的临床研究%Clinical study of arthroscopic four bone-tunnel double-bundle tendon allograft reconstruction of anterior cruciate ligament

    Institute of Scientific and Technical Information of China (English)

    苑广科; 韦良心; 焦兆德; 殷鹏

    2014-01-01

    Objective To explore the treatment method and clinical effect of arthroscopic four bone-tunnel double-bundle tendon allograft reconstruction of anterior cruciate ligament (ACL). Methods A total of 32 cases undergone arthroscopic four bone-tunnel double-bundle tendon allograft reconstruction of anterior cruciate ligament were in this study. Preoperative and postoperative follow-up and Lysholm score were applied in the analysis of knee joint function and curative effect. Results The result of Lysholm score showed that there were 31 good cases (96.9%) and 1 fair case (3.1%). The good rate was 96.9%. Conclusion The surgery of arthroscopic four bone-tunnel double-bundle tendon allograft reconstruction of anterior cruciate ligament can effectively recover the stability and knee function in anterior-posterior dimension and spin. This reconstruction is close to the reconstruction of anatomic biomechanics. The application of tendon allograft transplant can reduce operation time and trauma, and it is a good choice for double-bundle anterior cruciate ligament reconstruction.%目的:探讨关节镜下应用同种异体跟腱四骨道双束解剖重建前交叉韧带(ACL)的手术方法和临床疗效。方法32例采用关节镜下同种异体跟腱四骨道双束解剖重建方法的前交叉韧带损伤患者,通过术前及术后随访, Lysholm评分表进行膝关节功能的评估和疗效分析。结果按照Lysholm评分表,31例患者(96.9%)分级评价优良,1例一般(3.1%),优良率达到96.9%。结论关节镜下同种异体跟腱四骨道双束解剖重建前交叉韧带,能够有效的恢复膝关节的前后向及旋转稳定性,更接近于解剖生物力学重建,同种异体跟腱移植物的应用可以缩短手术时间,减少创伤,是双束解剖重建ACL的良好选择之一。

  10. Biological fixation in anterior cruciate ligament surgery

    Directory of Open Access Journals (Sweden)

    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.

  11. Cruciate ligament reconstruction using LARS artificial ligament under arthroscopy: 81 cases report

    Institute of Scientific and Technical Information of China (English)

    HUANG Jian-ming; WANG Qian; SHEN Feng; WANG Zi-min; KANG Yi-fan

    2010-01-01

    Background There are many different materials used for ligament reconstruction. Currently, autograft, allograft, and artificial ligaments are used in the reconstruction. The objective of this study was to explore the clinical result of cruciate ligament reconstruction under arthroscopy.Methods Eighty-one cases were reconstructed with the LARS ligament under arthroscopy, including 43 cases of anterior cruciate ligament (ACL) injury, 20 cases of posterior cruciate ligament (PCL) injury, and 18 cases of ACL combined with PCL injuries of the knee. The follow up period was 10 to 49 months. The International Knee Documentation Committee (IKDC) and Lysholm knee score scales were used for functional evaluation. We examined the anterior and posterior stability of the knee with KT-1000.Results According to the Lysholm knee function score scale, the average preoperative score of (44.6±1.4) increased to a postoperative score of (82.8±2.5) in the ACL group and from (46.6±2.3) to (80.8±2.0) in the PCL group. In the ACL combined with PCL injury group, the preoperative score increased from (45.2±1.2) to (85.5±2.3). According to IKDC score standards, in ACL group we evaluated 19 cases as C and 24 cases as D, preoperatively, and postoperatively 27 cases as A, 14 cases as B and two cases as C. In the preoperative PCL group, we had 11 cases defined as C and nine cases as D that resolved to 12 cases as A, seven as B and one case of C in postoperative evaluation. In the ACL combined with PCL injury group we defined four cases as C and 14 as D during preoperative scoring. These patients had postoperative grades of six cases as A, 10 as B, and two cases as C. All of the results have statistical significance. Conclusions ACL, PCL, or combined ACL and PCL reconstruction using the LARS ligament under arthroscopy is a minimally invasive, safe and effective method to treat cruciate ligament injuries of the knee. Clinical results are satisfactory in the short term.

  12. Guideline on anterior cruciate ligament injury

    OpenAIRE

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

    2012-01-01

    textabstractThe Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a steering group of the Dutch Orthopaedic Association. • What is the role of physical examination and additional diagnostic tools? • Which patient-related outcome measures should be used? • Wh...

  13. Anterior cruciate ligament ganglion: case report

    Directory of Open Access Journals (Sweden)

    André Pedrinelli

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

  14. Anterior Cruciate Ligament (ACL) Injuries

    Science.gov (United States)

    ... knee injury, especially for athletes. Ligaments are long, rope-like bands that fasten bones together. The ACL ... re used to doing all the time, like jumping and landing hard on the feet. If the ...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-09-15

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

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

    NARCIS (Netherlands)

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

    2005-01-01

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

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

    NARCIS (Netherlands)

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

    2005-01-01

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

  18. Arthroscopic simultaneous reconstruction of posterior cruciate ligament using double femoral tunnel technique and anterior cruciate ligament with achilles allograft%关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉与前交叉韧带

    Institute of Scientific and Technical Information of China (English)

    邵德成; 陈百成; 高石军; 王晓峰; 孙然

    2008-01-01

    目的 评价关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带的临床疗效.方法 14例前、后交叉韧带损伤患者在关节镜下应用异体跟腱同时重建前、后交叉韧带,且后交叉韧带股骨侧应用双束双隧道重建.受伤至手术时间平均19.5 d.术后平均随访34.5个月.采用Lysholm评分和Tegner评分对患膝功能进行评估,通过KT-1000检查膝关节的前后松弛度.术前患者屈膝活动度(123.6±2.5)°,Lysholm评分(52.8±2.2)分,伤前Tegner评分平均为(5.9±0.5)分,术前为(1.2±0.9)分.结果 术后患者屈膝活动度(117.9±2.8)°,与术前比较差异无统计学意义(t=1.54,P=0.14).术后Lachman试验阴性者13例(92.9%),后抽屉试验阴性者12例(85.7%).KT-1000屈膝25°双侧胫骨前后松弛度差值在2 mm以内9例,3~5 mm 4例,6 mm1例.屈膝70°差值2 mm以内10例,3~5 mm 3例,6 mm 1例.Lysholm评分术后提高至(92.9±3.3)分,差异具有统计学意义(t=17.009,P<0.001).术后Tegner评分终末随访时平均为(5.4±0.8)分.手术前后的差异有统计学意义(F=4.2,P<0.01).11例恢复到受伤前运动水平(78.6%),另外3例运动水平较受伤前有所降低.结论 关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带,后交叉韧带股骨侧应用双束双隧道重建,更接近后交叉韧带解剖重建,能够恢复膝关节的稳定性,较满意地恢复膝关节功能.%Objectives To introduce the technique of arthroscopic simultaneous reconstruction of posterior cruciate ligament(PCL)using double femoral tunnel,single-bundle transtibial tunnel PCL technique and anterior cruciate ligament(ACL)with achilles allograft,and to evaluate the clinical outcome.Methods Fourteen patients with PCL and ACL injuries after a minimum follow-up 18 months were recieved.Arthroscopically assisted simultaneous ACL/PCL reconstruction with achilles allograft were performed using the single

  19. CARTILAGE-LIKE PHENOMENON IN THE ANTERIOR CRUCIATE LIGAMENT

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective. To detect histological characteristic of anterior cruciate ligament (ACL) and medial collateral ligament (MCL). Methods. In each of 20 skeletally mature male mongrels and 4 men, the ACL and MCL were examined by standard hematoxylin-eosin procedure and toluidine blue staining for histologic observation. Results. The fibroblasts in medial collateral are elongated to spindle shape and aligned in a row between the bundles of collagenous fibers. Toluidine blue staining is negative. The anterior cruciate ligament demonstrated more heterogenous cell types and arrangement. It had three major cell forms:spindle, round and ovoid type, which were shorter but greater than the cells in medial collateral ligament. Toluidine blue staining was positive in anterior cruciate ligament. Most cells in anterior cruciate ligament were enclosed within lacunae. Conclusion. This study suggests that the ACL has different histological characteristics from MCL, and is more cartilage-like in nature.

  20. CARTILAGE-LIKE PHENOMENON IN THE ANTERIOR CRUCIATE LIGAMENT

    Institute of Scientific and Technical Information of China (English)

    蒋青; 林共周; 典绵域; 崔国庆; 滕华建

    2001-01-01

    Objective. To detect histological characteristic of anterior cruciate ligament (ACL) and medial collateral ligament (MCL). Methods. In each of 20 skeletally mature male mongrels and 4 men, the ACL and MCL were examined by standard hematoxylin-eosin procedure and toluidine blue staining for histologic observation. Results. The fibroblasts in medial collateral are elongated to spindle shape and aligned in a row between the bundles of collagenous fibers. Toluidine blue staining is negative. The anterior cruciate ligament demonstrated more heterogenous cell types and arrangement. It had three major cell forms: spindle, round and ovoid type,which were shorter but greater than the cells in medial collateral ligament. Toluidine blue staining was positive in anterior cruciate ligament. Most cells in anterior cruciate ligament were enclosed within lacunae. Conclusion. This study suggests that the ACL has different histological characteristics from MCL, and is more cartilage-like in nature.

  1. Double bundle posterior cruciate ligament reconstruction: surgical technique and results.

    Science.gov (United States)

    Fanelli, Gregory C; Beck, John D; Edson, Craig J

    2010-12-01

    The keys to successful posterior cruciate ligament reconstruction are to identify and treat all pathology, use strong graft material, accurately place tunnels in anatomic insertion sites, minimize graft bending, use a mechanical graft tensioning device, use primary and back-up graft fixation, and use the appropriate postoperative rehabilitation program. Adherence to these technical principles results in successful single and double-bundle arthroscopic transtibial tunnel posterior cruciate ligament reconstruction based upon stress radiography, arthrometer, knee ligament rating scales, and patient satisfaction measurements.

  2. Infections after reconstructions of anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Ristić Vladimir

    2014-01-01

    Full Text Available Introduction. Infections after anterior cruciate ligament reconstructions are rare, but, on the other hand, they are difficult to be treated. The aim of this study was to analyze causes of infections, risk factors, diagnostics, and possibilities of their prevention. Material and Methods. Seventeen deep infections (1.2% were found in 1425 patients who had undergone anterior cruciate ligament reconstructions. Fifteen patients were males and two were females. Out of 475 professional athletes nine (1.9% had this postoperative complication. Eleven patients with septic arthritis were allergic to penicillin. Three of them had immunosuppressive diseases. Results. Staphylococcus aureus was isolated in eleven cases (65%, other Staphylococcus and Streptococcus groups were found in four and three patients, respectively; while one patient had infection although the punctate was negative. Out of 965 patients with the patellar tendon grafts, ten (1.03% had this complication, while the incidence was 1.52% (7/460 in those with the hamstring grafts. Fifteen infections were acute with obvious symptoms within 14 days after surgery. Severe pain, limited range of motion, swelling of the knee joint and fever were the most common symptoms, while rubor and pus developed rarely. The infection was three times more frequent in the patients who had undergone surgery lasting more than 1.5 hour. Discussion and Conclusion. The following population groups are at risk of developing septic arthritis after anterior cruciate ligament reconstructions: professional athletes, those who are allergic to penicillin, and those with immunosuppressive diseases. Staphyllococus aureus is the most common cause of infection. The patients with the hamstring autografts have a higher risk than those with the patellar tendon grafts. Preventive measures that should be performed include aseptic conditions in operative rooms, irrigation of the graft before its placement into the bone tunnels

  3. Tunnel widening in anterior cruciate ligament reconstruction

    DEFF Research Database (Denmark)

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

    1999-01-01

    .1% in the patella tendon group (P = film measurements. Tunnel widening did not correlate with the clinical findings, knee scores, KT-1000 or isokinetic muscle strength. Tunnel widening is marked in the hamstring group. Tunnel widening does not correlate with instability......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...

  4. Essentials of anterior cruciate ligament rupture management.

    Science.gov (United States)

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

    2013-05-01

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

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

    Science.gov (United States)

    Zarychta, P

    2015-12-01

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

  6. MRI of anterior cruciate ligament autografts

    Energy Technology Data Exchange (ETDEWEB)

    Ogi, Shigeyuki; Ariizumi, Mitsuko; Yamagishi, Tsuneo [The Aoyama Tokyo Metropolitan office' s Hospital (Japan); Agata, Toshihiko; Tada, Shinpei; Fukuda, Kunihiko

    2000-09-01

    The purpose of this study was to assess the usefulness of MRI in the evaluation of autografts after anterior cruciate ligament reconstruction. The subjects were 110 patients with anterior cruciate ligament reconstruction using patellar tendon autografts who underwent clinical examination, MRI, and arthroscopy of the knee. T1- and T2-weighted MR images were obtained in sagittal plane. Clinical findings were categorized into three groups: normal, borderline, and abnormal. The MRI appearances of the autografts were categorized into three types: straight continuous band (type I), interrupted band (type II) and generalized increased intensity band (type III). The clinical findings and MRI findings were compared with arthroscopic findings. Ninety-six percent of the type I showed no autograft tear on arthroscopy. In comparison with the clinical findings, MRI was found to be well correlated with arthroscopic findings. In conclusion, if the clinical findings are normal, patients are to be followed-up without MRI and arthroscopy. However, if clinical findings are either borderline or abnormal, MRI should be performed prior to arthroscopy. (author)

  7. Anterior cruciate ligament remnant and its values for preservation

    Directory of Open Access Journals (Sweden)

    Takeshi Muneta

    2017-01-01

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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  9. Reconstruction of anterior cruciate ligament with bone-anterior cruciate ligamentbone allograft in rabbits: a prophase study with histology and biomechanics%兔异体骨-前交叉韧带-骨移植重建前交叉韧带术后早期组织学与生物力学观察

    Institute of Scientific and Technical Information of China (English)

    郭珊成; 张峡; 郝勇

    2011-01-01

    Objective To observe the prophase histology and biomechanics in the reconstructed anterior cruciate ligament (ACL) with bone-anterior cruciate ligament-bone ( B-ACL-B ) allograft in rabbits.Methods Based on the study of anatomy, histology and biomechanics of normal rabbit ruciate ligaments,ACLs were reconstructed with B-ACL-B complex allografts in rabbits. Twenty-four skeletally matured New Zealand white rabbits underwent ACL reconstruction with aseptically harvested fresh-frozen B-ACL-B allograft on one knee randomly. No any immunosuppressive agent was used intra-operative and post-operatively. Gross observation, histological examination and biomechanics test were performed in these groups at 3, 6 and 12 weeks after operation. The opposite side of normal ACL served as control. Results In the early period, the allograft tissue underwent a gradually healing process including the graft necrosis, cellular migration and collagen formation. After operation, a lot of fibroblasts were found in each period, especially at 6 weeks. The virgin collagen fibers crimped and degenerated, and the new collagen fibers were formed. At 12 weeks, the new collagen fibers organized regularly and tightly. The maximum loads of the allograft was 5.5% (5.6 ±0.9 N) after 3 weeks, and 14. 5% ( 14.9 ±2.3 N) after 6 weeks, and 41.5% (42.6 ± 3.7 N) after 12 weeks. The maximum loads of the control group was 102.6 ± 7.8. There was significant difference among 4 groups in maximum loads (P <0.05 ). Conclusion The ACL reconstructed with graft of same anatomic and histological tissue can achieve a good result in prophase histological and biomechanics.%目的 对兔同种异体骨-前交叉韧带-骨(bone-anterior cruciate ligament-bone,B-ACL-B)移植重建ACL术后早期(12周)移植物进行组织学观察及生物力学测试.方法 24只骨骼成熟新西兰大白兔,用新鲜冰冻异体B-ACL-B移植重建兔前交叉韧带,术中及术后均不使用免疫抑制剂.分别于术后3、6

  10. Preoperative cryotherapy use in anterior cruciate ligament reconstruction.

    Science.gov (United States)

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

    2014-12-01

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

  11. Immunohistological analysis of extracted anterior cruciate ligament graft impinged against posterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Kato So

    2011-11-01

    Full Text Available Abstract A young female athlete suffered from the residual instability of the knee after anterior cruciate ligament (ACL reconstruction with hamstring autograft. The 3-dimensional (3-D CT scan showed the "high noon" positioning of the primary femoral bone tunnel. The revision surgery with anatomic double-bundle technique was performed two years after the primary surgery and the femoral tunnels were created with the assistance of the 3-D fluoroscopy-based navigation. An arthroscopic examination confirmed the ACL graft impingement against posterior cruciate ligament (PCL when the knee was deeply flexed. The histological analysis of the resected primary ACL graft showed local inflammatory infiltration, enhanced synovial coverage and vascularization at the impinged site. The enhanced expression of vascular endothelial growth factor (VEGF at the impinged area when compared with non-impinged area was observed on immunohistochemical analysis. Abnormal mechanical stress by the impingement against PCL might have induced chronic inflammation and VEGF overexpression.

  12. EFFECTIVENESS OF BONE-ANTERIOR CRUCIATE LIGAMENT-BONE ALLOGRAFT IN RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT UNDER ARTHROSCOPE%关节镜下同种异体骨-前交叉韧带-骨移植重建前交叉韧带的疗效分析

    Institute of Scientific and Technical Information of China (English)

    郭珊成; 张峡; 郝勇

    2011-01-01

    目的 前交叉韧带(anterior cruciate ligament,ACL)是膝关节重要的稳定结构,探讨关节镜下应用深低温冻存同种异体骨-ACL-骨移植重建ACL的方法及疗效.方法 2007年10月-2010年2月,对22例ACL损伤患者于关节镜下采用深低温冻存的同种异体骨-ACL-骨移植重建ACL.男15例,女7例;年龄19~55岁,平均27.6岁.损伤原因:运动伤12例,摔伤1例,重物压伤2例,交通事故伤7例.左膝14例,右膝8例.病程7 d~12个月,中位病程65 d.前抽屉试验阳性19例,轴移试验阳性19例,Lachman试验阳性21例.术前根据国际膝关节评分委员会(IKDC)分级评定标准,异常5例,严重异常17例:IKDC主观评分为(49.6 4±6.9)分,Lysholm评分为(48.5 4±5.3)分,Tegner膝火节运动功能评分受伤前为(6.8 4±1.2)分,受伤后术前为(2.1 4±0.5)分.20例行MRI检查,其中18例提示ACL损伤.结果 手术时间65~85 min,平均75 min;出血量80~150 mL,平均110 mL.术后切口均Ⅰ期愈合,均无免疫排斥反应及下肢深静脉血栓形成等并发症发生.患者术后均获随访,随访时间7~34个月,平均18个月.末次随访时无伸膝受限;屈膝活动度为125~135°,平均130.5°.前抽屉试验阳性2例,轴移试验阳性1例,Lachman试验阳性3例.根据IKDC分级评定标准:正常10例,接近正常11例,异常1例;IKDC主观评分为(90.0 ±5.8)分,与术前比较差异有统计学意义(t=4.653,P=0.021).Lysholm评分为(91.6 4±7.1)分,与术前比较差异有统计学意义(t=4.231,P=0.028).Tegner评分为(6.1 4±1.5)分,与受伤前比较差异无统计学意义(t=1.321,P=0.070),与受伤后术前比较差异有统计学意义(t=3.815,P=0.033).术后6个月19例关节镜复查示无移植韧带断裂,17例移植物张力正常,2例稍松弛.结论 关节镜下应用深低温冻存的同种异体骨-ACL-骨移植重建ACL,可达到ACL解剖重建,术后膝天节功能恢复良好.%Objective The anterior cruciate ligament (ACL) is the important stable

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

    Directory of Open Access Journals (Sweden)

    A. V. Rybin

    2015-01-01

    Full Text Available Based on the analysis of the scientific publications, the authors analyzed the possibilities and effectiveness of platelet- rich plasma (PRP application as a stimulator of engraftment and biological transformation of tendinous autografts and allografts after arthroscopic reconstruction of knee anterior cruciate ligament. The topic of impossibility of spontaneous recovery of torn anterior cruciate ligament of knee, and describe the staging of biological incorporation of tendinous transplant in a bone wall was discussed. The authors presented methods and techniques of accelerating engraftment of free tendinous graft into bone channels described in the literature and the difference of terms of remodeling the autografts and allografts. The effect of different techniques of sterilization and preservation of tendinous allografts on the change of their biological properties was disclosed.

  14. [Chondroblastoma in the anterior cruciate ligament origo: a case report].

    Science.gov (United States)

    Aydin, Hafız; Turhan, Ahmet Uğur; Karataş, Metin; Onay, Atilgan; Yildiz, Kadriye

    2012-01-01

    Chondroblastoma is a rarely seen cartilage originated tumor. It is mostly localized in the epiphysis of long bones. In this article, we present an 18-year-old male case in whom the tumor was located in the right distal femoral lateral condyle and destroyed anterior cruciate ligament origo. The tumor was curetted and the cavity was filled with cement. Anterior cruciate ligament resection was mandatory for this treatment. The patient had no complaint in the postoperative period.

  15. Anterior cruciate ligament reconstruction without drill holes.

    Science.gov (United States)

    Brief, L P

    1991-01-01

    Anterior cruciate ligament (ACL) reconstruction in adolescents with open physes remains a difficult problem for the orthopedic surgeon, especially in view of growing teenage participation in contact sports. Traditionally, treatment of ACL tears in adolescents has been conservative; the patient is advised to delay surgery up to several years for fear of damaging physes by drilling holes across them. Unfortunately, this waiting period may inflict irreparable knee damage. This paper suggests an ACL reconstruction technique that utilizes no drill holes, thus causing no harm to physes or other essential knee structures. A graft consisting of semitendinosus and gracilis (SG) tendons is passed under the anterior horn of the medial meniscus through the knee joint, then brought out through the posterior capsule and secured to the lateral femoral metaphysis. The graft is augmented with an iliotibial band tenodesis. Designed primarily but not exclusively for teenagers with open physes, the procedure has produced encouraging results thus far in a small series.

  16. Day case arthroscopic anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Elgafy, H; Elsafty, M

    1998-10-01

    This is a report of the first 33 consecutive patients who had arthroscopic anterior cruciate ligament (ACL) reconstruction in the day unit of Sandwell District General Hospital. Bone-patellar tendon-bone autograft was used. This study assessed post-operative pain control, clinical results and patient satisfaction with day case surgery. The mean age was 29 years, (range 17-43). The mean period between injury and reconstruction was 29 months, (range 2-50). The mean follow-up period was 16 months (range 6-31). In 31 patients (94%), adequate post-operative pain control was achieved with oral non opioid analgesic. No patient required readmission for pain control, nausea, vomiting or urinary retention. At the last follow up, the mean Lysholm score was 93.9, (range 68-100). Thirty-one patients (94%) were satisfied with the day case surgery and believed that they did not require hospitalization after surgery.

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

    Institute of Scientific and Technical Information of China (English)

    HUANG Jian-ming; LIU Hao-yuan; CHEN Feng-rong; JIAN Guo-jian; CHEN Qi; WANG Zi-min; KANG Yi-fan

    2012-01-01

    Background 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.Methods 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.Results 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.Conclusions 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.

  18. Oblique reconstruction of the cruciate ligaments on computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    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).

  19. Anterior cruciate ligament: 3-D fiber anatomy, fluorescence arthroscopy & healing

    NARCIS (Netherlands)

    Nguyen, D.T.

    2015-01-01

    One of the current emphases in optimizing anterior cruciate ligament (ACL) reconstructions is closer mimicking the anatomy of the ACL. The aim of Chapter 2 and Chapter 3 is to develop and validate a methodology to quantify the 3-D collagen fiber orientation of ligaments, accurately and at a high res

  20. Immune rejection following anterior cruciate ligament reconstruction with tendon allograft%同种异体肌腱移植重建前交叉韧带的免疫排斥反应

    Institute of Scientific and Technical Information of China (English)

    左健; 孙皓; 潘乐

    2011-01-01

    背景:近年来同种异体肌腱移植逐渐用于治疗膝关节前交叉韧带损伤.目的:综述膝关节前交叉韧带损伤的特点及其同种异体肌腱移植重建后的免疫排斥反应问题.方法:应用计算机检索1990-01/2011-10 PubMed数据库及维普数据库相关文献.英文检索词"anterior cruciate ligament,allograft,anatomy,transplantation",中文检索词"前交叉韧带,同种,肌腱,移植".检索文献量总计164篇,最终纳入符合标准的文献34篇.结果与结论:国内外学者对同种异体肌腱移植重建前交叉韧带进行了几十年的研究,已逐步了解了膝关节前交叉韧带的生物力学特性;通过冷冻处理法、细胞毒物质处理法解决了同种异体肌腱移植后的免疫排斥反应,使其既能降低异体肌腱的抗原性,又能保存肌腱细胞的活性,促使肌腱的内源性愈合,提高肌腱愈合速度与强度,减轻或避免肌腱粘连的发生,临床应用取得了很好的效果.%BACKGROUND: Organ transplant patients require lifelong use of immunosuppressive reagent, so a rational use of immunosuppressive agents is the key to organ transplantation.OBJECTIVE: To summarize various representative drugs in organ transplantation and to propose a suitable immunosuppressive agent for organ transplant patients.METHODS: The first author searched PubMed database (http://wiouu.ncbi.nlm.nih.gov/PubMed) and Wanfang Database (http://wuwy.wanfangdata.com.cn) from 1999-01/2011 -06. English key terms are "immunosuppressh/e drug, reject reaction, cyclosporine A, tacrolimus (FK506T, and Chinese key terms are "immunosuppressive drugs, renal trans plantation, liver transplantation, rejection". A total of 105 documents were screened out, and those foe us ing on the application and clinical effectiveness of different immunosuppressri/e drugs in organ transplantation were included, while repeated experiment and old articles were excluded. Recently published articles or those published in the

  1. 异体肌腱保留残端重建前交叉韧带的前瞻性随机对照研究%Allograft reconstruction of anterior cruciate ligament with remnant preservation: a prospective, randomized, controlled study

    Institute of Scientific and Technical Information of China (English)

    洪雷; 李旭; 张辉; 刘心; 冯华

    2012-01-01

    Objective To compare the short-term clinical outcomes of remnant-preserving anterior cruciate ligament (ACL) reconstruction with allografts and standard ACL reconstruction.Methods A prospective randomized controlled study was performed in 90 eligible consecutive patients with ACL rupture who were equally assigned into 2 groups from August 2008 through April 2010.Group A (n =45) received ACL reconstruction with remnant preservation technique and group B (n =45) the standard ACL reconstruction.4-strand allografts were used for all cases.The Lysholm score,International Knee Documentation Committee (IKDC) grading,and stability assessments (Lachman test,pivot shift test and KT-1000 side-to-side differences)were evaluated pre-and post-operatively.Synovial coverage of the graft and proprioception evaluation were estimated postoperation.Results Thirty-nine patients in group A and 41 in group B were followed up for at least 2 years(mean,25.7 months).At the last follow-up,the mean Lysholm score was 96.0 ± 6.0 in group A and 93.0 ± 7.5 in group B; there were 38 cases of IKDC grading A or B in group A and 40 in group B; 97.4%(38/39) in group A and 97.6% (40/41) in group B had negative Lachman test results; 94.9% (37/39) in group A and 87.8% (36/41) in group B had negative pivot-shift tests; the KT-1000 side-to-side differences averaged 1.6 ± 1.7 mm in group A and 1.8 ± 1.8 mm in group B; the synovial coverage of grade A or B was 71.4% (20/28)in group A and 70.4% (19/27) in group B; the passive angle reproduction test at 15° was 3.6° ± 1.8° in group A and 3.9°± 2.2° in group B.There were no significant differences between the 2 groups regarding all the above indexes (P > 0.05).Conclusion In the allograft ACL reconstruction,compared with standard ACL reconstruction,remnant-preserving ACL reconstruction may not result in significant improvements in postoperative stability,synovial coverage and proprioceptive recovery of the knee joint.%目的 比较使

  2. Predictors of Revision Surgery After Primary Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Yabroudi, Mohammad A.; Björnsson, Haukur; Lynch, Andrew D.; Muller, Bart; Samuelsson, Kristian; Tarabichi, Majd; Karlsson, Jón; Fu, Freddie H.; Harner, Christopher D.; Irrgang, James J.

    2016-01-01

    Background: Revision anterior cruciate ligament (ACL) reconstruction surgery occurs in 5% to 15% of individuals undergoing ACL reconstruction. Identifying predictors for revision ACL surgery is of essence in the pursuit of creating adequate prevention programs and to identify individuals at risk for reinjury and revision. Purpose: To determine predictors of revision ACL surgery after failed primary ACL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 251 participants (mean age ± SD, 26.1 ± 9.9 years) who had undergone primary ACL reconstruction 1 to 5 years earlier completed a comprehensive survey to determine predictors of revision ACL surgery at a mean 3.4 ± 1.3 years after the primary ACL reconstruction. Potential predictors that were assessed included subject characteristics (age at the time of surgery, time from injury to surgery, sex, body mass index, preinjury activity level, return to sport status), details of the initial injury (mechanism; concomitant injury to other ligaments, menisci, and cartilage), surgical details of the primary reconstruction (Lachman and pivot shift tests under anesthesia, graft type, femoral drilling technique, reconstruction technique), and postoperative course (length of rehabilitation, complications). Univariate and multivariate logistic regression analyses were performed to identify factors that predicted the need for revision ACL surgery. Results: Overall, 21 (8.4%) subjects underwent revision ACL surgery. Univariate analysis showed that younger age at the time of surgery (P = .003), participation in sports at a competitive level (P = .023), and double-bundle ACL reconstruction (P = .024) predicted increased risk of revision ACL surgery. Allograft reconstructions also demonstrated a trend toward greater risk of revision ACL surgery (P = .076). No other variables were significantly associated with revision ACL surgery. Multivariate analysis revealed that revision ACL surgery was

  3. 关节镜下前交叉韧带重建后内侧和外侧半月板同期移植术%Both the medial and lateral meniscal allograft transplantation following the anterior cruciate ligament reconstruction by arthroscopic surgical technique

    Institute of Scientific and Technical Information of China (English)

    章亚东; 侯树勋; 张轶超; 罗殿中; 衷鸿宾; 张洪

    2011-01-01

    Objective To discuss the minimal invasive arthroscopic surgery technique and clinical results of both the medial and lateral meniscal transplantation following the anterior cruciate ligament reconstruction with double bundles and bone tunnels.Methods In August 2008 a minimal invasive surgery of both the medial and lateral meniscal allograft transplantation following anterior cruciate ligament reconstruction was preformed for 1 case with both the medial and lateral menicectomy by arthroscopic surgery.The method of two bone plugs attached on tibial plateau was employed for medial meniscal allograft transplantation and the technique the bridge in slot for lateral meniscal allograft transplantation.The VAS,Lysholm score and IKDC rating were recorded before and after operation.The stability of knee was assessed by Lachman test,drawer sign and pivot shift test.Results The patient was followed up 26 month after the operations.The degrees of knee flexion,extension and function of walk were normal.The Lachman test,drawer sign and pivot shift test were nearly normal.The VAS after operation was 2 points lower than that before operation.The Lysholm score post-operation was 20 points higher than pre-operation.The IKDC became B degree in late following-up from C degree before the operation.MRI revealed anterior cruciate ligament graft was continuous and the meniscal allograft was normal shape on year 1 after the operation.The posterior horn of medial meniscal allograft and anterior corner of lateral meniscal allograft showed slightly shrunk.The second-look arthroscopy showed that the healing occurring between meniscal allograft and the capsule and meniscal allograft was normal shape on month 18 after the operation.The anterior horn of medial and lateral meniscus was slightly worn.Conclusions Both the medial and lateral meniscal transplantation following the anterior cruciate ligament reconstruction in appropriately selected patients with the medial and lateral meniscus

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

    OpenAIRE

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

    2016-01-01

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

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

    OpenAIRE

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

    2016-01-01

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

  6. 自体及同种异体肌腱重建前交叉韧带的前瞻性比较研究%Prospective comparative study of arthroscopic anterior cruciate ligament construction with autograft and allograft

    Institute of Scientific and Technical Information of China (English)

    毕海勇; 孙秀江; 慕宏杰; 张国栋; 杨勇

    2013-01-01

    Objective To study the clinical effect of arthroscopic anterior cruciate ligament (ACL) construction with different transplants.Methods From March 2006 to April 2009,86 patients including 60 male and 26 female undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into autograft group (44 patients,using autogeneic hamstring tendons) and allograft group (42 patients,using allogenic lower extremity tendons).The age of those patients were 22-56 years,averaging (32 ±7) years.The operations were made by the same doctor with the standard technology.The postoperative effects were assessed by the range of motion and tibia forward distance,Lachman test,pivot shift test,Daniel test,IKDC scores systems,Lysholm-Tegner scores.Results Seventy-nine patients were followed up,41 patients in autograft groups averaged 39.6 months and 38 patients in allograft group averaged 37.4 months.The operation time of autograft group was (87 ± 11) minutes,that of allograft group was (55 ±10) minutes (t =15.732,P < 0.05).The time of postoperative fever of autograft group was (3.2 ±1.4) days,that of allograft groups was (7.6 ± 5.3) days (t =5.740,P < 0.05).The Lysholm scores of autograft group was 42 ± 7 before operation,and 89 ± 8 at final follow-up.The Lysholm scores of allograft group was 44 ± 6 before operation,and 87 ± 9 at final follow-up.There was statistic difference in both groups between before operation and final follow-up (t =13.534 and 17.768,P <0.05).But no statistic difference existed between the two groups (P > 0.05).The Tegner scores of autograft group was 2.9 ± 2.1 before operation,and 7.7 ± 1.2 at final follow-up.The Tegner scores of allograft group was 2.7 ± 1.4 before operation,and 7.1 ± 1.6 at final follow-up.There was statistic difference in both groups between before operation and final follow-up (t =16.004 and 12.338,P < 0.05).No statistic difference existed between the two groups (P > 0.05).The KT2000 results showed

  7. Complications of anterior cruciate ligament reconstruction: MR imaging.

    Science.gov (United States)

    Papakonstantinou, Olympia; Chung, Christine B; Chanchairujira, Kullanuch; Resnick, Donald L

    2003-05-01

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

  8. Complications of anterior cruciate ligament reconstruction: MR imaging

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-05-01

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

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

    Science.gov (United States)

    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.

  10. Posterior cruciate ligament's tibial insertions: topographic anatomy and morphometric study

    Directory of Open Access Journals (Sweden)

    Julio Cesar Gali

    2013-06-01

    Full Text Available OBJECTIVE: To provide anatomical and morphometric basis of the posterior cruciate ligament's tibial insertions in order to assist the creation of anatomical tibial tunnels, in the ligament surgical reconstruction. MATERIAL AND METHODS: The topographic anatomy and morphometry of the posterior cruciate ligament's anterolateral and posteromedial bundles' tibial insertions were analyzed in 24 anatomical knee pieces. The pieces were photographed by a digital camera and the images obtained were studied by the software ImageJ, where the bundles' insertion areas were measured in square millimeters, and the length of structures and the distances between significant points were measured in millimeters. RESULTS: In 54.2% of the knees the insertion' shape was concave; in most pieces (41.6% the form of insertion was oval. The average posterior cruciate ligament's tibial insertion total area was 88.33 ± 21.66 mm2; the average anterolateral bundle's tibial insertion area was 46.79 ± 14.10 mm2 and it was 41.54 ± 9.75 mm2 for the posteromedial bundle. CONCLUSIONS: The anterolateral bundle has a tibial insertion area larger than the posteromedial bundle; the insertion areas of those bundles in our study, were smaller than the ones found in the literature. The variations in the posterior cruciate ligament's tibial insertion area suggest that there should be an indication for anatomical reconstructions of this ligament using single or double tibial tunnels according to individual characteristics.

  11. Failure of Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Gonzalo Samitier

    2015-10-01

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

  12. Failure of Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Gonzalo Samitier

    2015-09-01

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

  13. Anterior cruciate ligament injury in professional dancers.

    Science.gov (United States)

    Meuffels, Duncan E; Verhaar, Jan A N

    2008-08-01

    Anterior cruciate ligament injury (ACL) is a common sport injury; however, there are no data concerning dance and ACL injury. We report the incidence, injury mechanism, and clinical follow-up of ACL injury in professional dancers. In a retrospective cohort study involving the three major dance companies in the Netherlands, by interviewing all 253 dancers who had had a full-time contract during 1991-2002, dancers with symptomatic ACL injury or past ACL reconstruction were identified and examined. 6 dancers (2 of whom were women) had had a symptomatic ACL rupture and reconstruction. Interestingly, all had been on the left side and had had a similar trauma mechanism: while dancing a classical variation they landed, after a jump, on their left leg, in the turned out position with a valgus force on their knee. There was a higher risk of ACL injury in the classical company than in the two contemporary companies. The risk of dancers having a rupture of the left ACL during a 10-year career in this classical company was 7%. ACL injuries are not an infrequently seen type of injury in professional classical dancers, with a very specific mechanism of injury--a landing on the left leg in exorotation. More attention and prophylactic measures should be given to this specific injury mechanism.

  14. [Augmented anterior cruciate ligament replacement with the Kennedy-LAD (ligament augmentation device)--long term outcome].

    Science.gov (United States)

    Riel, K A

    1998-01-01

    The ligament augmentation device (Kennedy-LAD) is used to protect tendon grafts during the posttransplantation decrease in strength in anterior cruciate ligament (acl) reconstructions. The augmentation with the LAD is based on the concept of load sharing. Since 1983 we used the LAD in acl-reconstructions in 856 patients. In 63 cases we had to treat complications like infection (8), recurrent effusions (21), arthrofibrosis (34). The overall results are good with respect to stability, regain of strength and sports activity. In 73 cases resurgery was necessary because of synovitis (7), LAD-rupture due to re-injury (9), fatigue-rupture of the LAD (22), meniscal tears (35), 2.7 +/- 2.3 years (range: 2 months to 10 years) after LAD implantation. Modern techniques in acl reconstruction lead to comparable results without synthetic augmentation. Therefore, we now recommend the use of a LAD only in cases of repeated acl replacement with week tendon grafts, to avoid an allograft.

  15. Nursing coordination of synchronized allograft Achilles reconstruction of posterior cruciate ligament by arthroscopy%关节镜下带跟骨异体跟腱重建膝后交叉韧带的护理配合

    Institute of Scientific and Technical Information of China (English)

    万效梅; 李娟

    2014-01-01

    To summarize the surgery nursing experiences of synchronized alograft Achiles reconstruction of posterior cruciate ligament and to improve the quality of coordination during surgery.Methods:41 cases of surgery nursing experiences of synchronized alograft Achiles reconstruction of posterior cruciate ligament including preparing special equipment, alograft ligament, placement of equipment and coordination during surgery between June of 2011 and December of 2012 were reviewed and analyzed.Results:41 patients were successfuly operated with wound healing, no infection of the joint cavity and good recovery from surgery.Conclusion:Missions, psychological care before surgery, careful preoperative preparation, correct preparation of alograft ligament, proper connection of various instruments and closely and effective coordination are al important for the successful operation.%目的:总结关节镜下带跟骨异体跟腱移植重建膝后交叉韧带的手术护理经验,以提高手术配合质量。方法:回顾性分析2011年6月到2012年12月期间,41例关节镜下带跟骨异体跟腱重建膝后交叉韧带护理配合情况,包括各种特殊器械准备、异体肌腱准备工作、仪器设备合理摆放及术中配合等。结果:41例患者均顺利完成手术,伤口一期愈合,未发生关节腔的感染,术后恢复良好。结论:术前做好宣教及心理护理、完善周密的术前准备、异体肌腱正确制备、正确连接各种仪器、密切有效的手术配合是手术顺利进行的重要保障。

  16. Compartment syndrome with mononeuropathies after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Kindle, Brett J; Murthy, Naveen; Stolp, Kathryn

    2015-05-01

    Compartment syndrome rarely follows anterior cruciate ligament reconstruction. However, when it does, it may result in mononeuropathies that are amenable to neurolysis. The authors of this study present an 18-yr-old woman who sustained a right anterior cruciate ligament tear and underwent uneventful anterior cruciate ligament reconstruction using femoral and popliteal nerve blocks. Postoperatively, she developed compartment syndrome requiring emergent fasciotomies. At 11 wks after fasciotomy, results of electrophysiologic tests showed evidence of severe fibular and tibial neuropathies. Magnetic resonance images showed extensive tricompartmental myonecrosis. Fibular and tibial neurolysis as well as decompression were performed, followed by intensive outpatient rehabilitation. At the 6-mo follow-up, she reported resolution of pain as well as significant improvement in sensation, strength, and function. Early recognition and intervention are crucial to prevent serious neurologic damage. Excessive tourniquet pressure and anesthetic nerve blocks may have been responsible.

  17. 自体腱与同种异体腱重建前交叉韧带术后体温的对照研究%Comparing research of post operative body temperature for patients reconstructing the knee anterior cruciate ligament with autograft or allograft

    Institute of Scientific and Technical Information of China (English)

    郭冬梅; 刘秀敏; 刘静

    2014-01-01

    Objective To study post-operative body temperature of patients after reconstruction of the knee anterior cruciate ligament (ACL)with autograft and allograft,and find out related nursing methodology. Methods 60 patients performed ACL reconstruction (autograft 30 as group A,and allograft 30 as group B) were selected.Temperature were measured 1 day before operation,the day of operation up to 4 days after operation at 6AM、10AM、2PM、6PM. Results The mean temperature and the lowest temperature of the second day after the operation of group B were higher than of group A,showing a significant difference (P0.05)。结论应对自体腱和异体腱重建前交叉韧带术后体温变化予以同等对待,改变同种异体移植术后早期体温高于自体移植的传统观念,并根据体温变化规律,做到科学护理。

  18. Concurrent arthroscopic bicruciate ligament reconstruction using Achilles tendon-bone allografts: experience with 15 cases

    Institute of Scientific and Technical Information of China (English)

    Shi De-hai; CAI Dao-zhang; WANG Kun; RONG Li-min; XU Yi-chun

    2008-01-01

    Objective: To evaluate the clinical outcome of arthroscopically assisted combined anterior and posterior cruciate ligament (ACL/PCL) reconstructions using Achil-les tendon-bone allografts. Methods: Associated meniscus injuries were treated according to established methods prior to ligament recon-structions during arthroscopic surgery. Thirty Achilles ten-don-bone allografts were used to reconstruct torn ACL and PCL in 15 knees. At postoperative follow-up, all knees were graded using the modified IKDC and the Lysholm scoring systems just as done preoperatively. Results were analyzed compared with the contralateral healthy knees. Results: Eleven men and 4 women with a minimum of 3-year follow-up (mean 38 months) were included in the study. Preoperatively, the group ratings by the modified IKDC standards were all severely abnormal. Twelve bicruciate reconstructions were performed in subacute or chronic stage (>3-8 weeks), 3 for acute ligamentous deficien-cies (≤ 3 weeks). The noticeable early complication was transitory local fever combined with joint effusion in one case. At postoperative follow-up, 9 knees were normal, 5 nearly normal and 1 abnormal. On Lysholm score the differ-ence was statistically significant (t- test, P<0.001) before and after operation. Conclusions: Achilles tendon-bone allograft offers an alternative for simultaneous arthroscopic ACL/PCL reconstructions. However, further investigation is needed to eradicate its potential immunogenicity for better use.

  19. Avulsion fracture of the posterior cruciate ligament in an uncommon location associated with distal injury to the patellar ligament

    Directory of Open Access Journals (Sweden)

    Rodrigo Pires e Albuquerque

    2015-12-01

    Full Text Available ABSTRACT Avulsion fractures of the posterior cruciate ligament in unusual locations are rare injuries. We report the first case in the literature of an avulsion fracture of the posterior cruciate ligament associated with distal injury to the patellar ligament. The aim of this study was to present a novel case, the therapy used and the clinical follow-up.

  20. STUDY OF ANTERIOR CRUCIATE LIGAMENT INJURY AND ITS MANAGEMENT

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    Tummala Venkata

    2016-03-01

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

  1. 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.

  2. Anterior Cruciate Ligament Injuries in Wakeboarding

    Science.gov (United States)

    Starr, Harlan M.; Sanders, Brett

    2012-01-01

    Background: Wakeboarding is an increasingly popular sport that involves aggressive stunts with high risk for lower extremity injury, including anterior cruciate ligament (ACL) rupture. Little has been reported on prevalence or mechanism of ACL injury while wakeboarding. Hypothesis: The prevalence of ACL injury in wakeboarding approaches that of other high-risk sports. Analyzing the mechanism of ACL injury may aid in future efforts of prevention. Study Design: Descriptive epidemiology study. Methods: In sum, 1580 surveys were sent internationally to professional and amateur wakeboarders. The survey questioned the participants on their history of an ACL tear while wakeboarding and asked them to describe the mechanism of injury and treatment. Results: A total of 123 surveys were returned. Of this group, 52 (42.3%) acknowledged having had an ACL tear while wakeboarding. The majority described feeling a pop or buckle after attempting to land a high jump. Only 5 participants (13.5%) described a rotational mechanism created by catching the board edge in the water. Thirty-seven participants (71.15%) said that the injury ruined their ability to wakeboard before reconstruction, and 41 (78.85%) had the injury repaired surgically. Conclusion: The prevalence of ACL tears in this data set, 42.3%, is the highest reported in the literature for wakeboarding and one of the highest for any sport. The main mechanism of injury appears to involve axial compression while one lands in a provocative position; it is not related to a rotational force created by fixed bindings. The injury should be surgically repaired to effectively continue the sport. Further study is needed to determine if wakeboarding represents a high-risk sport for ACL injury. Clinical Significance: Wakeboarding may be a high-risk sport for ACL injury. Noncontact axial compression appears to be the main mechanism of injury. PMID:23016104

  3. 碳化二亚胺交联同种异体肌腱修复兔前交叉韧带损伤生物力学实验研究%Reconstruction of anterior cruciate ligament with rabbit tendon allograft cross-linked and heparinized by EDC/NHS

    Institute of Scientific and Technical Information of China (English)

    谷守滨; 何金海; 方波

    2011-01-01

    目的 探讨利用碳化二亚胺(1-3-(dimethylamino)propyl-3 -ethylcarbodiimide methiodide,EDC)交联并肝素化的方法对同种异体肌腱进行预处理改善其修复韧带损伤效果,为临床应用提供实验基础和理论依据.方法 采用冷冻干燥法获得兔同种异体肌腱,应用EDC交联并肝素化方法进行再处理;自体肌腱移植组、未交联同种异体肌腱移植组和EDC交联同种异体肌腱移植组分别对兔前交叉韧带损伤进行修复,于1、3、6个月生物力学测试检测各时间点肌腱最大拉伸强度,其结果进行统计学分析;交联组和未交联组肌腱取材做光镜和扫描电镜观察,对比1、3、6个月不同时间段腱骨愈合情况.结果术后1个月最大拉伸强度自体肌腱移植组、EDC交联肌腱移植组、未交联肌腱移植组两两比较,差异有统计学意义(P<0.05);术后3、6个月进行比较,EDC交联肌腱移植组和自体肌腱移植组比较无显著性差异(P>0.05),与未交联肌腱移植组相比较有显著性差异(P<0.05).组织学观察EDC交联并肝素化的同种异体肌腱在修复ACL损伤过程中的腱骨愈合能力比未交联的同种异体肌腱强,Sharpey's纤维出现早.结论 经碳化二亚胺交联并肝素化处理的同种异体肌腱,其稳定性明显增强,免疫原性明显降低,有利于肌腱与骨的愈合.%Objective To evaluate the anterior cruciate ligament reconstruction effect of rabbit tendon allograft cross-linked and heparinized by EDC/NHS. Methods The rabbit' s tendon allograft was obtained by lyophilization, then cross-linked and heparinized by EDC/NHS; the rabbit anterior cruciate ligaments were reconstructed with cross-linked and non-crosslinked liga ment allograft. After 1,3,6 months, the tendons were harvested, the maximum tensile strength was compared; the tendon-bone junction were harvested and evaluated by microscopy and scanning electric microscopy. Results The maximum tensile strength of

  4. Graft infection following arthroscopic anterior cruciate ligament reconstruction: a report of four cases.

    Science.gov (United States)

    Wee, James; Lee, Keng Thiam

    2014-04-01

    Septic arthritis following arthroscopic anterior cruciate ligament reconstruction (ACL) is a rare complication and associated with severe morbidity. Its risk factors include (1) concomitant procedures during the reconstruction, (2) previous knee surgery, (3) allograft usage, (4) peri-operative wound contamination, and (5) presence of intra-articular foreign bodies. We present a series of 3 men and one woman aged 22 to 35 years who developed septic arthritis following ACL reconstruction. The risk factors identified were local infection (n=2), previous ipsilateral knee surgery (n=2), and the use of an allograft (n=1). All patients underwent emergency knee washout and debridement with graft retention within 24 hours, together with a course of intravenous antibiotic therapy. All the patients achieved eradication of their infections (with intact ACL grafts) and satisfactory functional outcome at a mean follow-up of 32 (range, 25-45) months.

  5. 关节镜下同种异体与自体移植物重建前交叉韧带的疗效比较%Comparative Study on the Efficacy of Arthroscopic Allograft vs Autograft for the Reconstruction of Anterior Cruciate Ligament

    Institute of Scientific and Technical Information of China (English)

    李跃峰; 雷青; 陈松

    2011-01-01

    [Objective] To compare the clinical efficacy of autologous patellar ligament bone graft vs allogenic boneligament graft for one-stage reconstruction of knee anterior cruciate ligament(ACL). [Methods] The patients with complete ACL rupture or subtotal ACL rupture confirmed by arthroscopy underwent one-stage reconstruction of ACL. According to the preoperative request, economic status and disease knowledge of the patients, arthroscopic reconstruction by allogenic bone-ligament graft or autologous patellar ligament-bone graft was performed respectively. [Results] All patients were followed up for 6 months to 3 years. No graft breakage, joint and bone infection of two reconstruction methods occurred. The motion of knee joint was similar to the uninjuried side. No immune response was found in allograft group. [Conclusion] The efficacy of arthroscopic autologous patellar ligament bone graft for the ligament reconstruction is the same as that of allogenic bone-ligament graft, and there is no significant difference between two methods.%[目的]采用自体髌韧带-骨移植物和同种异体骨-韧带移植物一期重建膝前交叉韧带,比较两者的临床疗效.[方法]在关节镜检后确认有前交叉韧带完全断裂或大部分断裂,需行交叉韧带重建者,即一期予行交叉韧带重建.根据术前患者要求,以及经济状况和对疾病的认知,分别采用同种异体骨-韧带移植物及自体髌韧带骨移植物予以关节镜下重建.[结果]术后患者获随访6个月至3年,两种重建方法均无重建移植物断脱,无关节及骨感染等症发生;膝关节活动度与健侧相似,同种异体移植物组无免疫反应.[结论]关节镜下采用自体髌韧带-骨移植物与同种异体韧带-骨移植物重建交叉韧带均能达到损伤韧带重建的效果,二者之间无显著差异.

  6. 关节镜下Rigidfix、Intrafix系统固定同种异体胫前肌重建膝关节前交叉韧带%Arthroscopic reconstruction of anterior cruciate ligament using Rigidfix and Intrafix system with allograft tibialis anterior tendons

    Institute of Scientific and Technical Information of China (English)

    孙景东; 龚泰芳; 卢云; 陈文; 王平年

    2013-01-01

    目的 探讨关节镜下应用Rigidfix和Intrafix系统固定同种异体胫前肌重建膝关节前交叉韧带的临床效果.方法 2010年1月至2011年12月在关节镜下应用同种异体胫前肌重建前交叉韧带21例,21例均采用Rigidfix和Intrafix系统固定同种异体胫前肌,术后进行系统的康复治疗并处理相应并发症,术后随访6~12月,按照Lysholm膝关节评分评价疗效.结果 本组21例均获得随访,21例患者均未发生严重并发症,均未发生排斥反应,术后6月复查均无乙肝及HIV等疾病传播.膝关节屈曲均达120°及以上,伸直0°,前抽屉试验19例阴性,2例Ⅰ度阳性,所有患者均无膝关节不稳的主观症状.Lysholm膝关节评分由术前的平均(32.2±4.2)分提高至平均(88.2±3.6)分,差异有统计学意义(P<0.05).结论 关节镜下应用Rigidfix和Intrafix系统固定同种异体胫前肌重建膝关节前交叉韧带临床效果良好,避免患者应用自体肌腱所产生的自体损伤,固定牢固,术后膝关节稳定性良好.%Objective To study the clinical effect ofarthroscopic reconstruction of anterior cruciate ligament using Rigidfix and Intraflx system with allograft tibialis anterior tendons.Methods 21 anterior cruciate ligaments rupture were reconstructed arthroscopically with allograft tibialis anterior tendons,all graft were fixed with Rigidfix and Intrafix system.Patients were treated with systematic rehabilitation therapy and relevant complications were managed postoperatively.All patients were followed up for 6~12 months,Lysholm rating were managed to evaluate clinical results.Result All patients were followed up for 6~12 months postoperatively and no serious complications were found,no rejection reaction,no HBV and HIV infection after 6 months.All patients achieve knee flexion above 120°,no extension lag,anterior drawer test negative 19 cases,positive 2 case with I degree.All patients had no sensation of knee instabilization.The Lysholm

  7. 精细化康复护理模式在行关节镜下异体肌腱重建前交叉韧带术患者中的应用%Application of fine rehabilitation nursing mode in the patients with tendon allograft reconstruction of anterior cruciate ligament under arthroscopy

    Institute of Scientific and Technical Information of China (English)

    李爱珍; 马志芳

    2015-01-01

    Objective:To study the application of fine rehabilitation nursing mode in the patients with tendon allograft reconstruction of anterior cruciate ligament under arthroscopy.Methods:120 patients with tendon allograft reconstruction of anterior cruciate ligament under arthroscopy were selected.They were randomly divided into the control group and the experimental group with 60 cases in each.The control group was given routine nursing mode.The experimental group was given fine rehabilitation nursing mode.The knee stability and functional recovery,the health education awareness of patients,the satisfactions of patients or family on the nursing work of two groups were compared.Results:120 patients were all followed up. Using lysholm knee function score,the excellent and good rate of knee joint function in the experimental group reached 90.0%,the control group reached 60.0%.The health education awareness of patients in the experimental group was 98%,the control group was 85%.The satisfaction of the nursing work in the experimental group was 97%,the control group was 91%.Conclusion:The fine rehabilitation nursing mode has a actively promote role on the postoperative knee joint function recovery of tendon allograft reconstruction of anterior cruciate ligament under arthroscopy.It improves the health education awareness of patients and the satisfactions of patients or family on the nursing work.%目的:研究精细化康复护理模式在行关节镜下异体肌腱重建前交叉韧带术患者中的应用。方法:收治行该术患者120例,随机分为对照组和试验组各60例,对照组采用常规护理模式,试验组采用精细化康复护理模式,比较两组膝关节稳定性及功能恢复情况、患者对健康教育知晓率及患者或家属对护理工作的满意度。结果:120例患者均得到随访,采用lysholm膝关节功能评分,试验组膝关节功能优良率达90.0%,对照组达60.0%;患者对健

  8. Ganglion cyst of the cruciate ligament with atlantoaxial subluxation.

    Science.gov (United States)

    Lee, Ching-Yi; Lai, Hung-Yi; Lee, Shih-Tseng

    2013-10-01

    Ganglion cysts of the cruciate ligament are rare and sometimes asymptomatic. The authors present three cases of ganglion cysts of the cruciate ligament with atlantoaxial subluxation, which has rarely been reported previously. Generally, ganglion cysts of the cruciate ligament are reported as case reports. Several theories regarding the process of cyst formation and the development of treatment options have been described. However, trans-oral decompression with total removal of the cyst may be one of the options for treatment of this kind of disease. A retrospective review of three patients, two female and one male patient, with a mean age of 68 years was conducted. The operation performed was a trans-oral decompression with cyst removal for all patients. Clinical outcomes were evaluated after the operation. All patients underwent trans-oral decompression with total removal of the cyst, followed by posterior fusion and pathologic examination of the cyst, revealing myxoid stroma with an absence of synovial linings. The ganglion cysts and synovial cysts of the cruciate ligament are two different diseases with different presentation, pathogenesis, pathophysiology, and pathologic findings.

  9. The effect of anterior cruciate ligament injury on bone curvature

    DEFF Research Database (Denmark)

    Hunter, D J; Lohmander, Stefan; Makovey, J

    2014-01-01

    OBJECTIVE: Investigate the 5-year longitudinal changes in bone curvature after acute anterior cruciate ligament (ACL) injury, and identify predictors of such changes. METHODS: In the KANON-trial (ISRCTN 84752559), 111/121 young active adults with an acute ACL tear to a previously un-injured knee ...

  10. A Comparison of Anterior and Posterior Cruciate Ligament Laxity Between Female and Male Basketball Players.

    Science.gov (United States)

    Weesner, Carol L.; And Others

    1986-01-01

    The anterior cruciate ligament and posterior cruciate ligament laxity of 90 uninjured male and female high school players were measured. No significant differences were found, indicating that the greater female injury rate may be due to inadequate conditioning, not greater knee ligament laxity. (Author/MT)

  11. Patella fracture following anterior cruciate ligament reconstruction: A case report

    Directory of Open Access Journals (Sweden)

    Milankov Miroslav

    2003-01-01

    Full Text Available Introduction The most frequent procedure in treatment of acute or chronic anterior cruciate ligament (ACL rupture is the so called bone-tendon-bone reconstruction. A transverse dislocated patella fracture is a rare complication of this procedure with an incidence of 0.23%-2.3%. In a five year period, (1998-2002, 407 arthroscopic reconstructions of the anterior cruciate ligaments were done at our Clinic, and there was only one case of patella fracture. Case report An 18-year-old female patient, a handball player, suffered an acute rupture of anterior cruciate ligament of the left knee, so arthroscopic bone-tendon-bone reconstruction of the anterior cruciate ligament was performed. After adequate skin incision, a bone graft was taken from the patella and upper part of trapezoid tibia, which was 25 mm long, 10 mm wide and 5 mm thick, together with a part of patellar ligament. After the remains of the anterior cruciate ligament had been arthroscopically removed, tunnels were made in tibia and femur and a graft was inserted and fixed with two metal interference screws. Knee stability was tested, and drainage was put in the knee joint. The wound was closed by layers. The quadriceps exercises and passive knee movements started immediately. Full range of movements was accomplished six weeks later when the patient started to walk with full weight-bearing on her operated leg. Three weeks later, (nine weeks after the operation, the patient has accidentally lost her balance and fell. A transverse, dislocated fracture of the left patella was diagnosed and osteosynthesis of the fractured patella with two Kirschner wires and a metallic loop was performed. Postoperatively, full range of movement was allowed. Six months later, the patient felt no pain, there was no swelling, full range of knee movement was achieved, while the Lachman Test was identical in both knees and the pivot shift test was negative. Discussion Fracture of patella after ACL reconstruction is

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

    Science.gov (United States)

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

    2017-01-01

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

  13. Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autografts Versus Anterior Tibial Muscle Tendon Allografts: A Comparative Study%自体腘绳肌腱与异体胫前肌腱重建前交叉韧带短期疗效比较

    Institute of Scientific and Technical Information of China (English)

    李孝海; 陈廖斌; 王华; 王欣; 胡东才; 李宁

    2013-01-01

    Objective: To compare the outcomes of hamstring tendon autografts versus anterior tibial muscle tendon allografts under arthroscopy in the treatment of anterior cruciate ligament reconstruction. Methods: Fifty cases of anterior cruciate ligament (ACL) rupture treated with hamstring tendon autografts (24 patients) or with anterior tibial muscle tendon allografts (26 patients) from August 2009 to February 2011 in Zhongnan Hospital of Wuhan University were retrospectively studied. Anterior drawer test, Pivot Shift Test, leg circumference 10 cm up the patella, active knee flexion angle, anterior knee pain, local tenderness, numbness, Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) scores were used to evaluate the clinical results. Results: There was no statistically significant difference between the two groups in anterior drawer test, Pivot Shift Test, leg circumference 10 cm up the patella, anterior knee pain,local tenderness,numbness, IKDC scores, Tegner scores, or Lysholm scores (P >0. 05). The allografts group had a better active knee flexion angle than autografts group (P< 0. 05) , and there was a statistically significant difference in Tegner scores between pre-surgery and post-surgery (P<0. 05). Conclusion: ACL reconstruction with hamstring tendon autografts had a similar excellent results versus anterior tibial muscle tendon allografts.%目的:探讨关节镜下应用自体腘绳肌腱与异体胫前肌腱重建前交叉韧带术后的短期疗效.方法:选择2009年8月-2011年2月在本院行前交叉韧带重建术并具有完整随访资料的患者50例,其中应用自体腘绳肌腱患者24例,应用异体胫前肌腱患者26例,术后随访指标包括前抽屉试验、轴移试验、髌上10 cm大腿周径、主动屈膝角度、有无膝前痛、局部压痛、感觉减退;同时,采用Lysholm评分表、Tegner评分表、IKDC膝关节主观评价表评价患者主观运动功能.结果:两组患者在前抽屉

  14. 自体腘绳肌腱与同种异体肌腱移植重建前交叉韧带的临床疗效分析%Clinical Effects of Anterior Cruciate Ligament Reconstruction with Tendon Allograft and Hamstring Tendon Autograft

    Institute of Scientific and Technical Information of China (English)

    杨光; 何飞; 李彦林; 陈文栋; 王国梁; 许鹏

    2011-01-01

    Objective To compare the clinical results of anterior cruciate ligament (ACL) reconstruction with anterior tibial muscle tendons allograft and hamstring tendons autograft. Methods 46 patients who received ACL reconstruction at the Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical College from December of 2008 to August of 2010, including 27 males and 19 females, were divided into 2 groups:group A (25 patients, used Hamstring Tendon Autograft) and group B (21 patients, used Anterior Tibial Muscle Tendons Allograft). Lysholm, IKDC, AKS clinical rating scales and Physical and clinical examination were used for evaluation postoperative effects. Patient were followed up for 4 ~ 24 months, averagely for 12.4 months. Result There was no statistically significant difference in Lysholm, IKDC, AKS clinical rating scales between group A and group B ( P >0.05). Conclusion The clinical outcomes of ACL reconstruction with Hamstringtendon allograft versus autograft are almost similar, and allograft is a reasonable alternative choice for ACL reconstruction.%目的 探讨关节镜下同种异体胫前肌腱与自体腘绳肌腱重建前交叉韧带(ACL)的临床疗效.方法 选择2008年12月至2010年8月昆明医学院第一附属医院骨科膝关节前交叉韧带重建患者46例,其中男27例,女19例,分为A组:自体肌腱移植重建25例,B组:同种异体肌腱移植重建21例.术后进行临床体检及前/后抽屉试验、Lachman试验、膝关节应力X线片、髌骨轴位片及MRI等相关检查,Lysholm评分,IKDC评分,AKS评分.术后随访4~24个月,平均12.4个月.结果 两组病例术后Lysholm评分,IKDC评分,AKS评分测试结果差异无统计学意义(P>0.05).结论 同种异体与自体肌腱重建ACL的疗效相近,是重建ACL良好的移植物之一.

  15. Bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction: allograft versus autograft%自体与异体骨-髌腱-骨移植物重建膝前十字韧带的远期疗效观察

    Institute of Scientific and Technical Information of China (English)

    李卫平; 宋斌; 黄建荣; 沈慧勇; 杨睿; 宋洋

    2008-01-01

    目的 比较自体与异体骨-髌腱-骨(bone-patella tendon-bone,B-PT-B)移植物关节镜下重建膝关节前十字韧带(anterior cruciate ligament,ACL)的远期临床疗效.方法 对66例膝ACL断裂患者分别采用自体与异体B-PT-B移植物重建,其中自体组31例,异体组35例;观察两组手术前后生化、免疫学指标的变化以及全身和膝关节局部反应,以Lysholm评分及Larson评分比较术后疗效.结果 自体组29例获随访,随访时间5~10年,平均7年;异体组32例获随访,随访时间5~6.5年,平均6年.术后两组发热时间无明显差异,术后生化、免疫学指标均无明显异常.Lysholm评分:自体组(93.28±3.12)分,异体组(93.15±3.22)分,两组比较差异无统计学意义(P>0.05).Lamon评分:自体组(93.12±2.15)分,异体组(92.75±3.25)分,两组比较差异无统计学意义(P>0.05).术后复查X线片及MRI示:自体组5例出现骨隧道扩大,异体组6例出现骨隧道扩大.术后两组均有1例发生化脓性关节炎;异体组9例冈出现不同程度排斥反应而行镜下冲洗或穿刺冲洗,但无一例取出移植物;异体组1例患者术后移植物发生断裂而行重建术.结论 异体与自体B-PT-B移植物重建ACL远期临床疗效相近,可以获得较为满意的关节活动度及关节稳定性,均为重建ACL的良好移植物.%Objective To compare the clinical curative effect between autograft and allograft bone patella tendon-bone (B-PT-B) transplant to reconstruct anterior cruciate ligament (ACL) arthroseopically.Methods ACL reconstruction using autograft and allograft B-PT-B were performed in 66 patients in the study,autograft group had 31 cases,allograft group had 35 cases; observe the biochemistry,immunology and the response of knee joint pre-and postoperation,observe the therapeutic effect after operation,Lysholm and Larson were used to compare the knee function pre-and postoperation.Results Twenty-nine cases in autograft group were followed up for

  16. Allogeneic versus autologous derived cell sources for use in engineered bone-ligament-bone grafts in sheep anterior cruciate ligament repair.

    Science.gov (United States)

    Mahalingam, Vasudevan D; Behbahani-Nejad, Nilofar; Horine, Storm V; Olsen, Tyler J; Smietana, Michael J; Wojtys, Edward M; Wellik, Deneen M; Arruda, Ellen M; Larkin, Lisa M

    2015-03-01

    The use of autografts versus allografts for anterior cruciate ligament (ACL) reconstruction is controversial. The current popular options for ACL reconstruction are patellar tendon or hamstring autografts, yet advances in allograft technologies have made allogeneic grafts a favorable option for repair tissue. Despite this, the mismatched biomechanical properties and risk of osteoarthritis resulting from the current graft technologies have prompted the investigation of new tissue sources for ACL reconstruction. Previous work by our lab has demonstrated that tissue-engineered bone-ligament-bone (BLB) constructs generated from an allogeneic cell source develop structural and functional properties similar to those of native ACL and vascular and neural structures that exceed those of autologous patellar tendon grafts. In this study, we investigated the effectiveness of our tissue-engineered ligament constructs fabricated from autologous versus allogeneic cell sources. Our preliminary results demonstrate that 6 months postimplantation, our tissue-engineered auto- and allogeneic BLB grafts show similar histological and mechanical outcomes indicating that the autologous grafts are a viable option for ACL reconstruction. These data indicate that our tissue-engineered autologous ligament graft could be used in clinical situations where immune rejection and disease transmission may preclude allograft use.

  17. Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Murphy, Michael V; Du, Dongyi Tony; Hua, Wei; Cortez, Karoll J; Butler, Melissa G; Davis, Robert L; DeCoster, Thomas A; Johnson, Laura; Li, Lingling; Nakasato, Cynthia; Nordin, James D; Ramesh, Mayur; Schum, Michael; Von Worley, Ann; Zinderman, Craig; Platt, Richard; Klompas, Michael

    2016-07-01

    OBJECTIVE To determine the effect of graft choice (allograft, bone-patellar tendon-bone autograft, or hamstring autograft) on deep tissue infections following anterior cruciate ligament (ACL) reconstructions. DESIGN Retrospective cohort study. SETTING AND POPULATION Patients from 6 US health plans who underwent ACL reconstruction from January 1, 2000, through December 31, 2008. METHODS We identified ACL reconstructions and potential postoperative infections using claims data. A hierarchical stratified sampling strategy was used to identify patients for medical record review to confirm ACL reconstructions and to determine allograft vs autograft tissue implanted, clinical characteristics, and infection status. We estimated infection rates overall and by graft type. We used logistic regression to assess the association between infections and patients' demographic characteristics, comorbidities, and choice of graft. RESULTS On review of 1,452 medical records, we found 55 deep wound infections. With correction for sampling weights, infection rates varied by graft type: 0.5% (95% CI, 0.3%-0.8%) with allografts, 0.6% (0.1%-1.5%) with bone-patellar tendon-bone autografts, and 2.5% (1.9%-3.1%) with hamstring autograft. After adjusting for potential confounders, we found an increased infection risk with hamstring autografts compared with allografts (odds ratio, 5.9; 95% CI, 2.8-12.8). However, there was no difference in infection risk among bone-patellar tendon-bone autografts vs allografts (odds ratio, 1.2; 95% CI, 0.3-4.8). CONCLUSIONS The overall risk for deep wound infections following ACL reconstruction is low but it does vary by graft type. Infection risk was highest in hamstring autograft recipients compared with allograft recipients and bone-patellar tendon-bone autograft recipients. Infect Control Hosp Epidemiol 2016;37:827-833.

  18. 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

    and the sensory threshold was determined. Stimulus amplitudes were increased to 1.5-2.0 times the sensory threshold, and inhibitory reflexes could be elicited from PCL in the quadriceps during active extension and in the hamstrings muscles during active flexion in all patients. Subsequently the ACL re......-constructions 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...

  19. Arthroscopic double-bundle posterior cruciate ligament reconstruction surgical technique.

    Science.gov (United States)

    Fanelli, Gregory C; Beck, John D; Edson, Craig J

    2010-06-01

    The keys to successful posterior cruciate ligament (PCL) reconstruction are to identify and treat all pathology, use strong graft material, accurately place tunnels in anatomic insertion sites, minimize graft bending, use a mechanical graft tensioning device, use primary and back-up graft fixation, and use the appropriate postoperative rehabilitation program. Adherence to these technical principles results in successful single-bundle and double-bundle arthroscopic transtibial tunnel PCL reconstruction based on stress radiography, arthrometer, knee ligament rating scales, and patient satisfaction measurements.

  20. Anterior Cruciate Ligament Reconstruction in Ehlers-Danlos Syndrome

    Directory of Open Access Journals (Sweden)

    John Williams

    2015-01-01

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

  1. 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.

  2. Core Stabilization Training After Anterior Cruciate Ligament Reconstruction

    OpenAIRE

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

    2014-01-01

    Objectives: The aim of this study was to compare the effects of core stabilization exercises and conventional rehabilitation exercises after anterior cruciate ligament reconstruction in terms of knee joint laxity, knee muscle strength, postural stability and functional tests. Methods: Twenty eight patients reconstructed with hamstring tendon were included. Thirteen patients evaluated after a conventional rehabilitation and fifteen after a core stabilization programme. Single-limb postural sta...

  3. Isokinetic profile of subjects with the ruptured anterior cruciated ligament

    OpenAIRE

    Drapšin Miodrag; Lukač Damir; Rašović Predrag; Drid Patrik; Klašnja Aleksandar; Lalić Ivica

    2016-01-01

    Background/Aim. All changes in the knee that appear after anterior cruciate ligament (ACL) lesion lead to difficulties in walking, running, jumping especially during sudden changes of the line of movement. This significantly impairs quality of life of these subjects and leads to decrease in physical activity. Knee injuries make 5% of all most severe acute sport injuries. The aim of the study was to determine strength of the thigh muscles in persons with uni...

  4. Anatomic anterior cruciate ligament reconstruction using an individualized approach

    Directory of Open Access Journals (Sweden)

    Carola F. van Eck

    2014-01-01

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

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

    OpenAIRE

    Majed Alrowaili

    2016-01-01

    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 a...

  6. Tibial inlay for posterior cruciate ligament reconstruction: a systematic review.

    Science.gov (United States)

    Papalia, Rocco; Osti, Leonardo; Del Buono, Angelo; Denaro, Vincenzo; Maffulli, Nicola

    2010-08-01

    Although no consensus has been reached regarding the management of PCL deficiency, in vitro and in vivo studies have investigated whether the tibial inlay technique restores the anatomical site of insertion of the PCL, prevents elongation, stretching, graft failure, and improves long-term PCL stability. A systematic search using PubMed, Ovid, the Cochrane Reviews, and Google Scholar databases using 'posterior cruciate ligament tear', 'Tibial inlay technique' and 'posterior cruciate ligament reconstruction' as keywords identified 71 publications, of which 10 were relevant to the topic, and included a total of 255 patients. The tibial inlay technique restores the anatomic insertion site of the PCL, eliminates the killer turn effect, and places the graft at lower potential risk for abrasion and subsequent rupture. It has the disadvantages of increased operating time and risk to the posterior neurovascular structures. There was no evidence of an association between outcome results and Coleman methodology score, but the Coleman methodology scores correlated positively with the level-of-evidence rating. The methodological quality of the studies included has not improved over the years. Given the few reported published findings, we cannot ascertain whether this procedure may provide a consistent alternative to commonly used PCL surgical strategies. The lack of published randomized clinical trials and few reported findings did not allow to ascertain whether the tibial inlay for posterior cruciate ligament reconstruction may provide a consistent alternative to commonly used PCL surgical strategies and to demonstrate procedure efficacy.

  7. Experience of CT arthrography of the cruciate ligaments of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Reiser, M.; Rupp, N.; Karpf, P.M.; Feuerbach, S.; Paar, O.

    1982-10-01

    CT arthrography of the cruciate ligaments in 512 patients has shown that this new procedure provides a reproducible method for demonstrating these ligaments and for making a confident diagnosis of abnormalities. A classification of cruciate ligament lesions into five injury types was introduced in order to distinguish the morphological CT findings. The indication for CT arthrography of the cruciate ligaments is uncertainty after clinical examination. CT can help materially in deciding on treatment and in planning surgery, particularly in cases of possible knee joint instability with a long history, in recent cases with marked muscle spasm and in patients with isolated anterior ligament rupture.

  8. Posterior cruciate ligament reconstruction using hamstring tendon graft with remnant augmentation.

    Science.gov (United States)

    Wang, Ching-Jen; Chan, Yi-Sheng; Weng, Lin-Hsiu

    2005-11-01

    Despite good early functional results, the posterior laxity of the knee is not completely eliminated after posterior cruciate ligament (PCL) reconstruction. The PCL can retain the normal tension only when the injured ligament is maintained anatomically. This article describes a technique of PCL reconstruction using hamstring tendon graft with PCL remnant augmentation. The harvested hamstring tendons were quadrupled, sized, and pretensioned before use. The PCL remnants and the synovium were preserved. Minimal debridement was performed to gain access to the insertion sites. The tibia and femoral tunnels were created with graft size-matched reamers. The graft was transfixed at 70 degrees of knee flexion with a 15-lb anterior drawer force on the proximal tibia. This surgical technique has several advantages. The hamstring graft acts as an independent PCL reconstruction and maintains the PCL remnant tension. The PCL remnants and synovium may be beneficial to ligament healing and postoperative rehabilitation. The procedure is technically feasible and cosmetically acceptable. The selection of autograft precludes the risks of allograft and artificial ligament. The short-term results are encouraging, but long-term results are needed to confirm the value of this technique for PCL reconstruction.

  9. Subsequent Surgery after Revision Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Ding, David; Group, Mars

    2016-01-01

    Objectives: Failure or reinjury after anterior cruciate ligament (ACL) reconstruction can lead to recurrent instability and concomitant intra-articular injuries. While revision ACL reconstruction (rACLR) can be performed to restore knee stability and improve patient activity level, outcomes after these surgeries are reported to be inferior to primary ACL reconstruction. Further reoperation after rACLR can have an even more profound effect on patient satisfaction and outcome. Yet, there is a current lack of information regarding the rate and risk factors for subsequent surgery after rACLR. Methods: 1205 patients who underwent rACLR were enrolled between 2006 and 2011, comprising the prospective cohort. Two-year questionnaire follow-up was obtained on 989 (82%), while telephone follow-up was obtained on 1112 (92%). If a patient reported having a subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categoriezed. A repeated meaures ANOVA was used to reveal significatnt differences in patient reported outcomes. Multivariate regression analysis was performed to determine independent risk factors for reoperation. Results: One hundred and twenty-two patients (10.1%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperation procedures, 26.7% were meniscus procedures (69% meniscectomy, 26% repair), 18.6% were subsequent rACLR, 17.4% were cartilage procedures (61% chondroplasty, 17% microfracture, and 13% mosaicplasty), 10% hardware removal, and 9.3% were procedures for arthrofibrosis such has lysis of adhesions and synovectomy. Patients who had reoperations had significantly lower IKDC, KOOS symptoms and pain scores, and WOMAC stiffness scores at two-year follow up. Multivariate analysis revealed that patients under 20 years old were 2.1 times more likely than patients aged 20-29 to have a reoperation. Use of allograft at the time of rACLR and staged revision (bone grafting of

  10. 自体与异体肌腱重建前十字韧带的对比研究%The Comparative Study of Anterior Cruciate Ligament Reconstruction with Autograft and Allograft Tendon

    Institute of Scientific and Technical Information of China (English)

    康明; 吴家文; 江玲波; 陈海涛; 郭汉明; 马泽萍

    2015-01-01

    Objective:To investigate the clinical efficacy and adverse reactions of autologous and allogeneic tendon reconstruction for anterior cruciate ligament (ACL).Method: 98 patients with ACL injury were selected and divided into the observation group and the control group randomly.50 cases in the observation group were performed arthroscopic ACL reconstruction from autologous semi tendon and femoral thin tendon.48 cases in the control group were performed ACL reconstruction with allogeneic tendon (allogeneic anterior tibial tendon),the short-term and long-term clinical efficacy and adverse reaction rate of the two groups were compared.Result:The postoperative fever time of observation group was significantly shorter than control group,the difference was statistically significant(P0.05).Conclusion: The clinical efficacy of autologous and allogeneic tendon reconstruction of ACL are quite similar, but allogeneic tendon reconstruction is more prone to the risk of immune rejection and the price is more expensive,it is priority using autologous tendon reconstruction for simple knee joint ACL injury.%目的:探讨自体与异体肌腱重建前十字韧带(ACL)临床疗效与不良反应的差异.方法:选取本院膝关节ACL损伤患者98例,采用随机数字表法将其分为观察组与对照组.观察组50例,采用自体肌腱(取自体半腱及股薄肌腱)行关节镜下ACL重建术;对照组48例,采用异体肌腱(同种异体胫前肌腱)行关节镜下ACL重建术,比较两组的近远期疗效与不良反应率的差异.结果:观察组的术后发热时间明显短于对照组,两组比较差异有统计学意义(P0.05).结论:自体与异体肌腱重建ACL的临床疗效相当,但同种异体材料更容易出现免疫排斥风险,且价格较为昂贵,对于单纯性膝关节ACL损伤患者优先采用自体肌腱重建ACL.

  11. The role of the RNFA in anterior cruciate ligament graft preparation.

    Science.gov (United States)

    Rozakis, Melissa

    2014-11-01

    Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed orthopedic procedures in the United States. Repair of the ACL often requires the use of autografts or allografts, and the RN first assistant (RNFA) often is the team member responsible for preparing the graft. Common grafts used in ACL repair include bone-patellar tendon-bone, hamstring, Achilles tendon, quadriceps tendon, and tibialis anterior tendon. The RNFA must be competent in preparing all of these grafts and in understanding the advantages and disadvantages of using each graft, such as the reasons for graft choice, and must ensure that all graft-related supplies and equipment are available and ready for use. The ability to prepare all graft types expands treatment options, reduces surgical time, and enhances the role of the RNFA.

  12. Massive bone loss from fungal infection after anterior cruciate ligament arthroscopic reconstruction.

    Science.gov (United States)

    Muscolo, D Luis; Carbo, Lisandro; Aponte-Tinao, Luis A; Ayerza, Miguel A; Makino, Arturo

    2009-09-01

    Although there are numerous reports of septic pyogenic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction, there is limited information regarding the outcomes of fungal infection. We determined the outcomes of six patients with mycotic infection after regular ACL reconstruction. There were four males and two females with a mean age of 33 years. We determined the number of procedures performed, bone loss originating to control infection, and final reconstruction in these patients. An average of five arthroscopic lavage procedures had been performed at the referring centers. Fungal infection was diagnosed based on pathologic samples; five infections were the result of mucormycosis and one was Candida. After final débridement, the mean segmental bone loss was 12.8 cm. All patients were treated with intravenous antifungal coverage and cement spacers before final reconstruction. At final followup, all patients were free of clinical infection. Three had reconstruction with an allograft-prosthesis composite, two with hemicylindrical allografts, and one with an intercalary allograft arthrodesis. Despite the extremely unusual presentation of this complication, surgeons should be aware of potential and catastrophic consequences of this severe complication after ACL reconstruction.

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

    NARCIS (Netherlands)

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

    2006-01-01

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

  14. Mechanisms of anterior cruciate ligament injury in basketball - Video analysis of 39 cases

    NARCIS (Netherlands)

    Krosshaug, Tron; Nakamae, Atsuo; Boden, Barry P.; Engebretsen, Lars; Smith, Gerald; Slauterbeck, James R.; Hewett, Timothy E.; Bahr, Roald

    2007-01-01

    Background: The mechanisms of anterior cruciate ligament injury in basketball are not well defined. Purpose: To describe the mechanisms of anterior cruciate ligament injury in basketball based on videos of injury situations. Study Design: Case series; Level of evidence, 4. Methods: Six international

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

    NARCIS (Netherlands)

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

    2006-01-01

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

  16. Mechanisms of anterior cruciate ligament injury in basketball - Video analysis of 39 cases

    NARCIS (Netherlands)

    Krosshaug, Tron; Nakamae, Atsuo; Boden, Barry P.; Engebretsen, Lars; Smith, Gerald; Slauterbeck, James R.; Hewett, Timothy E.; Bahr, Roald

    2007-01-01

    Background: The mechanisms of anterior cruciate ligament injury in basketball are not well defined. Purpose: To describe the mechanisms of anterior cruciate ligament injury in basketball based on videos of injury situations. Study Design: Case series; Level of evidence, 4. Methods: Six international

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

    NARCIS (Netherlands)

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

    2005-01-01

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

  18. 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.

  19. FUNCTIONAL OUTCOME OF ARTHROSCOPIC RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT TEARS

    Directory of Open Access Journals (Sweden)

    Ashok Kumar

    2016-02-01

    Full Text Available BACKGROUND Anterior Cruciate Ligament (ACL tear is the most common serious ligamentous injury to the knee joint. Anterior Cruciate Ligament (ACL injury is quite common among young active population, athletes and contact sports. The exact incidence of anterior cruciate ligament tears is not known as the cases are being under reported. The ACL is the primary stabilizer against anterior translation of the tibia on the femur and is important in counteracting rotation and valgus stress. MATERIALS AND METHODS Between November 2012 to October 2014, 34 consecutive patients who underwent arthroscopic assisted ACL reconstructions in the Department of Orthopedics and Traumatology, King George Hospital, Visakhapatnam were the material in our study. Age groups between 18 to 45 years considered. We utilised both BPTB and Quadrupled hamstring graft depending on the patient’s age, outcome testing in all cases was performed at the latest follow-up (at least 6 months. Post-operative physiotherapy rehabilitation protocol followed for 06 months. RESULTS Standard protocol of Lysholm and IKDC knee scoring system were used for evaluation of the results of the surgery during followup. Patients were evaluated periodically at preop, 3 months, 6 months, 12 months, 18 months and 24 months. CONCLUSION Patients with isolated ACL injury had better outcome compared to patients who underwent associated meniscectomy. Most common mechanism of injury was activity of sports in 20 patients. Postoperatively at 3 months, anterior drawer’s was 1+ in 6, 29 (85.2% patients had normal range of motion; 29 (85.29% patients had 5/5 quadriceps power (MRC grading 94% of them had 5/5 power at latest followup. No significant difference between outcomes of BPTB and Hamstrings graft. Functional outcome of our study were similar to the previously published studies.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Samir H. Shah, MD

    2015-01-01

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

  2. Arthroscopic reconstruction of anterior cruciate ligaments with long tendon autograft and allograft tendon:A com-parative study%关节镜下自体腓骨长肌腱与同种异体肌腱重建膝关节前交叉韧带的对比研究

    Institute of Scientific and Technical Information of China (English)

    张勇; 史福东; 王雪臣; 崔泽军; 赵少平; 李长江

    2015-01-01

    目的:比较关节镜下自体腓骨长肌腱及同种异体肌腱移植重建膝关节前交叉韧带的临床疗效。方法选取2008年6月—2013年6月前交叉韧带损伤患者60例,数字表法随机分为自体腓骨长肌腱组(31例)和异体肌腱组(29例),比较2组基本资料、手术情况、中立位前抽屉试验(ADT)和国际膝关节评分(IKDC)、Lysholm及Tegner评分。结果2组患者的性别、年龄、损伤部位以及治疗前的ADT试验阳性率、Lachman试验阳性率、浮髌试验阳性率、Lysholm评分、Tegner评分等差异无统计学意义( P >0 y.05)。异体肌腱组手术时间为(91.3±12.5)min,短于自体腓骨长肌腱组的(66.1±13.5)min( t =5.225, P =0.000);与术前比较,2组术后IKDC评分、Lysholm评分、Tegner评分、胫骨前移距离等指标均改善( P <0.01),但2组术后比较差异无统计学意义( P >0.05);术后1年,2组患者的IKDC评分等级、Lysholm评分等级及ADT试验结果差异均无统计学意义( P >0.05)。结论关节镜下同种异体肌腱重建膝关节前交叉韧带近期疗效较为满意,与关节镜下自体腓骨长肌腱重建膝关节前后交叉韧带相似。%Objective To compare the clinical effects of arthroscopic reconstruction of anterior cruciate ligament with long tendon autograft and allograft tendon allograft.Methods Sixty cases of patients with cruciate ligament injury were select-ed from June 2008 to June 2013.The digital table method used to randomly divided patients into autogenous fibula long tendon group (31 cases), allogeneic tendon group (29 cases), and compared with the basic data, surgical cases of neutral position in the front drawer test ( ADT) and international knee score ( IKDC) , Lysholm and Tegner score.Results Differences in gender, age, site of injury and treatment of ADT test positive rate, Lachman test positive rate, floating patella

  3. Surgery for anterior cruciate ligament deficiency: a historical perspective.

    Science.gov (United States)

    Schindler, Oliver S

    2012-01-01

    The anterior cruciate ligament (ACL) has entertained scientific minds since the Weber brothers provided biomechanical insight into the importance of the ACL in maintaining normal knee kinematics. Robert Adams described the first clinical case of ACL rupture in 1837 some 175 years to date, followed by Mayo-Robson of Leeds who performed the first ACL repair in 1895. At that time, most patients presented late and clinicians started to appreciate signs and symptoms and disabilities associated with such injuries. Hey Groves of Bristol provided the initial description of an ACL reconstruction with autologous tissue graft in 1917, almost as we know it today. His knowledge and achievements were, however, not uniformly appreciated during his life time. What followed was a period of startling ingenuity which created an amazing variety of different surgical procedures often based more on surgical fashion and the absence of a satisfactory alternative than any indication that continued refinements were leading to improved results. It is hence not surprising that real inventors were forgotten, good ideas discarded and untried surgical methods adopted with uncritical enthusiasm only to be set aside without further explanation. Over the past 100 years, surgeons have experimented with a variety of different graft sources including xenograft, and allografts, whilst autologous tissue has remained the most popular choice. Synthetic graft materials enjoyed temporary popularity in the 1980 and 1990s, in the misguided belief that artificial ligaments may be more durable and better equipped to withstand stresses and strains. Until the 1970s, ACL reconstructions were considered formidable procedures, often so complex and fraught with peril that they remained reserved for a chosen few, never gaining the level of popularity they are enjoying today. The increasing familiarity with arthroscopy, popularised through Jackson and Dandy, and enhancements in surgical technology firmly established

  4. 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

  5. 异体胫前肌腱"Y"形双束双隧道重建后十字韧带的疗效分析%Posterior cruciate ligament reconstruction by double bundle-double tunnel Y-shape of the anterior tibialis tendon allograft

    Institute of Scientific and Technical Information of China (English)

    黄华扬; 郑小飞; 李凭跃; 张余; 王泽锦

    2010-01-01

    Objective To investigate the clinical results of posterior cruciate ligament (PCL) reconstruction by double bundle-double tunnel Y-shape of the anterior tibialis tendon allograft. Methods From March 2001 to January 2008, 47 patients underwent PCL reconstruction were included. The allogeneic adult anterior tibialis tendon was prepared into the Y-shape double bundles with the length of 130 mm; A bundle was defined as A-side; B-side was two short bundle (B1, B2 bundle). A bundle was 70 mm in length with a diameter of 10-12 mm. B1 bundle (anterolateral bundle) was 55 mm long with a diameter of 6 mm; B2 bundle(posteromedial bundle) was about 50 mm with a diameter of 6 mm. The allograft ligament was installed through the antero-medial approach. Absorbable interface screws were fixed in the tibial tunnel firstly, and then in the femoral tundles. When being fixed, anterolateral bundle was in flexion of 90°, postero-medial bundle was in 30°. Assisted exercise with knee an angle-locked walking aid had continued for 8-10 weeks. Results The average operating time were 45 min. The average follow-up time was 49.5 months. Preoperative Lachmann was positive in all cases while Lachmann was negative in 39 cases, weakly positive in 5 cases, and positive in 4 cases postoperatively. Post-operative KT-1000 testing, Lysholm score and Tegner activity levels has improved significantly compare with the pre-operative ones. Conclusion The double folded bundles of adult anterior tibialis tendon has sufficient length and diameter for posterior cruciate ligament reconstruction with power tension. The methods of ligament passing through the tunnel has improved to ease the procedure.%目的 探讨异体胫前肌腱"Y"形双柬双隧道移植重建后十字韧带(posterior cruciate ligament,PCL)的临床效果.方法 2001年3月至2008年1月,采用将异体胫前肌腱编织成"Y"形双束韧带的方法治疗PCL损伤患者,其中47例具有完整随访资料,男39例,女8例;年龄18~43

  6. Anterior cruciate ligament reconstruction with bone patellar tendon bone autograft, irradiated versus non-irradiated deep frozen allograft%自体与γ射线照射和非照射异体骨-髌腱-骨重建前十字韧带的比较研究

    Institute of Scientific and Technical Information of China (English)

    孙康; 田少奇; 张积华; 张才龙; 夏长所; 于腾波

    2009-01-01

    Objective Analyze the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction with bone patellar tendon bone (B-PT-B) allograft or autograft. Methods A total of 107 patients underwent same arthroscopie ACL reconstruction technique were randomized into three groups (A: autograft 36, B: non-irradiated deep-frozen allograft 36, C: irradiated allograft 35). Before surgery and at follow-up, patients were evaluated by general conditions, pivot shift test, Lachman and Anterior Drawer Test (ADT), KT-2000 arthrometer testing, Daniel one-leg hop test, overall IKDC rating, Lysholm and Tegner activ-ity score. Results A total of 103 patients were available for full evaluation. The mean follow-up time of A, B and C groups were 39.5, 36.3 and 37.6 months respectively. 1) In A group, patellar fracture occurred in 1 patient and anterior knee pain occurred in 2. In B group, 1 patient had late septic infection. Patients in the B and C groups underwent shorter operation time and longer fever time. There was no difference between the three groups in hospital stay time. 2) According to pivot shift test, Lachman test, ADT, and KT-2000 arthrom-eter testing, differences were found between C group to A or B groups, while no statistically significant dif-ferences between A and B groups. The failure rate in C group (36%) was higher than that with A (8%) and B group (9%). According to Daniel one-leg hop test, the overall IKDC, Lysholm and Tegner activity score, no differences were found between the three groups. Conclusion Patients underwent ACL reconstruction with B-PT-B non-irradiated deep-frozen allograft or autograft had similar clinical outcomes. Non-irradiated B-PT-B allograft is a reasonable alternative to autograft. While the anterior and rotational stability decreased signifi-cantly, when irradiated B-PT-B allograft was used.%目的 比较自体与γ射线照射和非照射异体骨-髌腱-骨(bone patellar tendon bone,B-PT-B)重

  7. 自体骨膜包裹同种异体肌腱重建前交叉韧带的前瞻性研究%A PROSPECTIVE CLINICAL STUDY ON AUTOLOGOUS PERIOSTEUM WRAPPING TENDON ALLOGRAFT FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    Institute of Scientific and Technical Information of China (English)

    王智慧; 陈百成; 张晓阳; 孙然; 刘虎; 谢磊; 朱超华

    2011-01-01

    Objective To study the effectiveness of anterior cruciate ligament (ACL) reconstruction using autologous periosteum wrapping tendon allograft by comparing with using simple tendon allograft. Methods Between March 2008 and November 2008, 68 patients with ACL injury were treated, who were in accordance with the inclusion criteria. They were divided into 2 groups randomly according to different treatment methods: ACL was reconstructed with autologous periosteum wrapping tendon allograft in 31 patients (test group) and with simple tendon allograft (control group) in 37 patients. There was no significant difference in gender, age, disease duration, the cause of injury, and functional score preoperatively between 2 groups (P > 0.05). Anatomic single-bundle ACL reconstruction was performed in 2 groups. Results Little exudation at tibial tunnel incision was found in 1 case respectively in both groups at 2 weeks after operation and was cured by dressing change and antibiotics. The other incisions healed by first intention. The patients were followed up 24-29 months (mean, 26 months) in the test group and 24-32 months (mean, 27 months) in the control group. CT showed bone tunnel enlargement in both groups at 2 years after operation, but the rate of the tunnel enlargement was less in the test group (5/31, 16.1%) than in the control group (14/37, 37.8%), showing significant difference (x2=3.948, P=0.047). At 2 years after operation, the results of Lachman test and pivot shift test were negative in 23 cases (74.2%) and 25 cases (80.6%) of the test group, and in 26 cases (70.3%) and 30 cases (81.1%) of the control group, respectively. KT-1000 examination showed the displacement of the test group [(1.74 ± 0.88) mm] was less than that of the control group [(2.36 ± 0.83) mm], showing significant difference (t= -2.979, P=0.004). There was no significant difference in Lysholm score, Hospital for Special Surgery (HSS) score, Tegner score, and International Knee Documentation

  8. Non-traumatic Thickening of the Anterior Cruciate Ligament

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-08-15

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

  9. ARTHROSCOPIC RECONSTRUCTION OF ANTERIO R CRUCIATE LIGAMENT TEARS: OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Thimma Reddy

    2015-09-01

    Full Text Available BACKGROUND: Anterior knee instability associated with rupture of the ACL (Anterior Cruciate Ligament is a disabling clinical problem. The ACL has a poor capacity for intrinsic repair. Thus for patients who have knee symptoms related to ACL deficiency, one may consider ligament reconstruction as a means of stabilizing the T ibio - F emoral articulation and restoring high level function of the knee joint. Arthroscopically assisted ACLR ( ACL Reconstruction has the advantage of being minimally invasive, accurate graft placement, less disturbance of normal tissue resulting in quicker recovery and rehabilitation, minimal hospital stay and very less infection rate. MATERIAL AND METHODS: Between April 2012 to May 2013, 30 patients who underwent arthroscopic assisted ACL reconstructions using either bone - patellar tendon - bone auto graft ( BTB or Quadrupled hamstring auto graft ( QHG or Quadriceps tendon graft ( QTG in the Department of Orthopaedics and Traumatology, Osmania Medical College, Hyderabad, Andhra Pradesh is the material in our study. CONCLUSIONS : Arthroscopic reconstruction of Anterior Cruciate Ligament is a reliable, safe procedure. It helps in the early restoration of function and stability of the Knee joint and helps the patient to get back to his normal activity much earlier than with the traditional open surgical methods. The choice of the graft does not play a major role in the function of the knee in the long run.

  10. Quadriceps muscle contraction protects the anterior cruciate ligament during anterior tibial translation.

    Science.gov (United States)

    Aune, A K; Cawley, P W; Ekeland, A

    1997-01-01

    The proposed skiing injury mechanism that suggests a quadriceps muscle contraction can contribute to anterior cruciate ligament rupture was biomechanically investigated. The effect of quadriceps muscle force on a knee specimen loaded to anterior cruciate ligament failure during anterior tibial translation was studied in a human cadaveric model. In both knees from six donors, average age 41 years (range, 31 to 65), the joint capsule and ligaments, except the anterior cruciate ligament, were cut. The quadriceps tendon, patella, patellar tendon, and menisci were left intact. One knee from each pair was randomly selected to undergo destructive testing of the anterior cruciate ligament by anterior tibial translation at a displacement rate of 30 mm/sec with a simultaneously applied 889 N quadriceps muscle force. The knee flexion during testing was 30 degrees. As a control, the contralateral knee was loaded correspondingly, but only 5 N of quadriceps muscle force was applied. The ultimate load for the knee to anterior cruciate ligament failure when tested with 889 N quadriceps muscle force was 22% +/- 18% higher than that of knees tested with 5 N of force. The linear stiffness increased by 43% +/- 30%. These results did not support the speculation that a quadriceps muscle contraction contributes to anterior cruciate ligament failure. In this model, the quadriceps muscle force protected the anterior cruciate ligament from injury during anterior tibial translation.

  11. Factors Influencing Graft Choice in Revision Anterior Cruciate Ligament Reconstruction in the MARS Group.

    Science.gov (United States)

    Group, Mars

    2016-08-01

    It has not been known what drives revision anterior cruciate ligament (ACL) reconstruction graft choice in the past. We undertook this study to utilize the Multicenter ACL Revision Study (MARS) group and propensity score statistical analysis to determine the drivers of revision ACL reconstruction graft choice. We hypothesized that propensity analysis would demonstrate that individual surgeons still have significant impact on revision ACL reconstruction. Twelve hundred patients were enrolled in this longitudinal revision cohort by 83 surgeons at 52 sites. The median age was 26 years and 505 (42%) were females. One thousand forty-nine (87%) patients were undergoing their first ACL revision. Graft choice for revision ACL reconstruction for these patients was 48% autograft, 49% allograft, and 3% combination. The independent variables of this model included gender, age, ethnicity, body mass index, smoking status, sport, activity level, previous graft, revision number, surgeon, surgeon's opinion of failure, previous technical aspects, etc. Surgeons were defined as those who contributed more than 15 patients during the enrollment period. . We calculated a propensity score for graft type based on the predicted probability of receiving an allograft from a logistic regression model. Propensity scores demonstrated that surgeon, prior graft choice, and patient age each had significant influence on which graft type was chosen for the revision ACL reconstruction (p  allograft was 3.6 times more likely to be chosen for the revision. This current study demonstrates that the individual surgeon is ultimately the most important factor in revision ACL reconstruction graft choice. Additional statistically significant influences of graft choice included age, gender, previous graft choice, ACL revision number, concurrent medial collateral ligament/posteromedial repair, and opinion of the previous failure. This demonstrates that if graft choice is determined to impact outcome then

  12. Risk factors for bilateral anterior cruciate ligament injuries

    Directory of Open Access Journals (Sweden)

    Ristić Vladimir

    2015-01-01

    Full Text Available Introduction. The aim of this study has been to identify which risk factors can influence bilateral anterior cruciate ligament injury. Material and Methods. Thirty-two operated patients took part in this survey during the period of ten years. There were 5 women and 27 men, with average age of 30.46 years (19-55. The respondents filled in the questionnaire by answering the questions regarding the time when getting injured and operated, mechanism of injuries, genetic and anthropometric data, characteristics of sports and every day activities. Results. The incidence of reconstructed bilateral injuries in relation to unilateral ones was 2.3% (50/2168. The age of respondents and side of the injured knee did not correlate significantly with the achieved subjective physical activity level after the second knee surgery. The average time from the first injury to operation was 10 months and 4.3 years since that moment up to the injury of the other knee. It took more than 9 months on average until the reconstruction of contralateral anterior cruciate ligament. The most of athletes were injured in football matches. Three-quarters of athletes returned to competition activities after the first operation, which caused the same injury of the contralateral knee. Discussion and Conclusion. Anterior cruciate ligament rupture of the contralateral knee most often occurs in young active athletes within the first four years after the initial reconstruction. Its frequency is not affected by sex, side of extremity, genetic predisposition, type of sport, concomitant injuries and the choice of graft. Returning to the same or higher level of sports activities after the first reconstruction is one of the preconditions for injuring the other knee in the same way.

  13. 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.

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

    Science.gov (United States)

    Arnold, T; Shelbourne, K D

    2000-01-01

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

  15. 关节镜下横穿钉固定重建膝关节前交叉韧带的临床疗效分析%Curative effects analysis on arthroscopic anterior cruciate ligament reconstruction with autogenous hamstring or allograft tendon using cross-pin(Transfix) fixation

    Institute of Scientific and Technical Information of China (English)

    温亮; 张博; 王志为; 张晓冬; 曲铁兵; 林源

    2012-01-01

    [Objective] To observe the curative effects on arthroscopic anterior cruciate ligament (ACL) reconstruction with autogenous hamstring or allograft tendon using Transfix at the femoral side, Interference Screw and Spiked Ligament Staple at the tibial side. [ Method]The technique of TransFix fixation was used for reconstructing ACL in 117 cases, including 81 cases with autogenous hamstring and 36 cases with allograft tendon. Pre-and post-operative knee joint function and stability as well as X-ray photograph were evaluated according to the Lysholm scoring scale system. The reliability of the fixation and its short-term effect were analyzed. [ Result]Totally 103 cases were followed, the follow-up duration ranged from 12 to 26 months( average, 18 months) . Lysholm score were 57. 60 ± 5. 74 and 94. 55 ± 2. 38 , respectively before operation and at the time of follow-up( P < 0. 05 ) . Both groups obtained significant improvement of knee stability after operation, with no significant differences between the two groups. [ Conclusion ] Using Transfix for ACL reconstruction under arthroscopy is a safe technique and its clinical outcome has been assured. The autogenous hamstring and allograft tendon have the same clinical therapeutic effects in ACL reconstruction. The graft can be selected according to the traumatic condition and the requirements of patients.%[目的]观察关节镜下股骨侧应用横穿钉(Transfix)固定,胫骨侧界面螺钉(Interference)结合门型钉固定自体腘绳肌腱或同种异体肌腱重建膝关节前交叉韧带的临床疗效.[方法]膝关节前交叉韧带重建患者117例,所有患者均应用股骨侧横穿钉(Transfix)固定,胫骨侧界面螺钉(Interference)结合门型钉固定行前交叉韧带单束重建,其中使用自体胭绳肌腱患者81例,使用同种异体肌腱患者36例,观察此固定方法的可靠性及近期疗效,使用Lysholm评分及IKDC 2000评价手术前后膝关节功能.[结果]103例

  16. One-stage arthroscopic reconstruction of anterior and posterior cruciate ligaments: A mid- and long-term curative effect of autograft versus allograft%关节镜下膝关节前后交叉韧带重建:自体移植与异体移植的中远期疗效对比

    Institute of Scientific and Technical Information of China (English)

    李卫平; 宋斌; 杨睿; 张正政; 王立晖

    2012-01-01

    BACKGROUND:Few studies on one-stage arthroscopic combined with arthroscopic reconstruction anterior crueiate ligament (ACL) and posterior cruciate ligament (PCL), especially on mid- and long-term follow-up.OBJECTIVE: To I ntroduce one-stage arthroscopic reconstruction of ACL and PCL, and to evaluate the mid- and long-termclinical curative effect.METHODS: From June 2002 to June 2007, 45 patients with ACL and PCL injuries received one-stage arthroscopicreconstruction. Totally 20 cases chosing autografts and 25 cases chosing allografts. The reconstruction with absorbable screwwas performed using the single-bundle ACL and PCL technique. Wound was treated simultaneously.RESULTS AND CONCLUSION: Totally 33 patients were followed up for 3 to 8 years. The range of motor was normal. Anteriordrawer test of 3 cases were mild-positive, posterior drawer test of 5 cases were mild-positive. LACHMAN test of 6 cases wasmild-positive, pivot shift test of 3 cases was mild-positive. Lysholm score and Larson score of autografts and allografts teamsafter 3 years construction were higher than those of before reconstruction (P 0.05). Eight cases were bone tunnel expansion,including 5 cases of ACL tibial segment, 3 cases of PCL tibial segment. Five cases suffered from hydrops articuli, and thentreated with paracentesis and clysis, none were broken again. It is indicated that one-stage arthroscopic reconstruction of ACLand PCL with autograft and allograft can both obtain satisfactory motion range, joint stability and well clinical effect of mid-andlong-term follow-up.%背景:关节镜下一期联合重建关节镜下前、后交叉韧带的文献报道不多,尤其是中长期随访研究.目的:关节镜下一期自体肌腱与同种异体肌腱重建前、后交叉韧带的中远期疗效比较.方法:自2002-06/2007-06对45例前后交叉韧带同时断裂患者行一期重建,20例选用自体移植物,25例选用异体移植物,以可吸收挤压钉固定行前后交叉韧带单束重

  17. Reconstruction of anterior cruciate ligament and anterolateral ligament using interlinked hamstrings - technical note.

    Science.gov (United States)

    Ferreira, Marcio de Castro; Zidan, Flavio Ferreira; Miduati, Francini Belluci; Fortuna, Caio Cesar; Mizutani, Bruno Moreira; Abdalla, Rene Jorge

    2016-01-01

    Recent anatomical and biomechanical studies on the anterolateral ligament (ALL) of the knee have shown that this structure has an important function in relation to joint stability, especially when associated with anterior cruciate ligament (ACL) injury. However, the criteria for its reconstruction have not yet been fully established and the surgical techniques that have been described present variations regarding anatomical points and fixation materials. This study presents a reproducible technique for ALL and ACL reconstruction using hamstring tendons, in which three interference screws are used for fixation.

  18. Role of platelet-rich plasma in tendon-bone healing after anterior cruciate ligament reconstruction with tendon allograft%富血小板血浆凝胶在同种异体肌腱重建前交叉韧带后腱-骨愈合中的作用

    Institute of Scientific and Technical Information of China (English)

    王亚斌; 于绍斌; 董启榕

    2010-01-01

    目的 观察富血小板血浆(platelet-rich plasma,PRP)凝胶对同种异体跟腱重建兔前交叉韧带(ACL)后腱一骨愈合的影响.方法 24只兔行双侧ACL重建;一侧膝关节移植物予自体PRP凝胶预处理(实验组),另一侧膝关节移植物不予处理(对照组).于术后2,6和12周行组织学、免疫组化和生物力学评价.结果 2周和6周时Burak评分实验组高于对照组.12周时对照组腱-骨界面为成熟瘢痕组织,而实验组显示该界面为成熟纤维软骨带.免疫组化显示实验组血管内皮生长因子(VEGF)的阳性表达在早期较对照组高,TGF-β1的表达持续高于对照组.生物力学分析显示2周及6周时实验组极限负荷[(15.3±2.9)N、(33.2±6.9)N]明显高于对照组((7.9±1.4)N、(23.7±4.9)N](P<0.05).结论 PRP凝胶可促进同种异体移植肌腱早期腱-骨愈合.%Objective To observe the effect of platelet-rich plasma(PRP)gel on tendon-bone healing following tendon allograft reconstruction of anterior cruciate ligament(ACL).Methods Bilateral ACL reconstructions using Achilles tendon allografts were performed in 24 New Zealand white rabbits matured skeletally.One knee joint was pretreated with the allograft PRP gel(served as experimental group),while the contralateral knee joint was free from treatment with PRP(served as control group).The reconstructions were assessed histologically,immunohistochemically and biomechanically at 2,6 and 12 weeks.Results At 2 and 6 weeks,Burak scores of experimental group were higher than control group.At 12 weeks,the grafts showed a mature zone of fibrocartilage in experimental group but mature scar tissues on the tendon-bone surface.Immunohistochemistry demonstrated early higher expression of VEGF in experimental group than control group and continually higher expression of TGF-β1 in experimental than control group.In contrast,the grafts of the controls group revealed the development of mature scar tissue resembling Sharpey fibers

  19. 同种异体肌腱材料重建膝关节后交叉韧带合并后外侧复合体损伤%Tendon allograft materials for repair of posterior cruciate ligament injury combined with posterolateral complex injury

    Institute of Scientific and Technical Information of China (English)

    黄克坚; 孙辉; 高立华; 臧学慧

    2011-01-01

    背景:膝关节后交叉韧带合并后外侧复合体损伤重建中移植物的选择迄今仍存在争议.目的:观察异体肌腱材料应用于重建膝关节后交叉韧带并后外侧复合体损伤的效果.方法:经关节镜证实为膝关节后交叉韧带并后外侧复合体损伤患者15例,均使用山西省医用组织库提供同种异体肌腱,重建后交叉韧带并后外侧复合体,重建中尽量保留原后交叉韧带残迹,制备后交叉韧带胫骨及股骨隧道,引入修整后同种异体肌腱并挤压螺钉固定.结果与结论:重建后膝关节屈伸度较重建前明显改进(P < 0.01),重建前后抽屉试验2+程度4例,4+程度11例,重建后后抽屉试验阴性8膝,后抽屉试验1+有6例,2+有1例,膝关节伸直位、屈曲30°位内翻试验均为阴性,显示关节的后移程度及稳定性较重建前有明显改善.重建后膝关节Lysholm功能评分重建前明显提高(P < 0.01),随访期间未见膝关节排斥、感染等并发症.结果证实,同种异体肌腱重建膝关节后交叉韧带并后外侧复合体损伤不损伤正常的自身结构,修复效果满意.%BACKGROUND: Selection of tendon allograft materials for posterior cruciate ligament (PCL) injury combined with posterolateral complex (PLC) injury is controversial.OBJECTIVE: To observe the effect of tendon allograft materials on PCL plus PLC injuries during reconstruction. METHODS: Fifteen patients with arthroscopic PCL plus PLC injuries of the knee joint received knee joint construction with tendon allograft supported by Shanxi Provincial Medical Tissue Bank. Original remnants of the PCL were retained as much as possible. PCL tibial and femoral tunnel were prepared, and extrusion screws were introduced during allogeneic tendon repair.RESULTS AND CONCLUSION: Degree of knee joint flexion and extension was improved greatly after reconstruction (P < 0.01). The drawer test results showed that there were 4 cases of 2+ and 11 of 4+ before

  20. FUNCTIONAL OUTCOME OF ARTHROSCOPY ASSISTED ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING BONE PATELLAR TENDON BONE AUTOGRAFT

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    Vinod Kumar

    2015-04-01

    Full Text Available INTRODUCTION: The anterior cruciate ligament (ACL is one of the most frequently injured ligaments in the human body. 1 The Anterior Cruciate ligament (ACL is the primary stabilizer of the knee and prevents the knee against anterior translation. 2 It is also important in counteracting rotational and valgus stress. 1 The middle third of the patellar tendon autograft for ACL reconstruction can be readily procured and firmly fixed. 3 It can tolerate the loads produced by an intensive rehabilitation programme. 3 Fixation of bone plugs using interference screws provides sufficient stability to meet the demand of a vigorous postoperative protocol. 3 It remains the gold standard for ACL reconstruction. 3 This study is to assess the functional outcome of arthroscopy assisted anterior cruciate ligament reconstruction using bone patellar tendon bone autograft. METHODS: This study was conducted in Kempegowda Institute of Medical Sciences Hospital from November 2012 to April 2014. During this period 20 cases of adult patients with ACL deficient patients were selected according to the inclusion criteria. Study aims to assess the functional outcome of arthroscopy assisted anterior cruciate ligament reconstruction using bone - patellar tendon - bone autograft in terms of range of motion, postoperative knee stability, graft site morbidity and subjective knee functions. RESULTS: Results of our study showed that arthroscopy assisted anterior cruciate ligament reconstruction with bone - patellar tendon - bone autograft could effectively improve knee stability and functions after surgery without any complication. CONCLUSION : Arthroscopy assisted anterior cruciate l igament reconstruction with bone - patellar tendon - bone autograft is an excellent treatment option for anterior cruciate ligament deficient knees. It provides a stable knee and reduces postoperative morbidity and enables early rehabilitation. The functional outcome of arthroscopy assisted anterior

  1. Bone-patellar tendon-bone autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Pan, Xiaoyun; Wen, Hong; Wang, Lide; Ge, Tichi

    2013-10-01

    The optimized graft for use in anterior cruciate ligament (ACL) reconstruction is still in controversy. The bone-patellar tendon-bone (BPTB) autograft has been accepted as the gold standard for ACL reconstruction. However, donor site morbidities cannot be avoided after this treatment. The artificial ligament of ligament advanced reinforcement system (LARS) has been recommended for ACL reconstruction. The purpose of this study is to compare the midterm outcome of ACL reconstruction using BPTB autografts or LARS ligaments. Between July 2004 and March 2006, the ACL reconstruction using BPTB autografts in 30 patients and LARS ligaments in 32 patients was performed. All patients were followed up for at least 4 years and evaluated using the Lysholm knee score, Tegner score, International Knee Documentation Committee (IKDC) score, and KT-1000 arthrometer test. There were no significant differences between the two groups with respect to the data of Lysholm scores, Tegner scores, IKDC scores, and KT-1000 arthrometer test at the latest follow-up. Our study demonstrates that the similarly good clinical results are obtained after ACL reconstruction using BPTB autografts or LARS ligaments at midterm follow-up. In addition to BPTB autografts, the LARS ligament may be a satisfactory treatment option for ACL rupture.

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

    OpenAIRE

    Anderson Delano; Aline Mendonça de Andrade; Thiago Freire

    2007-01-01

    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...

  3. Microvascular system of anterior cruciate ligament in dogs.

    Science.gov (United States)

    Kobayashi, Shigeru; Baba, Hisatoshi; Uchida, Kenzo; Negoro, Kohei; Sato, Mituhiko; Miyazaki, Tsuyoshi; Nomura, Eiki; Murakami, Kaname; Shimizubata, Matsuyuki; Meir, Adam

    2006-07-01

    This study was done to investigate the microvascular system of anterior cruciate ligament (ACL) using dogs. The objective was to study the microvascular architecture and the status of the barrier function of the capillary wall in the ACL by using microangiogram, scanning (SEM), and transmission electron microscopy (TEM). The vascular system in the ACL has been intensively studied by a number of researchers, using several microangiographic techniques in dogs, rabbits, and humans. However, most of these microangiographic studies had significant shortcomings, including the lack of three-dimensional observations and function of the blood-joint barrier in the ACL. In this study, the microstructure of the ACL was examined using microangiogram, SEM, and TEM. We investigated the vasculature of the ACL with SEM of vascular corrosion casts. In addition, we examined the status of the barrier function of the capillary wall in the ACL using the protein tracer horseradish peroxidase (HRP). Feeding vessels of the ligament were predominantly coming from the synovial-derived vessels originating from the synovium attached to the ligament near the tibial and femoral bone insertions of the ACL. The anterior cruciate ligament was surrounded by synovium, which had abundant vessels. The branches of these synovial vessels were penetrating into the ligament and making the intrinsic vascular network. It was also ascertained under SEM that the perivascular space around the intrinsic vessels were communicating through the intrinsic ligament fiber bundles and the mesh-like synovial membrane. The capillaries in the ACL were all of the continuous type under TEM. The protein tracer that was injected into the joint space passed through the synovial membrane and entered into the capillary lumen in the ACL, but the tracer that was injected intravenously did not appear in the perivascular space. The existence of a blood-ACL barrier does not necessarily imply the existence of an ACL-blood barrier. We

  4. Tissue engineering of ligaments : A comparison of bone marrow stromal cells, anterior cruciate ligament, and skin fibroblasts as cell source

    NARCIS (Netherlands)

    Van Eijk, F; Riesle, J; Willems, WJ; Van Blitterswijk, CA; Verbout, AJ; Dhert, WJA

    2004-01-01

    Anterior cruciate ligament (ACL) reconstruction surgery still has important problems to overcome, such as "donor site morbidity" and the limited choice of grafts in revision surgery. Tissue engineering of ligaments may provide a solution for these problems. Little is known about the optimal cell sou

  5. Tissue engineering of ligaments : A comparison of bone marrow stromal cells, anterior cruciate ligament, and skin fibroblasts as cell source

    NARCIS (Netherlands)

    Van Eijk, F; Riesle, J; Willems, WJ; Van Blitterswijk, CA; Verbout, AJ; Dhert, WJA

    Anterior cruciate ligament (ACL) reconstruction surgery still has important problems to overcome, such as "donor site morbidity" and the limited choice of grafts in revision surgery. Tissue engineering of ligaments may provide a solution for these problems. Little is known about the optimal cell

  6. Surgical treatment of acute and chronic anterior and posterior cruciate ligament and lateral side injuries of the knee.

    Science.gov (United States)

    Levy, Bruce A; Boyd, Joel L; Stuart, Michael J

    2011-06-01

    Combined anterior cruciate ligament, posterior cruciate ligament, and lateral-sided injuries of the knee most often occurs secondary to a forced varus moment or after knee dislocation. Management controversies include the optimal timing of surgery, operative techniques, and postoperative rehabilitation. Recent systematic literature reviews have demonstrated higher rates of failure with repair of the lateral and posterolateral corner structures, as opposed to reconstruction. However, the ideal ligament reconstruction techniques remain unclear. This chapter will review the combined anterior cruciate ligament/posterior cruciate ligament/lateral-sided injury pattern, including the physical examination findings, imaging, timing of surgery, graft selection, operative techniques, and postoperative rehabilitation protocols.

  7. Posttraumatic incarceration of medial collateral ligament into knee joint with anterior cruciate ligament injury

    Institute of Scientific and Technical Information of China (English)

    Sunil Gurpur Kini; Karel du Pre; Warwick Bruce

    2015-01-01

    Medial collateral ligament of the knee is an important coronal stabiliser and often injured in isolation or as combination of injuries.The article reports a case of incarcerated medial collateral ligament (MCL) injury in combination with anterior cruciate ligament (ACL) injury in 20 year old male who presented to us 4 weeks after injury.Clinical examination and MRI was correlated to complete ACL tear with torn distal MCL and incarceration into the joint.Patient was taken up for ACL hamstring graft reconstruction with mini-arthrotomy and repair of the torn MCL.Patient was followed up with dedicated rehabilitation protocol with good functional results.At one year follow-up, patient exhibited full range of motion with negative Lachman, Pivot shift and valgus stress tests.This article highlights the rare pattern of MCL tear and also reviews the literature on this pattern of injury.

  8. In vivo evaluation of electrospun polycaprolactone graft for anterior cruciate ligament engineering.

    Science.gov (United States)

    Petrigliano, Frank A; Arom, Gabriel A; Nazemi, Azadeh N; Yeranosian, Michael G; Wu, Benjamin M; McAllister, David R

    2015-04-01

    The anterior cruciate ligament (ACL) is critical for the structural stability of the knee and its injury often requires surgical intervention. Because current reconstruction methods using autograft or allograft tissue suffer from donor-site morbidity and limited supply, there has been emerging interest in the use of bioengineered materials as a platform for ligament reconstruction. Here, we report the use of electrospun polycaprolactone (PCL) scaffolds as a candidate platform for ACL reconstruction in an in vivo rodent model. Electrospun PCL was fabricated and laser cut to facilitate induction of cells and collagen deposition and used to reconstruct the rat ACL. Histological analysis at 2, 6, and 12 weeks postimplantation revealed biological integration, minimal immune response, and the gradual infiltration of collagen in both the bone tunnel and intra-articular regions of the scaffold. Biomechanical testing demonstrated that the PCL graft failure load and stiffness at 12 weeks postimplantation (13.27±4.20N, 15.98±5.03 N/mm) increased compared to time zero testing (3.95±0.33N, 1.95±0.35 N/mm). Taken together, these results suggest that electrospun PCL serves as a biocompatible graft for ACL reconstruction with the capacity to facilitate collagen deposition.

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

    Science.gov (United States)

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

    2016-01-01

    [Purpose] The purpose of this study was to provide useful information for future treatments and to organize rehabilitation programs for anterior cruciate ligament injury by assessing isokinetic muscle strength and laxity of knee joints in athletes with anterior cruciate ligament injuries. [Subjects and Methods] Thirty-one high school athletes with anterior cruciate ligament injuries participated in this study. Isokinetic muscle strength at 60°/sec and anterior cruciate ligament laxity for non-involved and involved sides, classified on the basis of the severity of anterior cruciate ligament injury, were assessed. [Results] A comparison of isokinetic muscle strength measured from the non-involved and involved sides showed a significant difference in the maximum strength and knee flexor muscle strength. For laxity, a significant difference was observed in the anterior drawer test results obtained with a force of 88 N. [Conclusion] In conclusion, this study has shown that the assessment of isokinetic muscle strength and ligament laxity from athletes with anterior cruciate ligament injury should be utilized to provide baseline data for prevention and prediction of injury. PMID:28174432

  10. 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

  11. Ring-shaped lateral meniscus with hypoplasic anterior cruciate ligament.

    Science.gov (United States)

    Esteves, Cátia; Castro, Ricardo; Cadilha, Rui; Raposo, Frederico; Melão, Lina

    2015-12-01

    Knee joint lesions can be solitary or occur concomitantly with other lower limb abnormalities. Ring-shaped lateral meniscus (RSM) and hypoplasic anterior cruciate ligament (ACL) are two rare malformations. The therapeutic management of such abnormalities is not consensual, and highly depends on clinical symptomatology. We report a case of a 25-year-old girl with progressive knee pain whose MRI demonstrated a continuous segment of lateral meniscus situated along the medial aspect of the lateral compartment, continuous with the otherwise normal-appearing lateral meniscus, compatible with an RSM. This anatomic variant can be mistaken by a displaced meniscal fragment, like a bucket-handle tear, a central tear of a discoid meniscus, or incomplete discoid meniscus, as previously reported. Her MRI examination also showed a thinned ACL with anomalous lateral course. This abnormality may be mistaken for an ACL rupture and/or a meniscofemoral ligament with agenesis of ACL. Multiple images in different planes as well as following the course of meniscal and ligaments are critical clues to avoid misdiagnosis. As a result, the diagnosis of an RSM along with hypoplasic ACL with abnormal attachment was assumed based on MRI and confirmed during arthroscopy. The patient was treated conservatively with clinical outcome improvement.

  12. Vascular Complications in Arthroscopic Repair Of Posterior Cruciate Ligament

    Science.gov (United States)

    Agotegaray, Juan Ignacio; Comba, Ignacio; Bisiach, Luciana; Grignaffini, María Emilia

    2017-01-01

    Introduction: Posterior cruciate ligament is the primary stabilizer of the knee. Among the potential complications in arthroscopic repair of this ligament, there are vascular lesions, due to laceration, thrombosis and injury of the intima of the popliteal artery. We used one case to show the vascular complications that may arise in arthroscopic repair of the posterior cruciate ligament, how to handle it and the results. Methods: One patient, 33 years old, with a history of traffic accident. In a physical exam the patient shows pain and swelling of the knee, positive posterior drawer test and positive Godfrey test. X-rays on the knee show posterior tibial translation and MRI a complete fibers rupture at the middle third of the posterior cruciate ligament. An arthroscopic repair surgery was scheduled three weeks after trauma, with PCL reconstruction using simple band technique.After surgical intervention, hemostatic cuff was released, no peripheral pulse, paleness and coldness of the member was confirmed. An arteriography was carried out, which confirmed absences of distal vascular filling in the popliteal artery. An urgent referral was carried out with Vascular Surgery Services, who had been informed of the surgery previously (a notification that is part of our routine for this kind of interventions). Arteriorrhaphy and venorrhaphy of the popliteal arteries was fulfilled 12 hours later, with a leg fasciotomy. Daily monitoring was performed, and after 72 hours, muscle necrosis is seen with wound drainage, analysis shows presence of gram-negative bacilli, Proteus Mirabilis-Pseudomonas spp and the lab results showed leukocytes: 8.700/ml, ESR: 58, CRP: 48. A new surgery is performed with complete resection of the anterior external compartment of the leg, and a system of continuous cleansing is applied with physiological saline solution and boric acid for 14 days until drainage is eliminated. Vancomycin and ceftazidime EV was indicated for 14 days and, after a good

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

    Directory of Open Access Journals (Sweden)

    Albu Daniel – Emil

    2016-06-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-06-01

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

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

    Directory of Open Access Journals (Sweden)

    G. Cerulli

    2014-01-01

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

  16. Surgical treatment of a rare isolated bilateral agenesis of anterior and posterior cruciate ligaments.

    Science.gov (United States)

    Cerulli, G; Amanti, A; Placella, G

    2014-01-01

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

  17. Effect of physiotherapy attendance on outcome after anterior cruciate ligament reconstruction: a pilot study

    OpenAIRE

    Feller, J; Webster, K.; Taylor, N; Payne, R.; Pizzari, T.

    2004-01-01

    Background: In many centres patients are routinely referred for physiotherapy after anterior cruciate ligament (ACL) reconstruction. However, to date the role and amount of supervised physiotherapy required has not been clearly established.

  18. Closed patella fracture combined with cruciate ligament injury:a case control study

    Institute of Scientific and Technical Information of China (English)

    LI Han; WANG Wei; LIU Yue-ju; CHEN Wei; ZHANG Qi; LI Xu; ZHU Lian

    2013-01-01

    Background Patellar fracture and cruciate ligament injury are a common consequence of traumatic knee injury.Patellar fracture combined with cruciate ligament injury is rarely reported,although the mechanisms of two things are similar.This study aimed to evaluate the incidence of closed patella fracture combined with cruciate ligament injury.Methods From 2012 March 1 to June 30,magnetic resonance images of 60 patients with unilateral closed patellar fracture were studied in our institution.The mean age of the patients at presentation was 40.2 years (range,13-64 years) and 48 patients were men.First,patients were divided according to the cause of injury.Twenty-eight patients had highenergy trauma from a falling injury or motor vehicle accident,and 32 patients had low-energy trauma resulting from a tumbling injury.Second,according to the fracture pattern,31 patients had a transverse fracture and 29 patients had a comminuted fracture.Results We found seven cases of closed patellar fracture combined with cruciate ligament injury among 60 patients,including two cases of a completely ruptured posterior cruciate ligament,two with a partially torn posterior cruciate ligament,and three with a partially torn anterior cruciate ligament.The percentage of this combined injury was 11.6% (7/60).The incidence of a combined injury of the cruciate ligament with a comminuted fracture (6/29,20.7%) was significantly higher than that with a transverse fracture (1/31,3.2%,P <0.05).The most common mechanism of injury in patellar fracture combined with cruciate ligament injury was high-energy trauma from road traffic accidents (94%),whereas in the patellar fracture alone,it was tumbling (62%).The incidence of combined injury with high-energy trauma (6/28,21.4%) was significantly higher than that with low-energy trauma (1/32,3.1%,P <0.05).Conclusions These data suggest that high-energy trauma often results in a comminuted patellar fracture,which is often combined with

  19. Initial evaluation of posterior cruciate ligament injuries: history, physical examination, imaging studies, surgical and nonsurgical indications.

    Science.gov (United States)

    Lopez-Vidriero, Emilio; Simon, David A; Johnson, Donald H

    2010-12-01

    Compared with anterior cruciate ligament injuries, posterior cruciate ligament injuries are a rare event. The mechanisms are predictable and a thorough physical examination is mandatory to rule out or define combined injury patterns. Stress radiography and magnetic resonance imaging studies are very helpful adjuncts. Acute and chronic injuries require slightly different approaches. As our understanding of normal and pathologic knee joint kinematics develops, nonoperative rehabilitation goals and operative techniques continue to evolve.

  20. Evaluation of vertical forces in the pads of Pitbulls with cranial cruciate ligament rupture

    OpenAIRE

    Souza, Alexandre N A; Tatarunas, Angelica C; Matera,Julia M.

    2014-01-01

    Abstract Background Cranial cruciate ligament rupture (CCLR) is one of the most important stifle injuries and a common cause of lameness in dogs. Our objective was to measure the vertical forces in the pads of Pitbulls with cranial cruciate ligament rupture (CCLR) using a pressure sensitive walkway. A pressure sensitive walkway was used to collect vertical force data from the pads of 10 Pitbulls affected with unilateral CCLR. Ten healthy...

  1. The impact of combined meniscus tear on quality of life after anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Harhaji Vladimir V.

    2016-01-01

    Full Text Available Introduction. An anterior cruciate ligament injury represents a significant epidemiological problem worldwide, especially due to involving young, sporty and active working-age population. This study has been conducted in order to compare the quality of life of patients who had isolated anterior cruciate ligament tear and of those who suffered from an associated meniscal injury. Material and Methods. This study included 185 patients who had undergone reconstruction of the anterior cruciate ligament at the Department of Orthopedic Surgery and Traumatology in Novi Sad from January 1st, 2012 to December 31st, 2012. The patients were divided into 2 groups: group A consisted of patients who had anterior cruciate ligament reconstruction only, and group B consisted of patients who had partial meniscectomy in addition to the anterior cruciate ligament reconstruction. The follow-up period was 12 months. Results. Distribution of patients by gender was significantly in favor of men. In our study, 146 patients were male and 39 patients were female. The average age of patients was 26.1 years overall (16-55 years, being 26.9 years for men, and 23.3 years for female patients. Out of 185 patients, 110 had an isolated anterior cruciate ligament injury, while 75 suffered both meniscus, internal or external, and anterior cruciate ligament injury. Conclusion. The comparison of the quality of life of patients in both groups showed no statistically significant difference. Therefore, we were not able to prove the hypothesis about the superior quality of life of those patients who had suffered from a ruptured anterior cruciate ligament only.

  2. Transient Superficial Peroneal Nerve Palsy After Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Alrowaili, Majed

    2016-04-26

    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.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  4. Factors influencing the treatment of posterior cruciate ligament injury.

    Science.gov (United States)

    Ittivej, Kittimasak; Prompaet, Sureeporn; Rojanasthien, Sattaya

    2005-10-01

    The primary objective was to determine the factors which influence the requirement of surgical treatment of posterior cruciate ligament (PCL) injury. Ninety one PCL injured patients diagnosed in the "Sports Medicine Clinic", Maharaj Nakorn Chiang Mai Hospital from January 1998 to December 2000 were included in the present study. There were 63 males and 28 females with an average age of 29 years. All of the PCL-insufficient knees were initially treated by non-operative method including 3 phases of rehabilitation. They were followed through to the end of December 2003. Analysis showed that the degree of posterior laxity was the only factor that had a statistical significant correlation to failure of conservative treatment. In addition, the need for surgical treatment was not associated with gender age, cause of injury, and concomitant of injury. The authors concluded that PCL injured patients with posterior laxity greater than 10 millimeters should be treated by PCL reconstruction.

  5. Popliteal pseudoaneurysm after arthroscopic posterior cruciate ligament reconstruction.

    Science.gov (United States)

    van Dorp, Karin B; Breugem, Stefan J M; Driessen, Marcel J M

    2014-09-01

    This report presents the case of a 30-year-old motocross (BMX) cyclist with a third-degree posterior cruciate ligament rupture. The technique used for reconstruction was the transtibial single-bundle autologous hamstring technique. Unfortunately, the procedure was complicated by a popliteal pseudoaneurysm, which was located in line with the tibial canal. The pseudoaneurysm was treated with an end-to-end anastomosis and the patient recovered without further complaints. In this case, the popliteal artery was damaged most probably by the edge of the reamer or the guide wire during removal. Vascular complications can be limb- and life-threatening. This case report aims to increase the awareness of this serious complication with a review of the literature.

  6. 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.

  7. Medial plica after reconstruction of anterior cruciate ligament

    Institute of Scientific and Technical Information of China (English)

    YIN Yu; WANG Jian-quan; HE Zhen-ming

    2009-01-01

    Background The medial plica may be caused by direct trauma or joint degeneration,which also could be iatrogenic.There have been few reports in the literature discussing incidence of the medial plica caused by an operation on the knee joint,specifically after the reconstruction of anterior cruciate ligament (ACL).In this study,we aimed to evaluate and analyze the relationship between the incidence of the medial plica and reconstruction of the ACL.Methods A retrospective case series study was conducted to review the findings of 1085 patients between 2003 and 2007,who underwent second-look arthroscopy after reconstruction of the ACL (between 2002 and 2006).The correlation of the incidence of medial plica with the stability of the knee joint,the time from onset of injury to reconstruction surgery,the associated injuries,and the rate of progress during postoperative rehabilitation were analyzed.Results We found that 722 patients had the structure of a medial plica.The incidence after reconstruction of the anterior cruciate ligament (66.5%) was significantly higher than usually reported.All these medial plica had avascular fibrotic and thickened edges.An excision of pathologic medial plica and fat pad synovial fringes were done.The incidences were significantly different between the two groups with their reconstruction operation time,from onset of injury to surgery (less than one month or over 2 years),and the progress rate of postoperative rehabilitation (knee flexion could not be over 90° in four weeks).The incidence was not different between the groups with knee stable conditions.Conclusions Medial plica is more common in patients after reconstruction of ACL.More associated injuries and more rehabilitation difficulties can increase the medial plica incidence.

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

    Directory of Open Access Journals (Sweden)

    Ashraf Abd Elmawgood

    2015-01-01

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

  9. Ultrastructure of periprosthetic Dacron knee ligament tissue. Two cases of ruptured anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Salvi, M; Velluti, C; Misasi, M; Bartolozzi, P; Quacci, D; Dell'Orbo, C

    1991-04-01

    Light- and electron-microscopic investigations were performed on two failed Dacron ligaments that had been removed from 2 patients shortly after failure of the implant 2-3 years after reconstruction of the anterior cruciate ligament. Two different cell populations and matrices were correlated with closeness to the Dacron threads. Fibroblasts surrounded by connective tissue with collagen fibrils were located far from the Dacron threads. Roundish cells, appearing to be myofibroblasts surrounded by a more lax connective tissue and elastic fibers, were found close to the Dacron threads. The presence of myofibroblasts and the matrix differentiation could be attributed to the different mechanical forces acting on the Dacron and on the connective tissue because of their different coefficients of elasticity. The sparse occurrence of inflammatory cells in the synovial membrane and in the connective tissue surrounding the Dacron supports the biologic inertness of this artificial material. However, the repair tissue was not structured to resist tension stresses.

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

    Science.gov (United States)

    Smith, James O; Yasen, Sam K; Lord, Breck; Wilson, Adrian J

    2015-11-01

    Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomic, biomechanical and radiological characteristics of the native anterolateral ligament (ALL) of the knee have led to a resurgent interest in reconstruction of this structure as part of the management of knee instability. This technical note describes our readily reproducible combined minimally invasive technique to reconstruct both the ACL and ALL anatomically using autologous semitendinosus and gracilis grafts. This method of ALL reconstruction can be easily integrated with all-inside ACL reconstruction, requiring minimal additional operative time, equipment and expertise. Level of evidence V.

  11. Quadriceps Strength and Endurance After Posterior Cruciate Ligament Tears Versus Matched Group With Anterior Cruciate Ligament Tears.

    Science.gov (United States)

    Lee, Dae-Hee; Han, Seung-Beom; Lee, Jin-Hyuck; Lee, Seok-Joo; Suh, Dong-Won; Jeong, Hye-Jin

    2015-06-01

    This study was designed to compare the preoperative strengths and endurances of the quadriceps and hamstring muscles in patients with anterior cruciate ligament (ACL) versus posterior cruciate ligament (PCL) tears. Quadriceps and hamstring muscle strength and endurance were compared between 20 prospectively enrolled patients with isolated PCL tears and a retrospective, matched control group of 20 patients with isolated ACL tears. The maximal torque (60°/s) and total work (180°/s) of the quadriceps and hamstring were evaluated with an isokinetic testing device. Total work (1,094.4 ± 505.8 J v 797.5 ± 332.7 J, P = .035) and peak torque (129.9 ± 56.2 N ∙ m v 98.2 ± 37.4 N ∙ m, P = .046) of the quadriceps muscle on the involved side were higher in the PCL tear group than in the ACL tear group. However, there were no significant differences between the PCL tear group and ACL tear group in hamstring muscle strength (45.8 ± 42.3 N ∙ m and 46.0 ± 24.4 N ∙ m, respectively; P = .940) and endurance (429.3 ± 238.9 J and 382.4 ± 256.1 J, respectively; P = .574) on the involved side. The strength and endurance of the quadriceps muscle of the injured limb were greater after PCL tears than after ACL tears. However, there were no significant between-group differences in hamstring muscle strength and endurance on the involved side. Level III, retrospective comparative study. Copyright © 2015 Arthroscopy Association of North America. Published by 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. Timing of surgery in anterior cruciate ligament-injured knees.

    Science.gov (United States)

    Shelbourne, K D; Patel, D V

    1995-01-01

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

  14. 关节镜下4束自体腘绳肌腱与异体胫前肌腱移植重建前交叉韧带的临床对比研究%Comparison of arthroscopic reconstruction of anterior cruciate ligament using either 4 bundles hamstring tendon autograft or anterior tibial tendon allograft

    Institute of Scientific and Technical Information of China (English)

    王泽锦; 黄炯锋; 黄炳生; 李凭跃; 黄华扬

    2015-01-01

    目的:探讨4束自体腘绳肌腱与异体胫前肌腱移植重建前交叉韧带(ACL)的临床疗效。方法回顾性分析2010年9月至2013年6月在广州市番禺中心医院行关节镜下ACL重建术的42例单纯ACL断裂患者的临床资料,根据移植物的不同分为自体组(4束自体腘绳肌腱移植,22例)和异体组(异体胫前肌腱移植,20例),比较两组手术时间、发热时间和伤口愈合时间的差异;采用Lysholm膝关节评分、国际膝关节文献委员会(IKDC)膝关节功能主观评分表评估膝关节功能,KT-2000关节测量仪评估膝关节稳定性。结果自体组手术时间长于异体组,发热时间少于异体组,两组比较,差异有统计学意义(P<0.05)。自体组和异体组随访时间分别为(27±3)和(27±4)个月。随访期间两组均无移植物断裂松动、下肢深静脉栓塞、伤口不愈合等并发症发生。末次随访时,两组Lysholm评分、IKDC分级、KT2000平移距离均较术前明显改善(P<0.05),但两组之间上述指标比较,差异无统计学意义(P>0.05)。结论4束自体腘绳肌腱与异体胫前肌腱重建ACL的临床疗效无明显差异;在缺乏自体韧带情况下,异体胫前肌腱是良好的替代物之一。%Objective To investigate the clinical effects of arthroscopic reconstruction of anterior cruciate ligament (ACL) using either 4 bundles hamstring tendon autograft or anterior tibial tendon allograft. Methods From September 2010 to June 2013, clinical data of 42 patients with ACL rupture underwent arthroscopic reconstruction in Guangzhou Panyu Central Hospital, were analyzed retrospectively. According to different kinds of grafts, the patients were divided into autograft group (n = 22, using 4 bundles hamstring tendon autograft) and allograft group (n = 20, using anterior tibial tendon allograft). Differences of operative time, fever time and wound healing time were

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  16. 关节镜下自体、异体骨-髌腱-骨与半腱肌腱3种重建后交叉韧带方法的比较%A comparative study on arthroscopic posterior cruciate ligament reconstruction using bone-patellar tendon-bone allograft, bone-patellar tendon-bone autograft and semitendinosus tendon autograft

    Institute of Scientific and Technical Information of China (English)

    郑小飞; 黄华扬; 张余; 李凭跃; 尹庆水

    2009-01-01

    现为胫骨隧道外口持续果酱样液体流出,经换药、激素或消炎痛治疗后痊愈.结论:关节镜下自体、异体骨-髌腱-骨与半腱肌腱移植重建后交叉韧带均取得满意的结果,并且疗效相似.%BACKGROUND: There are many methods for posterior cruciate ligament (PCL) reconstruction, which is involved in many graft materials, but few studies aim to compare the differences in outcomes of different grafts for PCL reconstruction. OBJECTIVE: To compare the clinical results of arthroscopic PLC reconstruction with bone-patellar tendon-bone (B-PT-B) autograft, B-TP-B allograft and semitendinosus tendon autograft. DESIGN, TIME AND SETTING: A retrospective case analysis was completed in the Department of Orthopedics, Guangzhou General Hospital of Guangzhou Area Military Command of Chinese PLA from January 2000 to September 2005. MATERIALS: Totally 76 patients underwent arthroscopic PLC reconstruction from January 2000 to September 2005, with the use of B-TP-B autograft in 21 patients, B-TP-B allograft in 27 patients, semitendinosus tendon autograft in 28 patients. METHODS: A retrospective analysis was performed in 76 patients underwent arthroscopic PCL reconstruction, with the use of B-TP-B autograft in 21 patients, B-TP-B allograft in 27 patients, semitendinosus tendon autograft in 28 patients. Postoperative body temperature was examined duration hospitalization. The follow-up parameters included International Knee Documentation Committee (IKDC) scores, Lysholm knee joint scores, and KT-1000 evaluation.MAIN OUTCOME MEASURES: ①Range of motion. ②joint stability: posterior draw test and KT-1000 test. ③overall function of knee: IKDC scores and Lysholm scores; ④complications and side effect. RESULTS: The time of follow-up visit was 26-79 months. Differences were no statistically significant among the IKDC scores, Lysholm scores, KT-1000 side-side difference, the positive rate of posterior draw test in three groups of patients with PCL

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

    Science.gov (United States)

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

    2017-07-01

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

  18. Arthroscopic Double-Bundle Posterior Cruciate Ligament Reconstruction Using Achilles Tendon Allograft%关节镜下应用同种异体跟腱双束重建后交叉韧带

    Institute of Scientific and Technical Information of China (English)

    胡光亮; 滕学仁; 赵永生; 周伦; 赵而海

    2005-01-01

    目的:探讨应用同种异体跟腱双束重建后交叉韧带(posterior crucial ligament,PCL)的方法并观察其早期效果.方法:2003年3月~2004年8月,对10例PCL受损患者实施关节镜下采用同种异体跟腱双束重建PCL术.其中2例合并前交叉韧带(anterior crucial ligament,ACL)损伤,同期取自体半腱股薄肌腱重建ACL;3例合并半月板后外侧角损伤,同期取自体半腱股薄肌腱重建后外侧角.术后随访6~24个月,平均13.2个月,其中6例获得12个月以上的随访.结果:采用Lysholm评分法评价患者手术前后患膝关节功能,术前平均50.3分,术后平均91.2分.客观检查结果显示,术前所有患者均出现胫骨结节后沉,后抽屉试验及Lachman试验阳性;术后所有患者后抽屉试验及Lachman试验阴性,有3例病史较长(大于1年)的患者胫骨结节有轻度后沉.合并ACL损伤的2例患者,膝关节屈曲活动轻度受限(5°~20°).结论:应用同种异体跟腱双束重建PCL可减少自体取材造成的损伤及相应的并发症;提前制作供材,软腱端容易通过骨道,缩短镜下操作时间,减轻手术创伤.

  19. Ganglion cysts of the cruciate ligaments. MR findings with clinical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Huang, G.S.; Hsueh, C.-J.; Juan, C.J.; Chen, C.Y. [Tri-Service General Hospital and National Defense Medical Center, Taipei (China). Dept. of Radiology; Lee, C.H. [Tri-Service General Hospital and National Defense Medical Center, Taipei (China). Dept. of Orthopedic Surgery; Chan, W.P. [Taipei Medical Univ., Wan Fang Hospital, Taipei (China). Dept. of Radiology; Taylor, J.A.M. [New York Chiropractic College, Seneca Falls, NY (United States). Dept. of Diagnosis; Yu, J.S. [Ohio State Univ. Medical Center, Columbus, OH (United States). Dept. of Radiology

    2002-07-01

    Purpose: To evaluate the MR findings of ganglion cysts of the cruciate ligaments in correlation with clinical findings. Material and Methods:We reviewed 12 patients with ganglion cysts of the cruciate ligaments obtained from a medical record of 4153 consecutive patients referred for knee MR examinations. All patients presented with chronic knee pain and 4 had restriction of knee motion. The MR imaging findings of the cysts were evaluated and correlated with clinical manifestations. Results:Seven ganglion cysts were found in the posterior cruciate ligaments and 5 in the anterior cruciate ligaments. All cysts were lobulated (n=7) or fusiform (n=5) in shape, 1.8-4.5 cm in size, along the posterior surface in the proximal or distal end of the ligaments. Ten patients had arthroscopic resection or aspiration of their cysts, became symptom free and had no recurrence on follow-up MR examinations. Two cysts reduced in size spontaneously by conservative treatment. Conclusion:MR imaging can offer useful information in detection and diagnosis of patients with chronic knee pain due to ganglion cysts of the cruciate ligaments. The size and location of the ganglion cysts can attribute to the clinical manifestations.

  20. 关节镜下应用带跟骨异体跟腱联合重建前交叉韧带及内侧副韧带%Reconstruction of Both Anterior Cruciate Ligament and Medial Collateral Ligament Using Calcanei Combined Achilles Tendon Allograft under Arthroscopy

    Institute of Scientific and Technical Information of China (English)

    冯会成; 黄迅悟; 孙继桐; 常青; 毕龙; 余方圆

    2013-01-01

    目的:探讨关节镜下应用带跟骨异体跟腱联合重建前交叉韧带(anterior cruciate ligament,ACL)及内侧副韧带(medial col-ateml ligament,MCL)和恢复膝关节前内侧稳定性的效果.方法:选择2007年1月至2010年1月收治符合纳入标准的27例A CL合并MCL损伤患者.其中男18例,女9例;年龄16~48岁,平均32.5岁;右膝15例,左膝12例.患者在排除手术禁忌后,均在关节镜下采用带跟骨异体跟腱一期联合重建ACL和MCL.患者受伤至手术时间7~14天,平均10天.结果:术后2周所有患者切口均Ⅰ期愈合.所有病例获得长期随访,随访时间24~32个月,平均26个月.术后24个月,Lysholm评分由术前的32.10±4.35升至86.25±4.12分,国际膝关节文献委员会(IKDC)评分由术前的33.27±4.25分,升至82.46± 4.13分,术前与术后Lysholm评分及I KDC评分均有显著差别(P<0.05).结论:关节镜下应用带跟骨异体跟腱一期联合重建治疗膝关节脱位能够较好的恢复患者膝关节前内侧稳定行,近期效果良好.

  1. Anterior cruciate ligament tears: MRI versus arthroscopy. Vordere Kreuzbandruptur: MRT versus Arthroskopie

    Energy Technology Data Exchange (ETDEWEB)

    Tosch, U.; Felix, R. (Strahlenklinik und Poliklinik, Universitaetsklinik Rudolf Virchow, Berlin (Germany)); Schauwecker, W.; Dreithaler, B. (Chirurgische Klinik und Poliklinik, Universitaetsklinik Rudolf Virchow, Berlin (Germany))

    1992-05-01

    Because of suspected rupture of the anterior cruciate ligament sixteen acute traumatised patients were investigated by MR and arthroscopy. The MR diagnosis of a lesion of the anterior cruciate ligament proved to be correct by arthroscopy in fifteen of sixteen cases. Diagnostic criteria for lesions of the anterior cruciate ligament were: increased signal intensity in T[sub 1]- and T[sub 2] weighted images, increased volume and discontinuity of ligamentous structures. Additional MR findings of meniscal tears were correct in three of four cases laterally and in four of four cases medially. Femoral cartilage lesions were correctly identified by MR in three cases. MR normal findings proved to be correct by arthroscopy in another five cases. (orig.).

  2. Mechanoreceptors found in a posterior cruciate ligament from a well-functioning total knee arthroplasty retrieval.

    Science.gov (United States)

    Mihalko, William M; Creek, Aaron T; Mary, Michelle N; Williams, John L; Komatsu, David E

    2011-04-01

    Histologic analysis of the posterior cruciate ligament has been reported in the normal and osteoarthritic knee but not after cruciate-retaining (CR) total knee arthroplasty (TKA). Retention of the posterior cruciate ligament during TKA has been debated as to whether it is beneficial in stability and function. If the presence of mechanoreceptors is shown to be maintained in CR TKA, then there may be an argument for retention. This case report used a retrieval of a well-functioning TKA specimen that had a CR TKA. To prove the presence of mechanoreceptors within the ligament, immunohistochemistry techniques using S100 protein and neurofilament protein were used. This specimen had pacini and lamellar type of mechanoreceptors present on immunohistochemistry analysis. The presence or retention of mechanoreceptors and innervations of the ligament may indicate an advantage when retained during TKA.

  3. Anterior cruciate ligament repair with LARS (ligament advanced reinforcement system: a systematic review

    Directory of Open Access Journals (Sweden)

    Machotka Zuzana

    2010-12-01

    Full Text Available Abstract Background Injury to the anterior cruciate ligament (ACL of the knee is common. Following complete rupture of the ACL, insufficient re-vascularization of the ligament prevents it from healing completely, creating a need for reconstruction. A variety of grafts are available for use in ACL reconstruction surgery, including synthetic grafts. Over the last two decades new types of synthetic ligaments have been developed. One of these synthetic ligaments, the Ligament Advanced Reinforcement System (LARS, has recently gained popularity. The aim of this systematic review was to assess the current best available evidence for the effectiveness of the LARS as a surgical option for symptomatic, anterior cruciate ligament rupture in terms of graft stability, rehabilitation time and return to pre-injury function. Method This systematic review included studies using subjects with symptomatic, ACL ruptures undergoing LARS reconstruction. A range of electronic databases were searched in May 2010. The methodological quality of studies was appraised with a modified version of the Law critical appraisal tool. Data relating to study characteristics, surgical times, complication rates, outcomes related to knee stability, quality of life, function, and return to sport as well as details of rehabilitation programs and timeframes were collected. Results This review identified four studies of various designs, of a moderate methodological quality. Only one case of knee synovitis was reported. Patient satisfaction with LARS was high. Graft stability outcomes were found to be inconsistent both at post operative and at follow up periods. The time frames of rehabilitation periods were poorly reported and at times omitted. Return to pre-injury function and activity was often discussed but not reported in results. Conclusions There is an emerging body of evidence for LARS with comparable complication rates to traditional surgical techniques, and high patient

  4. 关节镜下同种异体骨-髌腱-骨重建前交叉韧带的临床疗效%Arthroscopic anterior cruciate ligament reconstruction with bone-patellar tendon bone allograft

    Institute of Scientific and Technical Information of China (English)

    徐琦; 杨柳; 郭林; 戴刚; 段小军; 陈光兴

    2009-01-01

    目的 评价关节镜下应用同种异体骨-髌腱-骨重建膝关节前交叉韧带的临床疗效.方法 2005年12月至2007年12月,我科住院患者经关节镜检查证实为前交叉韧带(anterior crueiate ligament,ACL)断裂者125例,获得随访的患者109例,所有患者均于关节镜下行同种异体骨-髌腱-骨重建膝关节前交叉韧带术.疗效评估采用:KTl000,Lysholm,Irrgang,改良larson,国际膝关节评分委员会(international knee documentation committee,IKDC)韧带评分系统.结果 所有患者术后随访6~24个月,平均16.9个月,所有患者随访时异体移植物位置良好,术后所有患者KT.1000检查双侧膝关节前向松弛度差值<3 mm,IKDC评分活动水平正常或接近正常98例(89.9%),Lysholm评分从(50.2±4.3)分提高至(88.4±6.4)分,lrrgang评分从(43.4±4.3)分提高争(82.6±5.3)分,Larson评分从(41.4±4.8)分提高至(88.5±4.3)分,和术前相比均有显著性意义(P<0.01).所有患者均无严重并发症发生.结论 同种异体移植物是前交叉韧带重建良好的选择之一,关节镜下同种异体骨-髌腱-骨移植物重建前交叉韧带手术能使膝关节功能获得良好的恢复.

  5. Hybrid Graft Anterior Cruciate Ligament Reconstruction: A Predictable Graft for Knee Stabilization.

    Science.gov (United States)

    Alvarez-Pinzon, Andres M; Barksdale, Leticia; Krill, Michael K; Leo, Brian M

    2015-06-01

    Trauma to the anterior cruciate ligament (ACL) is a season-ending injury and involves months of activity modification and rehabilitation. The annual incidence of ACL tears in the United States is approximately 200,000, which allows for a broad range of individualized treatment options. Various surgical techniques, including transtibial and independent tunnel drilling, allograft and autograft tissue, and various implants, have been described in the literature. This article describes the indications and technique for a hybrid soft tissue graft for ACL reconstruction. Autologous grafts eliminate the risk of disease transmission and have recently been shown to have a lower rerupture rate, particularly in younger, active patients; however, the harvesting of autologous hamstring grafts carries a risk of donor-site morbidity, iatrogenic injury of the graft, and inadequate graft size. In contrast to a traditional autologous soft tissue graft, the hybrid graft allows for graft size customization for a desired reconstruction, especially in cases where autograft hamstrings may be iatrogenically damaged or of inadequate size when harvested. The goal of a hybrid graft ACL reconstruction is to provide a favorable-sized graft with clinical outcomes comparable with autologous soft tissue grafts. In contrast to a traditional autologous soft tissue graft, this technique provides another option in the event of unforeseen deficiencies or complications associated with harvesting and preparation of the autologous gracilis and semitendinosis soft tissue graft.

  6. Joint infection unique to hamstring tendon harvester used during anterior cruciate ligament reconstruction surgery.

    Science.gov (United States)

    Tuman, Jeffrey; Diduch, David R; Baumfeld, Joshua A; Rubino, L Joseph; Hart, Joseph M

    2008-05-01

    Joint infection after anterior cruciate ligament (ACL) reconstruction is a rare but important clinical issue that must be resolved quickly to prevent secondary joint damage and preserve the graft. After careful analysis, we observed 3 infection cases within a 12-month period after ACL reconstruction, which represented an abnormally elevated risk. All reconstructions were performed by the same surgeon and used hamstring tendon allograft. For each surgery, the Target Tendon Harvester (DePuy Mitek, Raynham, MA) was used to harvest hamstring tendons. Through our review, we learned that this instrument was sterilized while assembled. It is our belief that ineffective sterilization of this hamstring graft harvester served as the origin for these infections. We have determined that appropriate sterilization technique involves disassembly of this particular hamstring tendon harvester before sterilization because of the tube-within-a-tube configuration. We have since continued to use the Target Tendon Harvester, disassembling it before sterilization. There have been no infections in the ensuing 12 months during which the surgeon performed over 40 primary ACL reconstructions via hamstring autograft. The information from this report is intended to provide arthroscopists with information about potential sources of infection after ACL reconstruction surgery.

  7. The single-bundle and single-tunnel reconstruction of anterior cruciate ligament using achilles tendon allograft with attached calcaneus under arthroscopy%关节镜下带跟骨异体跟腱单束单隧道重建前交叉韧带

    Institute of Scientific and Technical Information of China (English)

    冯会成; 黄迅悟; 孙继桐; 常青; 毕龙; 余方圆

    2013-01-01

    Objective To investigate the effectiveness of anterior cruciate ligament (ACL) reconstruction using achilles tendon allograft with attached calcaneus in promoting the tendon-bone healing through comparing with that of ACL reconstruction using simple tendon allograft under arthroscopy. Methods From January 2008 to December 2009, 41 patients with ACL injuries in accordance with the inclusion criteria were treated. They were randomly divided into 2 groups according to different treatment methods. In the trial group, ACL reconstruction using achilles tendon allograft with attached calcaneus was performed on 21 patients. In the control group, ACL reconstruction using simple tendon allograft was performed on 20 patients. There were no significant differences in such general data as the age, gender, cause of injury, disease duration, preoperative functional score and so on between the 2 groups (P>0.05), which were comparable. The single-bundle and single-tunnel ACL reconstruction was performed in both groups. Results All the incisions in both groups were healed by the first intention 2 weeks postoperatively. The patients were followed up for an average period of 26 months (range; 24-28 months) in the trial group, and 28 months (range; 24-30 months) in the control group. 2 years after the operation, 15 cases (71.4%) were negative in the Lachman test, and 16 cases (76.2%) were negative in the anterior drawer test in the trail group. In contrast, 14 cases (70.0%) and 15 cases (75.0%) were negative respectively in the control group. There were no significant differences in the Lysholm score and International Knee Documentation Committee (IKDC) score between the 2 groups 2 years after the operation (P>0.05). The CT exam showed the bone tunnel diameter was enlarged in different degrees in both groups 2 years after the operation, when compared with that 1 month postoperatively. However, the rate of bone tunnel enlargement in the trial group (4/21, 19.0%) was obviously less than

  8. A comparative study on arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone between allograft and autograft%自体和异体骨-髌腱骨移植物重建膝前十字韧带的比较研究

    Institute of Scientific and Technical Information of China (English)

    江东; 王永健; 程序; 余家阔; 敖英芳; 于长隆; 王健全; 崔国庆; 胡跃林; 田得祥; 龚熹

    2008-01-01

    Objective To compare clinical results of arthroscopic anterior cruciate ligament(ACL) reconstruction with bone-patellar tendon-bone(B-PT-B) between allograft and autograft.Methods Twentyseven patients underwent ACL reconstruction using irradiated deep-frozen B-PT-B allograft,including 18 males and 9 females,with an average age of 25.5 years(range,16-49 years).Twenty-five patients underwent the same operation but using autograft B-PT-B,including 19 males and 6 females,with an average age of 26.7 years (range,18-43 years).The same arthroscopie technique was used to perform the reconstruction.Postoperative temperature,erythrocyte sedimentation rate,C reactive protein examined.During follow-up,parameters included International Knee Documentation Committee (IKDC) scores,Tegner scores,Lysholm scores,anterior knee pain and KT-2000 side-to-side difference.Muscle strength were measured by the Biodex dynamometer.Results The average follow-up was 37.1 (range,30-48) months in the allograft group and 36.3 (range,30-54) months in the autograft group.No significant difference was found for IKDC scores (89.5/86.5),Lysholm scores (93.0/94.6),Tegner scores (8.0/7.7),anterior knee pain (44.4%/72.0%)and side-to-side difference[30°: (1.72±1.73) mm vs (1.16±1.32) mm; 90°:(1.37±1.90) nun vs (-0.08±1.62)mm].Quadriceps muscle strength recovered to 82.7%/82.8% (60°/s and 120°/s) and 86.6%/85.3% (60°/sand 120°/s) for the allograft and autograft group with no significant difference.Conclusion There was no significant difference with stability and muscle strength recovery between B-PT-B aUograft and autograft.%目的 比较异体和自体骨-髌腱-骨(B-Pt-B)移植物重建膝关节前十字韧带(ACL)的临床效果.方法 27例ACL断裂患者接受关节镜下异体B-PT-B重建ACL手术,男18例,女9例;年龄16~49岁,平均25.5岁.同期25例ACL断裂患者接受关节镜下自体B-PT-B重建ACL手术,男19例,女6例;18~43岁,平均26.7岁.两组患者均采用相同的

  9. A novel silk-based artificial ligament and tricalcium phosphate/polyether ether ketone anchor for anterior cruciate ligament reconstruction - safety and efficacy in a porcine model.

    Science.gov (United States)

    Li, Xiang; He, Jiankang; Bian, Weiguo; Li, Zheng; Zhang, Wenyou; Li, Dichen; Snedeker, Jess G

    2014-08-01

    Loss of ligament graft tension in early postoperative stages following anterior cruciate ligament (ACL) reconstruction can come from a variety of factors, with slow graft integration to bone being widely viewed as a chief culprit. Toward an off-the-shelf ACL graft that can rapidly integrate to host tissue, we have developed a silk-based ACL graft combined with a tricalcium phosphate (TCP)/polyether ether ketone anchor. In the present study we tested the safety and efficacy of this concept in a porcine model, with postoperative assessments at 3months (n=10) and 6months (n=4). Biomechanical tests were performed after euthanization, with ultimate tensile strengths at 3months of ∼370N and at 6months of ∼566N - comparable to autograft and allograft performance in this animal model. Comprehensive histological observations revealed that TCP substantially enhanced silk graft to bone attachment. Interdigitation of soft and hard tissues was observed, with regenerated fibrocartilage characterizing a transitional zone from silk graft to bone that was similar to native ligament bone attachments. We conclude that both initial stability and robust long-term biological attachment were consistently achieved using the tested construct, supporting a large potential for silk-TCP combinations in the repair of the torn ACL.

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    SHI Dong-liang; YAO Zhen-jun

    2011-01-01

    Background 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.Methods 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.Results Anterior cruciate ligament reconstruction using hamstring tendon grafts resulted in greater pain upon kneeling than reconstruction using pateliar 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).Conclusion Anterior cruciate ligament reconstruction using patellar or hamstring tendon grafts results in similar long-term knee function.

  12. Can anterior cruciate ligament reconstruction be performed routinely in day clinic?

    Science.gov (United States)

    De Beule, J; Vandenneucker, H; Claes, S; Bellemans, J

    2014-09-01

    Anterior cruciate ligament reconstruction is performed as an outpatient procedure in selected cases. Whether it can be safely performed on a routine basis in day clinic remains unclear. Our hypothesis was that routinely performing outpatient anterior cruciate ligament reconstruction would be equally safe as compared to inpatient procedures. A cohort of 355 patients who underwent outpatient primary reconstruction was analysed at an average follow-up of 3.8 years. Four patients (1.1%) could not be discharged or were readmitted within 24 hours. The 1-month readmission rate was 1.4%. The overall complication rate was 12.1% (43 cases) of which 4.2% (15 patients) occurred within the first 30 days. Performing anterior cruciate ligament reconstructions routinely in day clinic is associated with almost negligible readmission rates and has similar complication rates as for standard in-hospital anterior cruciate ligament reconstructions. Outpatient anterior cruciate ligament reconstructions can therefore be safely performed without specific preoperative patient selection protocols.

  13. The Impact of the Multicenter Orthopaedic Outcomes Network (MOON) Research on Anterior Cruciate Ligament Reconstruction and Orthopaedic Practice.

    Science.gov (United States)

    Lynch, T Sean; Parker, Richard D; Patel, Ronak M; Andrish, Jack T; Spindler, Kurt P; Amendola, Annunziata; Brophy, Robert H; Dunn, Warren R; Flanigan, David C; Huston, Laura J; Jones, Morgan H; Kaeding, Christopher C; Marx, Robert G; Matava, Matthew J; McCarty, Eric C; Pedroza, Angela D; Reinke, Emily K; Wolf, Brian R; Wright, Rick W

    2015-03-01

    With an estimated 200,000 anterior cruciate ligament reconstructions performed annually in the United States, there is an emphasis on determining patient-specific information to help educate patients on expected clinically relevant outcomes. The Multicenter Orthopaedic Outcomes Network consortium was created in 2002 to enroll and longitudinally follow a large population cohort of anterior cruciate ligament reconstructions. The study group has enrolled >4,400 anterior cruciate ligament reconstructions from seven institutions to establish the large level I prospective anterior cruciate ligament reconstruction outcomes cohort. The group has become more than a database with information regarding anterior cruciate ligament injuries; it has helped to establish a new benchmark for conducting multicenter, multisurgeon orthopaedic research. The changes in anterior cruciate ligament reconstruction practice resulting from the group include the use of autograft for high school, college, and competitive athletes in their primary anterior cruciate ligament reconstructions. Other modifications include treatment options for meniscus and cartilage injuries, as well as lifestyle choices made after anterior cruciate ligament reconstruction.

  14. 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 mech

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Diego Protásio de Vasconcelos

    2015-02-01

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

  17. Anterior cruciate ligament remnants nodule: potential factor causing extension loss

    Institute of Scientific and Technical Information of China (English)

    WANG Jian; AO Ying-fang

    2013-01-01

    Background Extension loss caused by anterior cruciate ligament (ACL) remnants nodule was usually reported by case reports.There is no systematic report analyzing ACL remnants nodule.The purpose of this study was to investigate the characteristics of extension loss caused by remnants of ACL after injury.Methods From June 2008 to December 2011,ACL remnants were observed by atthroscopy in 1012 cases with ACL injuries at the time of primary reconstruction.ACL remnants nodules were recorded.The time of extension loss occurrence caused by ACL remnants nodule,associated symptom and sign,magnetic resonance imaging (MRI),and arthroscopic findings were observed.Histological examination was performed on the lesion resected.Results Twenty-four cases with ACL remnants nodules were found by arthroscopy.Among them extension loss caused by remnants of ACL happened in 19 cases (male 13; female 6).The average extension loss were 9.1° (range,5°-20°).The average time from injury to operation was 8.9 weeks (range,3-26 weeks).The remnants of ACL depressed in the inter-condylar notch were found on MRI in 15 cases with extension loss.The rupture locations of ACL were all close to the upper insertion of ACL.The microscopic examination of the resected remnants of ACL revealed disorganized fibrous connective tissue and tissue of ACL ligament.Conclusions Among 1012 ACL injury cases,24 ACL remnants nodules were found with arthroscopy and 19 nodules could cause knee extension loss.ACL remnants nodule should be paid attention to as a potential cause of extension loss.

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

    Institute of Scientific and Technical Information of China (English)

    MEI Yu; AO Ying-fang; WANG Jian-quan; MA Yong; ZHANG Xin; WANG Jia-ning; ZHU Jing-xian

    2013-01-01

    Background Clinical features of anterior cruciate ligament (ACL) injury are important for its prevention,diagnosis and treatment.However,few studies have reported such data,especially in China.The purpose of this study was to describe the clinical characteristics of ACL injury on a large cohort.Methods Between 1993 and 2007,a total of 4355 ACL deficient inpatients (612 athletes and 3743 non-athletes) were registered.Data were collected using a special database system.And the distributions of characteristics in different groups were compared and analyzed statistically.Results All subjects were confirmed with ACL tear during surgery.Statistical analysis revealed that the percentage of females in Athlete Group was significantly higher than that in Non-athlete Group (56.05% vs.24.95%,P<0.001).This study also found that sports trauma was the main cause of ACL tears.Soccer,basketball,judo,wrestling and track and field were the five most responsible activities for athletes.The average injury time for athletes was significantly shorter than that for non-athletes (413.3 days vs.717.5 days,P<0.001).Three thousand nine hundred and eight cases were ordered ACL reconstruction (76.04% single-bundle,18.30% double-bundle).Three hundred and forty-five patients (7.92%)were combined with other ligaments injuries,2667 (61.24%) were found with various grades of cartilage lesions,and 3377 (77.54%) were found with meniscal injury.Conclusions Sports trauma was the main cause of ACL tears in China,and reconstruction had become the principal surgical choice.In order to restore knee joint stability and reduce the incidence of cartilage and meniscal injury,patienttailored ACL reconstruction should be suggested at the right moment.

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

    Directory of Open Access Journals (Sweden)

    Beris Alexandros E

    2010-02-01

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

  20. Concomitant injuries of anterior cruciate ligament and meniscus

    Directory of Open Access Journals (Sweden)

    Ristić Vladimir

    2016-01-01

    Full Text Available Introduction. The aim of this study was to determine the correlation between meniscal injuries with injuries of the anterior cruciate ligament, as well as risk factors for those associated injuries. Material and Methods. This study included 496 operated patients. Almost half of patients with meniscal injury were between the ages of 21 and 30 years. Results. Meniscal injuries were diagnosed in 187 patients (38%. These patients were significantly older than the patients without meniscal injury. Meniscal injuries were significantly more frequent in patients who played sports recreationally than in professional athletes. The patients with meniscal injury underwent surgery almost four months later than the patients with preserved menisci. Meniscal injuries occurred significantly more frequently by non - contact mechanism, as a result of landing and sudden changes of direction and rhythm of running. Conclusion. Male patients hurt the medial meniscus more often, “bucket handle” type of lesion being much more frequent than on the lateral meniscus. The increase of body mass index is exactly proportional to the increase in the incidence of meniscal injuries.

  1. 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.

  2. Anterior cruciate ligament injuries among wakeboarders: a case report.

    Science.gov (United States)

    Narita, Tetsuya; Mori, Atsushi; Hashiguchi, Hiroshi; Iizawa, Norishige; Takeda, Tomomichi; Hattori, Mikihiko; Ito, Hiromoto

    2004-02-01

    No previous cases of anterior cruciate ligament (ACL) injuries sustained during wake-boarding have been reported. We report on a case involving an ACL injury sustained during wakeboarding. A 27-year-old man sustained an injury while attempting a wakeboarding maneuver(a heel-side back roll, consisting of a jump and simultaneous roll toward the heel side). He failed to complete his roll before landing, striking the water with his right shoulder foremost, then plunging underwater. When his wakeboard struck the water, his left knee was sprained by the rotational force exerted by the board. The patient was diagnosed with an isolated ACL injury and underwent arthroscopic ACL reconstructive surgery. The board used in wakeboarding is wider and subject to greater water resistance than that used in water skiing. The feet of the wakeboarder are firmly attached by binding boots to a board, laterally with respect to the direction of motion, impeding easy separation of the board from the feet in the event of a fall. Thus, wakeboarding conditions would appear to put wakeboarders at particular risk for ACL injuries. These conditions need be assessed from a medical perspective in order to devise ways to minimize the risk of such injuries.

  3. 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.

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

    Science.gov (United States)

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

    2011-08-01

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

  5. LOWER EXTREMITY MALALIGNMENTS AND ANTERIOR CRUCIATE LIGAMENT INJURY HISTORY

    Directory of Open Access Journals (Sweden)

    Rebecca A. Braham

    2004-12-01

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

  6. Anatomic double-bundle anterior cruciate ligament reconstruction

    Institute of Scientific and Technical Information of China (English)

    DAI Xue-song

    2012-01-01

    Objective: To retrospectively evaluate the early results of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction and compare with the results of native ACL of the contralateral knee.Methods: The results of a consecutive series of 118 patients receiving arthroscopic ACL reconstruction were evaluated.Eight patients were lost to the latest follow-up,leaving a total of 110 patients available for study within at least 3 years' clinical follow-up.Among them,63 patients underwent postoperative MRI and CT scan,as well as clinical evaluation.Results: After reconstruction,the knees were stable and pain-free.Mean postoperative Lysholm score was 95.54 in 110 patients after 3 years.CT and MRI assessment showed that the reconstruction centered in the femoral footprint of ACL (n=63).The sagittal ACL angle in the reconstructed ACL (52.16°±2.45°) was much close to that in the contralateral intact ACL (51.31 °±2.18°,P>0.05).By ACL-Blumensaat line angle analysis,there was no difference between doublebundle reconstructed knees and their contralateral normal knees (4.67°±0.43° vs.4.62°±0.60°,P>0.05).Conclusion:Anatomic double-bundle ACL reconstruction can place grafts more precisely in the anatomic footprint of the ACL and better restore knee kinematics.

  7. Ruptures of the anterior cruciate ligament in soccer.

    Science.gov (United States)

    Rochcongar, P; Laboute, E; Jan, J; Carling, C

    2009-05-01

    Ruptures of the anterior cruciate ligament (ACL) are serious, common and costly injuries. The present 12-year investigation was undertaken to examine the frequency of ACL ruptures and identify the game events that may have contributed to the cause of these injuries in male soccer players across a French district. A retrospective questionnaire was used to record the players' age at the time of injury, laterality, standard of play, playing position and injured side. The characteristics of the injury situations were described in detail to investigate the game events involved in each case. A total of 934 ruptures was reported. Significantly more ruptures were sustained in a non-contact versus a contact situation (pgame events reported in the injury situations were shown to be related to player's age, standard and position. While these results have confirmed observations from previous investigations on ACL ruptures in soccer, the analysis of a considerably larger number of injury cases has brought new findings to the literature as well as recommendations for future research.

  8. Dynamic knee joint mechanics after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Clarke, Sarah B; Kenny, Ian C; Harrison, Andrew J

    2015-01-01

    There is scarcity of information on the long-term adaptations in lower limb biomechanics during game-specific movements after anterior cruciate ligament (ACL) reconstruction. Particularly, variables such as knee abduction moments and transverse plane knee motion have not been studied during a game-specific landing and cutting task after ACL reconstruction. The purpose of this study was to compare the hip and knee mechanics between the ACL-reconstructed (ACLr) group and a healthy control group. Thirty-eight reconstructed athletes (18 ACLr, 18 control) participated in the study. Three-dimensional hip, knee, and ankle angles were calculated during a maximal drop jump land from a 0.30-m box and unanticipated cutting task at 45°. During the landing phase, ACLr participants had increased hip flexion (P knee range of motion (P = 0.027). During the cutting phase, the ACLr participant's previously injured limb had increased internal knee abduction moment compared with that of the control group (P = 0.032). No significant differences were reported between the previously injured and contralateral uninjured limb. Previously injured participants demonstrated higher knee abduction moment and transverse plane range of motion when compared with those of control participants during a game-specific landing and cutting task.

  9. 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.

  10. Anterior cruciate ligament reconstruction in patients older than 35 years.

    Science.gov (United States)

    El-Sallakh, Sameh; Pastides, Philip; Thomas, Panos

    2014-12-01

    Anterior cruciate ligament (ACL) reconstruction is an increasingly established method even in patients older than 35 years. Our hypothesis is that functional outcome after ACL reconstruction is comparable in patients younger and older than 35 years. A total of 28 patients (5 women and 23 men) with average age of 41.5 years (36-68) were retrospectively evaluated. The average follow-up period was 33 months. All of them were treated operatively with arthroscopic single-bundle four-strand hamstring tendon autograft. The functional outcome was determined by clinical scores (Tegner activity scale and Lysholm knee score). The median values for the Lysholm knee score were preoperatively 77 and postoperatively 96 points (range, 90-100) with significant improvement (p pre- and postoperatively with an overall return to baseline for all patients. No significant correlation between functional outcome and patients' age was present and no reported significant complications. The good results and a high level of patient satisfaction show that ACL reconstruction is justified even in patients (older than 35 years) with symptomatic anterior knee instability. We commonly propose surgical treatment in symptomatic patients who express the need to restore their preinjury activity levels, regardless of their age.

  11. Displaced anterior cruciate ligament avulsion fractures: Arthroscopic staple fixation

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    S R Sundararajan

    2011-01-01

    Full Text Available Background: Anterior cruciate ligament (ACL avulsion fracture is commonly associated with knee injuries and its management is controversial ranging from conservative treatment to arthroscopic fixation. The aim of our study was to assess the clinical and radiological results of arthroscopic staple fixation in the management of ACL avulsion fractures. Materials and Methods: Twenty-two patients (17 males and 5 females who underwent arthroscopic staple fixation for displaced ACL avulsion fractures were analysed. The mean age was 32.2 years (15-55 years with a mean followup of 21 months (6-36 months. All patients were assessed clinically by calculating their Lysholm and International Knee Documentation Committee (IKDC scores and the radiological union was assessed in the followup radiographs. Results: The mean Lysholm score was 95.4(83-100 and the mean IKDC score was 91.1(77-100 at the final followup. In 20 patients anterior drawer′s test was negative at the end of final followup while two patients had grade I laxity. Associated knee injuries were found in seven cases. The final outcome was not greatly influenced by the presence of associated injuries when treated simultaneously. At final followup all the patients were able to return to their pre-injury occupation Conclusion: Arthroscopic staple fixation is a safe and reliable method for producing clinical and radiological outcome in displaced ACL avulsion fractures.

  12. Return to sport following anterior cruciate ligament reconstruction.

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    Feller, Julian; Webster, Kate E

    2013-02-01

    Rates of return to pre-injury sport following anterior cruciate ligament (ACL) reconstruction are less than might be expected from standard outcome measures and there appears to be a rapid decline in sporting participation after two to three years. There are many factors that influence whether an individual will return to sport following this type of surgery. They include not only surgical details and rehabilitation, but also social and psychological factors, as well as demographic characteristics. Age is of particular importance with older patients being less likely to resume their pre-injury sport. It is important that future research clearly identify the pre-injury characteristics of the study cohort when investigating return to sport, and also that there is consistent and precise terminology used to report rates of return to sporting activities. Little is known about how to determine when it is safe to return to sport following ACL reconstruction or how to predict whether an athlete will be able to successfully return to sport. Finally, it needs to be recognised that return to sport following ACL reconstruction is associated with a risk of further injury and the development of osteoarthritis.

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

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    Vivek Pandey

    2014-01-01

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

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

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    Eduardo Frois Temponi

    2015-02-01

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

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

    Science.gov (United States)

    Kielar, Maciej

    2016-01-01

    Aim The purpose of the study was to improve the ultrasonographic assessment of the anterior cruciate ligament by an inclusion of a dynamic element. The proposed functional modification aims to restore normal posterior cruciate ligament tension, which is associated with a visible change in the ligament shape. This method reduces the risk of an error resulting from subjectively assessing the shape of the posterior cruciate ligament. It should be also emphasized that the method combined with other ultrasound anterior cruciate ligament assessment techniques helps increase diagnostic accuracy. Methods Ultrasonography is used as an adjunctive technique in the diagnosis of anterior cruciate ligament injury. The paper presents a sonographic technique for the assessment of suspected anterior cruciate ligament insufficiency supplemented by the use of a dynamic examination. This technique can be recommended as an additional procedure in routine ultrasound diagnostics of anterior cruciate ligament injuries. Results Supplementing routine ultrasonography with the dynamic assessment of posterior cruciate ligament shape changes in patients with suspected anterior cruciate ligament injury reduces the risk of subjective errors and increases diagnostic accuracy. This is important especially in cases of minor anterior knee instability and bilateral anterior knee instability. Conclusions An assessment of changes in posterior cruciate ligament using a dynamic ultrasound examination effectively complements routine sonographic diagnostic techniques for anterior cruciate ligament insufficiency. PMID:27679732

  16. Massage Therapy Protocol for Post–Anterior Cruciate Ligament Reconstruction Patellofemoral Pain Syndrome: A Case Report

    OpenAIRE

    2008-01-01

    Background: The intent of the present study was to determine the effectiveness of massage therapy in the rehabilitation of post–anterior cruciate ligament reconstruction patellofemoral pain syndrome. The primary complications following surgical repair of the anterior cruciate ligament—classified as patellofemoral pain syndrome—are hamstring flexion contracture and quadriceps weakness, leading to patellofemoral dysfunction and retropatellar pain. Methods: Treatment included lymphatic drainage,...

  17. 关节镜下髌韧带和六股异体腘绳肌腱单束重建前交叉韧带的临床研究%Arthroscopic single-bundle anterior cruciate ligament reconstruction with six-strand hamstring tendon and patellar tendon allograft

    Institute of Scientific and Technical Information of China (English)

    王飞; 陈百成; 康慧君; 董江涛; 王晓峰; 张晓阳; 孙然

    2011-01-01

    目的 比较关节镜下采用髌韧带和六股异体腘绳肌腱单束重建前交叉韧带的临床效果.方法 回顾性分析2006年10月至2009年12月我科采用关节镜下异体移植物单束重建前交叉韧带(ACL)的108例患者的临床资料,其中六股异体腘绳肌腱58例(腘绳肌腱组),异体髌韧带50例(髌韧带组).术后应用Lachman和pivot-shift试验以及KT-1000评估膝关节稳定性,按照国际膝关节评分委员会(IKDC)、Lysholm膝关节评分评价膝关节功能.结果 术后患者随访时间12~38个月,平均为28.6个月.腘绳肌腱组KT-1000检查示双侧膝关节前向松弛度差异为(1.2±1.2)mm,显著小于髌韧带组(1.8±1.5)mm,差异具有统计学意义(P<0.05).腘绳肌腱组轴移试验阴性55例(94.8%),阳性3例(5.2%),髌韧带组阴性41例(82.0%),阳性9例(18.0%),差异具有统计学意义(P<0.05).术后腘绳肌腱组和髌韧带组IKDC评分为(90±5)分和(89±5)分,Lysholm评分为(94±5)分和(93±6)分,两组比较差异无统计学意义(P>0.05).结论 关节镜下单束重建前交叉韧带采用六股异体腘绳肌腱较髌韧带能够明显提高膝关节稳定性.%Objective To compare the outcome of arthroscopic single-bundle anterior cruciate ligament(ACL)reconstruction with six-strand hamstring tendon and patellar tendon allograft.Methods From October 2006 to December 2009,108 patients with arthroscopic single-bundle ACL reconstruction were retrospectively reviewed,with 58 patients with six-strand hamstring tendon(Group H),and 50 patients with patellar tendon allograft(Group P).Patients were available for clinical evaluation with KT-1000 arthrometer measurements,Lachman and pivot-shift test,and knee function with the Internationa]Knee Documentation Committee(IKDC),Lysholm scores.Results All the patients were followed up at an average of 28.6 months(range 12-38 months).The average side-to-side difference was lesser for group H(1.2 ± 1.2)mm than group P(1.8 ±1.5)mm(P<0

  18. Multiple risk factors related to familial predisposition to anterior cruciate ligament injury: fraternal twin sisters with anterior cruciate ligament ruptures.

    Science.gov (United States)

    Hewett, T E; Lynch, T R; Myer, G D; Ford, K R; Gwin, R C; Heidt, R S

    2010-09-01

    A multifactorial combination of predictors may increase anterior cruciate ligament (ACL) injury risk in athletes. The objective of this twin study was to examine these risk factors to identify commonalities in risk factors that predisposed female fraternal twins to ACL injury. Female twins in high-risk sports were prospectively measured prior to an injury for neuromuscular control using three-dimensional motion analysis during landing, hamstrings and quadriceps muscular strength on a dynamometer and joint laxity using a modified Beighton-Horan index and a Compu-KT arthrometer. Intraoperative measures of femoral intercondylar notch width were recorded during ACL reconstruction. Abduction angles were increased at one knee in both of the twin sister athletes relative to uninjured controls at initial contact and at maximum displacement during landing. The twin female athletes that went on to ACL injury also demonstrated decreased peak knee flexion motion at both knees than uninjured females during landing. The twin athletes also had increased joint laxity and decreased hamstrings to quadriceps (H/Q) torque ratios compared to controls. Femoral intercondylar notch widths were also below the control mean in the twin siblings. Prescreened mature female twins that subsequently experienced ACL injury demonstrated multiple potential risk factors including: increased knee abduction angles, decreased knee flexion angles, increased general joint laxity, decreased H/Q ratios and femoral intercondylar notch width.

  19. Management of septic arthritis following anterior cruciate ligament reconstruction: a review of current practices and recommendations.

    Science.gov (United States)

    Cadet, Edwin R; Makhni, Eric C; Mehran, Nima; Schulz, Brian M

    2013-11-01

    Septic arthritis following anterior cruciate ligament reconstruction is a rare and potentially devastating complication that often leads to articular destruction and adverse clinical outcomes. Because of its rare occurrence, best practices for diagnosis and management have yet to be established. However, graft retention and favorable outcomes are possible with early diagnosis, surgical intervention, and appropriate antibiotic management. Clinicians must be familiar with the diagnostic criteria and management options for septic arthritis. Most patients require multiple procedures to effectively eradicate infection. When the original reconstructed graft cannot be salvaged, a staged anterior cruciate ligament reconstruction revision is required.

  20. 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.

  1. Novel anterior cruciate ligament graft fixation device reduces slippage

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    Lopez MJ

    2013-05-01

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

  2. Biomechanical study on the suture strength of ligament in cruciate ligament reconstruction

    Institute of Scientific and Technical Information of China (English)

    张春礼; 李起鸿; 杨柳

    2003-01-01

    Objective: To test the suture strength on the tendon or ligament end and evaluate the stitch in the reconstruction of cruciate ligament and its clinical application. Methods: Twenty-four specimens of patellar tendon with free ends were divided into 3 groups: Group I (3 Krackow stitches), Group II (2 Krackow stitches) and Group III (2 Krackow stitches with the first stitch passing through the tendon tissue as a modified Krackow stitch). These 3 groups were further divided into 6 subgroups according to different suture materials, No 1 Ethilon or stainless steel wire (φ= 0.4 mm). Tensile test was undertaken to find out the least stitches with efficient suture pattern. Results: Two Krackow locking stitches had stronger strength than 0.4 mm-diameter stainless steel wire. The fixation strength of 2 stitches with No 1 Ethilon was more than 80 N, superior to the failure strength of the material itself. The same strength was maintained if the first stitch was across the tendon tissue transversely. There was no statistically significant difference in the suture strength between 2 and 3 Krackow locking stitches. Conclusions: The suture strength is greater than the failure strength of the suture material. Less suture exposure can be achieved when the first stitch is across the tendon tissue while maintaining a comparable strength to other sutures. To attain higher suture strength, stronger materials or multiple strands rather than more stitches are preferred. Therefore, a rapid early rehabilitation of range of motion (ROM) is possible and reliable in practice.

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

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    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

  4. Novel anterior cruciate ligament graft fixation device reduces slippage.

    Science.gov (United States)

    Lopez, Mandi J; Borne, Allen; Monroe, W Todd; Bommala, Prakash; Kelly, Laura; Zhang, Nan

    2013-01-01

    Clinically significant laxity occurs in 10%-30% of knees after anterior cruciate ligament reconstruction. Graft slippage and tension loss at the hamstring graft tibial fixation site during and after reconstruction surgery contribute to postoperative joint laxity and are detrimental to long-term knee stability and graft properties. Limiting graft slippage will reduce associated complications. We sought to compare the in vitro mechanical properties and in vivo joint stabilization, postoperative limb use, and graft incorporation of the novel GraftGrab™ (GG) device designed to reduce hamstring graft tibial fixation slippage with the commercially available bioabsorbable Bio-Post™ and spiked washer (BP). Mechanical testing was performed on canine tibia-hamstring graft constructs to quantify initial fixation properties. In vivo joint stabilization, postoperative limb use and graft incorporation of hamstring graft reconstructions were determined in a canine model. Outcomes included tibial translation and ground reaction forces preoperatively and 4 and 8 weeks postoperatively, three-dimensional graft and bone tunnel dimensions at the latter two time points, and graft-bone microstructure, as well as mechanical properties 8 weeks after implantation. Immediately after fixation, all grafts slipped from the BP constructs versus about 30% of GG constructs. In vivo limb use remained low, and tibial translation increased with time in the BP cohort. These results together confirm that initial graft slippage is lower with GG versus BP extracortical hamstring graft tibial fixation. In addition, postoperative recovery and joint stability are more consistent with the GG. This information supports the GG as an alternative to extracortical tibial hamstring graft fixation that has procedural advantages over current implants and reduces graft failure from slippage.

  5. Isokinetic profile of subjects with the ruptured anterior cruciated ligament

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    Drapšin Miodrag

    2016-01-01

    Full Text Available Background/Aim. All changes in the knee that appear after anterior cruciate ligament (ACL lesion lead to difficulties in walking, running, jumping especially during sudden changes of the line of movement. This significantly impairs quality of life of these subjects and leads to decrease in physical activity. Knee injuries make 5% of all most severe acute sport injuries. The aim of the study was to determine strength of the thigh muscles in persons with unilateral rupture of the ACL and to evaluate potential bilateral differences between healthy and injured leg. Methods. This study involved 114 male athletes of different sport specialities with the clinical diagnosis of ACL rupture. Each subject had unilateral ACL rupture and the other leg was actually the control for this research. An isokinetic device was used to evaluate the muscle strength of thigh muscles. Testing was performed for two testing speeds, 60º/s and 180º/s. Results. Data analysis showed a statistically significant difference (p < 0.01 between the ACL and the healthy leg in the following parameters: peak torque for thigh extensors (Ptrq_E, angle to peak torque during extension (Ang_E, power of extension (Pow_E and work during extension (Work_E. Analysing hamstrings to quadriceps (H/Q ratio we found the unilateral disbalance of thigh muscle strength in ACL leg. Conclusion. A high level of validity makes isokinetic dynamometry the method for evaluation of thigh muscles strength and leaves this field of research open for new studies in order to improve both diagnostic and rehabilitation of patients with the insufficient ACL.

  6. The effectiveness of Pilates for partial anterior cruciate ligament injury.

    Science.gov (United States)

    Çelik, Derya; Turkel, Nilgun

    2017-08-01

    This study explored the effects of Pilates on the muscle strength, function, and instability of patients with partial anterior cruciate ligament (ACL) injuries in situations in which a non-surgical treatment option is preferred. Fifty participants 20-45 years of age who were diagnosed with isolated ACL injuries were included in the study. The participants were randomly assigned to either the Pilates exercise group (n = 24) or the control group (n = 26). The subjects in the Pilates exercise group performed basic mat exercises that focused on the muscle strength and flexibility of the lower limbs and core muscles during each class session, which met three times per week for 12 weeks. The control group did not receive any treatment or home exercise programme. All patients were evaluated using the Lysholm Knee Scale, the Cincinnati Knee Rating System, and isokinetic quadriceps and hamstring strength. Patient satisfaction regarding improvement in knee stability was assessed using the Global Rating of Change scale. The Pilates group experienced significant improvement over the control group as measured by the difference in quadriceps strength at 12 weeks (p = 0.03). Both groups showed some clinical change over time, but the Pilates group improved for all outcome measurements at the 12-week follow-up, and the control group only improved for functional outcomes. Patient satisfaction with the level of knee stability based on the Global Rating of Change scale was higher in the Pilates group than in the control group. Although both groups exhibited improvements in knee strength and functional outcomes, the results suggest that Pilates is a superior management approach over a control treatment for increasing quadriceps strength in participants with partial ACL injury. Pilates may provide clinicians a novel option when choosing a treatment for a partial ACL injury. Further study is needed to determine whether certain subgroups of individuals might achieve an added

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

    Directory of Open Access Journals (Sweden)

    Demet Pepele

    2014-03-01

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

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

    Science.gov (United States)

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

    2016-03-01

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

  9. 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.

  10. Factors affecting proprioceptive recovery after anterior cruciate ligament reconstruction

    Institute of Scientific and Technical Information of China (English)

    ZHOU Mou-wang; GU Li; CHEN Ya-ping; YU Chang-long; AO Ying-fang; HUANG Hong-shi; YANG Yan-yan

    2008-01-01

    Background Proprioception plays an important role in knee movements.Since there are controversies surrounding the overall recovery time of proprioception following surgery,it is necessary to define the factors affecting proprioceptive recovery after anterior cruciate ligament (ACL) reconstruction and to investigate the relationship between proprioception and muscle strength.Methods A total of 36 patients who had their ACL reconstructed with a semitendinosus/gracilis graft (reconstructed group:6 months post-surgery) and 13 healthy adults without any knee injury (control group) were included in the study.Knee proprioception was evaluated with a passive reproduction test.Isokinetic strength was measured using the Biodex System.Statistical analysis was used to compare proprioception of the reconstructed group versus the control group,and to define causal factors,including sex,hamstring/quadriceps ratio,and the course of injury before reconstruction.We also investigated the correlation between the passive reproduction error and quadriceps index.Results There was a significant difference in proprioception between the reconstructed and control groups (P <0.05).When the course of injury before reconstruction was less than 4 months,there was a linear correlation with proprioception 6 months after the operation (r=0.713,P <0.05).There was a positive correlation between post-surgery proprioception and the quadriceps index at 6 months post-surgery.Conclusions Impaired knee proprioception is observed 6 months after ACL reconstruction.Within 4 months of injury,early undertaking of reconstruction is associated with better proprioception outcome.Patients with enhanced proprioception have a better quadriceps index.

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

    Science.gov (United States)

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

    2016-01-01

    AIM To systematically review the currently available literature concerning the application of biologic agents such as platelet-rich plasma (PRP) and stem cells to promote anterior cruciate ligament (ACL) healing. METHODS A systematic review of the literature was performed on the use of biologic agents (i.e., PRP or stem cells) to favor ACL healing during reconstruction or repair. The following inclusion criteria for relevant articles were used: Clinical reports of any level of evidence, written in English language, on the use of PRP or stem cells during ACL reconstruction/repair. Exclusion criteria were articles written in other languages, reviews, or studies analyzing other applications of PRP/stem cells in knee surgery not related to promoting ACL healing. RESULTS The database search identified 394 records that were screened. A total of 23 studies were included in the final analysis: In one paper stem cells were applied for ACL healing, in one paper there was a concomitant application of PRP and stem cells, whereas in the remaining 21 papers PRP was used. Based on the ACL injury pattern, two papers investigated biologic agents in ACL partial tears whereas 21 papers in ACL reconstruction. Looking at the quality of the available literature, 17 out of 21 studies dealing with ACL reconstruction were randomized controlled trials. Both studies on ACL repair were case series. CONCLUSION There is a paucity of clinical trials investigating the role of stem cells in promoting ACL healing both in case of partial and complete tears. The role of PRP is still controversial and the only advantage emerging from the literature is related to a better graft maturation over time, without documenting beneficial effects in terms of clinical outcome, bone-graft integration and prevention of bony tunnel enlargement. PMID:27672573

  12. Ultrasonographic test for complete anterior cruciate ligament injury

    Directory of Open Access Journals (Sweden)

    Piotr Grzelak

    2015-01-01

    Full Text Available Background: Although ultrasound (US has a wide range of applications in orthopedic diagnostics, sonographic evaluation of traumatic anterior cruciate ligament (ACL insufficiency is still inadequate. There is a growing need for diagnostic tests that allow for simple and reliable assessment of ACL instability. This investigation aims to evaluate feasibility of sonographic technique for diagnosing complete ACL insufficiency. Materials and Methods: Eighty three consecutive patients suspected of ACL injury were examined with sonographic, dynamic test of anterior instability. The translation of the intercondylar eminence against the patellar tendon was measured in the injured and opposite (injured knee. Subsequent magnetic resonance imaging was performed on all patients. Forty-seven of them underwent a further arthroscopy. Five patients have been examined for the 2 nd time to evaluate interclass and intraclass agreement and bias. Results: Complete ACL insufficiency has been confirmed in 37 patients. In those individuals, the total anterior knee translation and the difference between two joints (side-to-side difference were significantly increased (8.67 mm standard deviation [SD] 2.65 mm in the affected knee versus 2.88 mm SD 1.26 mm in uninjured joint; P < 0.001. Based on a threshold of 2.0 mm for the side-to-side difference and 5.0 mm for the absolute translation, the sonographic test was found to have a sensitivity and specificity of 91.9% and 95.6%, respectively. Conclusions: The present technique supports the clinician with additional fast and noninvasive diagnostic procedure that can facilitate the evaluation of anterior knee instability.

  13. Long-term outcome in dogs after surgical repair of cranial cruciate ligament disease

    OpenAIRE

    MölsÀ, Sari

    2014-01-01

    Cranial cruciate ligament (CCL) disease is one of the most common causes of lameness in dogs. Surgical treatment is recommended to stabilize the stifle joint, alleviate pain, and delay the progression of osteoarthritis (OA). A variety of surgical techniques has been introduced and can be broken down into the more traditional intracapsular ligament replacement and extracapsular suture techniques and the newer neutralizing dynamic osteotomy techniques. Although an enormous amount of literature ...

  14. Experimental evaluation of 3-dimensional kinematic behavior of the cruciate ligaments

    OpenAIRE

    2007-01-01

    PURPOSE: The purpose of this study was to evaluate a low-cost and easily reproducible technique for biomechanical studies in cadavers. In this kind of study, the natural effect of loading of the joint and shear forces are not taken into account. The objective is to describe the plastic deformation of the ligaments into 3-dimensional space. METHOD: For 18 intact human cadaver knees, the cruciate ligaments were divided into 3 fiber bundles, the tibial or femoral fixation points were marked, and...

  15. Clinical observation on reconstructing the anterior and posterior cruciate ligaments of knee joint with allograft-tendon by arthroscopy%关节镜下同种异体肌腱重建膝关节前后交叉韧带的临床观察

    Institute of Scientific and Technical Information of China (English)

    阳波; 谭雄进

    2014-01-01

    目的:比较关节镜下同种异体肌腱移植和自体肌腱移植重建膝关节前后交叉韧带的临床效果。方法将130例膝关节前后交叉韧带断裂的患者按手术方式的不同分为2组,观察组采用同种异体肌腱移植,对照组采用自体肌腱移植,观察患者临床疗效。结果观察组手术时间明显少于对照组(P0.05);2组患者术后Lysholm及Tengner评分均明显高于术前,2组差异有统计学意义(P0.05)。结论同种异体与自体肌腱重建ACL及PCL的疗效相近,是重建ACL及PCL良好的移植物。%Objective To compare the clinical effect of reconstructing the anterior and posterior cruciate ligaments of knee joint with al-lografttendon and autogenous tendon transplantation. Methods 130 patients with anterior and posterior cruciate ligaments of knee fractured were randomly divided into two groups:the observation group were given allogeneic tendon transplantation while the control group were autol-ogous tendon transplantation. Observed the clinical efficacy of the two groups. Results The operation time of the observation group was ob-viously less than control group(P0. 05);the Lysholm and Tengner score of the two groups were significantly higher compared with the preoperative scores with a statistically significant difference (P0. 05). Conclusion Allogeneic tendon transplantation has similar curative effect with autologous tendon transplantation, both of them are good transplantation material for anterior and posterior cruciate ligaments reconstruction.

  16. 关节镜下单束与双束同种异体腱重建前交叉韧带的临床观察%Clinical study of single bundle vs double-bundle reconstruction of anterior cruciate ligament with allograft tendons by arthroscopy

    Institute of Scientific and Technical Information of China (English)

    李兴中; 吴恙; 倪东亮; 童鑫; 马安军; 叶必谦; 付驰; 赵德伟; 王卫明

    2015-01-01

    Objective To compare the clinical effects of arthroscopic single tunnel double-bundle reconstruction anatomy system ( Intrafix system) vs Rigidfix plus Intrafix system on the treatment of anterior cruciate ligament (ACL) rupture.Methods From June 2011 to June 2013, 60 patients underwent ACL reconstruction with hamstring tendon allograft in Jinhua central hospital .According to the fixation method , the patients were divided into the Intrafix group ( 30 cases ) and the Rigidfix plus Intrafix group ( 30 cases).The range of motion (ROM) of the knee joint was compared before and after the knee surgery , as well as KT-1000 (flexion 70°30 lbs), anterior drawer test, Lachman test, Lysholm knee score and the symptoms of the involved knee .Results The Intrafix group were followed up for 12 to 36 months, 20.61 ± 8.20 months in average .The difference between the preoperative Lysholm knee score and the postoperative one was statistically significant (t=-29.2, P0.05).The difference of the postoperative Lysholm knee score between the Intrafix group and the Rigidfix plus Intrafix group was not statistically significant (t=0.538, P>0.05) .In the Intrafix group , Lachman test was positive in one patient , and in the Intrafix plus Rigidfix group, the anterior drawer test was positive in one patient .No extension deficit was observed .The ROM and KT-1000 measurement results were normal .Conclusion According to the short-term results, the single tunnel double-bundle reconstruction with Intrafix system and the anatomic single-bundle reconstruction with Rigidfix plus Intrafix are both reliable methods for the ACL reconstruction with allograft tendons.The long-term results need further follow-up.%目的:比较关节镜下运用Intrafix单隧道双束解剖重建系统和Rigidfix+Intrafix系统治疗前交叉韧带( ACL)断裂的临床疗效。方法2011年6月至2013年6月,我院使用同种异体腘绳肌腱重建ACL患者60例,根据固定方

  17. Combined Reconstruction of the Medial Collateral Ligament and Anterior Cruciate Ligament Using Ipsilateral Quadriceps Tendon-Bone and Bone-Patellar Tendon-Bone Autografts.

    Science.gov (United States)

    Hetsroni, Iftach; Mann, Gideon

    2016-06-01

    The exclusive autograft choice for medial collateral ligament (MCL) reconstruction that has been described until today is the semitendinosus tendon. However, this has some potential disadvantages in a knee with combined MCL-anterior cruciate ligament (ACL) injury, including weakening of the hamstring's anterior restraining action in an already ACL-injured knee and nonanatomic distal MCL graft insertion when leaving the semitendinosus insertion intact at the pes anserinus during reconstruction. Moreover, because some surgeons prefer to use the hamstring for autologous ACL reconstruction, the contralateral uninjured knee hamstring needs to be harvested as a graft source for the MCL reconstruction if autografts and not allografts are the surgeons' preference. We describe a technique for performing combined reconstruction of the MCL and ACL using ipsilateral quadriceps tendon-bone and bone-patellar tendon-bone autografts. This technique of MCL reconstruction spares the hamstring tendons and benefits from the advantage provided by bone-to-bone healing on the femur with distal and proximal MCL tibial fixation that closely reproduces the native MCL tibia insertion.

  18. Late quadriceps tendon rupture at the donor site following cruciate ligament reconstruction using central quadriceps tendon graft.

    Science.gov (United States)

    Pandey, Vivek; Madi, Sandesh; Joseph, Amy; Acharya, Kiran

    2015-10-16

    Central quadriceps tendon (CQT) graft has been successfully used as a viable autograft option in cruciate ligament reconstruction of the knee. The prime emphasis in the majority of the literature is given to surgical details of quadriceps graft harvesting and outcome of cruciate ligament reconstruction. There is less discussion about donor site morbidity in CQT graft, and it is less frequent as compared to that in bone patellar tendon bone graft. We report an extremely unusual case of late quadriceps tendon rupture at the donor site following anterior cruciate ligament reconstruction using CQT graft.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    BACKGROUND: The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown. METHODS: We conducted a randomized, controlled trial involving 121 young, active adults with acute ACL injury in which we compared two strategies: structured rehabilitation plus early ACL reconst...

  20. Canine stifle stability following cranial cruciate ligament transection and medial meniscal release

    DEFF Research Database (Denmark)

    Jensen, Tanja Vedel; Kristiansen, Signe Søndergaard; Jensen, Bente Rona;

    Introduction: The patellar tendon angle (PTA), describing the relationship of the patellar tendon to the tibial plateau, is biomechanically significant for canine stifle stability. The crossover point, at which the cranial cruciate ligament (CrCL) becomes the primary stifle stabilizer, has been p...

  1. Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction

    NARCIS (Netherlands)

    Gokeler, Alli; Welling, Wouter; Zaffagnini, Stefano; Seil, R. (Romain); Padua, Darin A.

    There is a lack of consensus regarding the appropriate criteria for releasing patients to return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). A test battery was developed to support decision-making. Twenty-eight patients (22 males and 6 females) with a mean age of 25.4 +/-

  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. Rye grass is associated with fewer non-contact anterior cruciate ligament injuries than bermuda grass

    OpenAIRE

    2005-01-01

    Objective: To assess the contribution of ground variables including grass type to the rate of anterior cruciate ligament (ACL) injury in the Australian Football League (AFL), specifically which factors are primarily responsible for previously observed warm season and early season biases for ACL injuries.

  4. Editorial Commentary: Anatomy of the Anterior Cruciate Ligament - Are We Up to Date?

    Science.gov (United States)

    Provencher, Matthew T

    2016-01-01

    This systematic review demonstrates that knee anterior cruciate ligament (ACL) anatomic landmarks continue to be better defined, but debate as to the precise location of the ACL femoral and tibial footprints persists. The ACL anatomy of an individual patient may ultimately be impossible to determine using generalized research data, but current research probably gets us pretty close.

  5. 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…

  6. Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: A systematic review

    NARCIS (Netherlands)

    M.S. Swain (Michael S.); N. Henschke (Nicholas); S.J. Kamper (Steven); A.S. Downie (Aron S.); B.W. Koes (Bart); C. Maher (Chris)

    2014-01-01

    textabstractBackground: Numerous clinical tests are used in the diagnosis of anterior cruciate ligament (ACL) injury but their accuracy is unclear. The purpose of this study is to evaluate the diagnostic accuracy of clinical tests for the diagnosis of ACL injury.Methods: Study Design: Systematic rev

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

    NARCIS (Netherlands)

    C.F. van Eck; B.P. Lesniak; V.M. Schreiber; F.H. Fu

    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 reco

  8. Early histologic, metabolic, and vascular assessment of anterior cruciate ligament autografts

    Energy Technology Data Exchange (ETDEWEB)

    Kleiner, J.B.; Amiel, D.; Harwood, F.L.; Akeson, W.H.

    1989-01-01

    A rabbit model for anterior cruciate ligament (ACL) reconstruction using autogenous patellar tendon was utilized to study the early events of autograft cellular dynamics. Biochemical, autoradiographic, histological, and vascular injection techniques demonstrated that the native autograft cell population rapidly necroses. This repopulation occurs without a vascular contribution; cells entering the autograft are reliant upon synovial fluid nutrition.

  9. Biomechanical analysis of posterior cruciate ligament retaining high-flexion total knee arthroplasty

    NARCIS (Netherlands)

    Zelle, J.; Zanden, van der A.C.; De Waal Malefijt, M.; Verdonschot, N.

    2009-01-01

    Background High-flexion knee replacements have been developed to accommodate a large range of flexion (>120°) after total knee arthroplasty. Both posterior cruciate ligament retaining and sacrificing high-flexion knee designs have been marketed. The main objective of this study was to evaluate the b

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  11. Guideline on anterior cruciate ligament injury A multidisciplinary review by the Dutch Orthopaedic Association

    NARCIS (Netherlands)

    Meuffels, D.E.; Poldervaart, M.T.; Diercks, R.L.; Fievez, A.W.F.M.; Patt, T.W.; van der Hart, C.P.; Hammacher, E.R.; van der Meer, F.; Goedhart, E.A.; Lenssen, A.F.; Muller-Ploeger, S.B.; Pols, M.A.; Saris, D.B.F.

    2012-01-01

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

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

    NARCIS (Netherlands)

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

    2001-01-01

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

  13. Retention versus sacrifice of the posterior cruciate ligament in total knee arthroplasty for treating osteoarthritis

    NARCIS (Netherlands)

    Verra, Wiebe C.; van den Boom, Lennard G. H.; Jacobs, Wilco; Clement, Darren J.; Wymenga, Ate A. B.; Nelissen, Rob G. H. H.

    2013-01-01

    Background The functional and clinical basis on which to choose whether or not to retain the posterior cruciate ligament during total knee arthroplasty surgery remained unclear after a Cochrane systematic review and meta-analysis in 2005, which contained eight clinical trials. Several new trials hav

  14. 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...

  15. Training for Women's Basketball: A Biomechanical Emphasis for Preventing Anterior Cruciate Ligament Injury.

    Science.gov (United States)

    Pettitt, Robert W.; Bryson, Erin R.

    2002-01-01

    Summarizes proposed variables linked with higher incidences of anterior cruciate ligament tears in females and the biomechanical aspects of the lower extremity during the performance of common basketball skills, focusing on gender differences in knee joint stability and neuromuscular control, biomechanical aspects of lower extremity skills in…

  16. Failed anterior cruciate ligament reconstruction: analysis of factors leading to instability after primary surgery

    Institute of Scientific and Technical Information of China (English)

    MA Yong; AO Ying-fang; YU Jia-kuo; DAI Ling-hui; SHAO Zhen-xing

    2013-01-01

    Background Revision anterior cruciate ligament (ACL) surgery can be expected to become more common as the number of primary reconstruction keeps increasing.This study aims to investigate the factors causing instability after primary ACL reconstruction,which may provide an essential scientific base to prevent surgical failure.Methods One hundred and ten revision ACL surgeries were performed at our institute between November 2001 and July 2012.There were 74 men and 36 women,and the mean age at the time of revision was 27.6 years (range 16-56 years).The factors leading to instability after primary ACL reconstruction were retrospectively reviewed.Results Fifty-one knees failed because of bone tunnel malposition,with too anterior femoral tunnels (20 knees),posterior wall blowout (1 knee),vertical femoral tunnels (7 knees),too posterior tibial tunnels (12 knees),and too anterior tibial tunnels (10 knees).There was another knee performed with open surgery,where the femoral tunnel was drilled through the medial condyle and the tibial tunnel was too anterior.Five knees were found with malposition of the fixation.One knee with allograft was suspected of rejection and a second surgery had been made to take out the graft.Three knees met recurrent instability after postoperative infection.The other factors included traumatic (48 knees) and unidentified (12 knees).Conclusion Technical errors were the main factors leading to instability after primary ACL reconstructions,while attention should also be paid to the risk factors of re-injury and failure of graft incorporation.

  17. 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...... reconstruction and to present reference values. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Between 2005 and 2008, 10 164 patients (mean age, 27 years; SD, 9.8; 42% females) with primary ACL reconstruction were registered in the Swedish national knee ligament register. There were 4438 (44...

  18. MRI appearance of the distal insertion of the anterior cruciate ligament of the knee: an additional criterion for ligament ruptures

    Energy Technology Data Exchange (ETDEWEB)

    Oldrini, G.; Teixeira, P.G.; Chanson, A.; Osemont, B.; Louis, M.; Blum, A. [CHU Nancy, Service d' imagerie Guilloz, Nancy (France); Erpelding, M.L. [CHU Nancy, Hopitaux de Brabois Allee du Morvan, Service Epidemiologie et Evaluation Cliniques, Vandoeuvre-les-Nancy (France)

    2012-09-15

    Anterior cruciate ligament tears are frequent and if not diagnosed may lead to relevant patient disability. Magnetic resonance imaging is the method of choice for the non-invasive diagnosis of these tears. Despite the high performance of this method some cases are challenging and the criteria described in the literature are not sufficient to reach a diagnosis. We propose a systematic method for the evaluation of anterior cruciate ligament tears based on the aspect of its distal portion. Magnetic resonance studies of 132 knees were evaluated in correlation with arthroscopy. The performance of the proposed method was compared with that of classic imaging signs of anterior cruciate ligament tear. The impact of image quality and reader expertise on the proposed method and the classic signs of tear were taken into account. This method had a sensitivity and specificity of 91.1% and 82.9% for the detection of abnormal ACLs. The interobserver agreement (kappa) of the proposed method was significantly higher than that of the classic signs at all levels of expertise (0.89 vs 0.76). This method was not influenced by image quality. Distal ACL analysis identified more partial tears and synovialization (granulation scar tissue) than the conventional method (71% vs 58.5% for partial tears and 83.5% vs 58.5% for synovialization). The proposed classification has a high performance and reproducibility for the identification of abnormal anterior cruciate ligament. The results were influenced neither by the level of expertise of the readers nor by the image quality. (orig.)

  19. Status and headway of the clinical application of artificial ligaments

    Directory of Open Access Journals (Sweden)

    Tianwu Chen

    2015-01-01

    Full Text Available The authors first reviewed the history of clinical application of artificial ligaments. Then, the status of clinical application of artificial ligaments was detailed. Some artificial ligaments possessed comparable efficacy to, and fewer postoperative complications than, allografts and autografts in ligament reconstruction, especially for the anterior cruciate ligament. At the end, the authors focused on the development of two types of artificial ligaments: polyethylene glycol terephthalate artificial ligaments and tissue-engineered ligaments. In conclusion, owing to the advancements in surgical techniques, materials processing, and weaving methods, clinical application of some artificial ligaments so far has demonstrated good outcomes and will become a trend in the future.

  20. 前交叉韧带移植物选择及重建中的相关问题%Selection and reconstruction of anterior cruciate ligament graft

    Institute of Scientific and Technical Information of China (English)

    李梁; 赵辉; 吴海山

    2011-01-01

    presently preferred for anterior cruciate ligament reconstruction.Quad riceps femoris tendon with or without bone, various allografts and artificial tendons are also gradually been used in the clinic.Meniscus injury, but not anterior cruciate ligament injury, is the most important risk factors for early osteoarthritis. For patients who undergo anterior cruciate ligament construction, proprioceptive sensibility recovery should be paid more attention during the process of therapy.

  1. Clinical thresholds for quadriceps assessment after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Kuenze, Christopher; Hertel, Jay; Saliba, Susan; Diduch, David R; Weltman, Arthur; Hart, Joseph M

    2015-02-01

    Normal, symmetrical quadriceps strength is a common clinical goal after anterior cruciate ligament reconstruction (ACLR). Currently, the clinical thresholds for acceptable unilateral quadriceps function and symmetry associated with positive outcomes after return to activity are unclear. To establish quadriceps-activation and knee-extension-torque cutoffs for clinical assessment after return to activity after ACLR. Descriptive laboratory study. Laboratory. 22 (10 female, 12 male; age = 22.5 ± 5.0 y, height = 172.9 ± 7.1 cm, mass = 74.1 ± 15.5 kg, months since surgery = 31.5 ± 23.5) recreationally active persons with a history of unilateral, primary ACLR at least 6 months prior and 24 (12 female/12 male, age = 21.7 ± 3.6 y, height = 168.0 ± 8.8 cm, mass = 69.3 ± 13.6 kg) recreationally active healthy participants. Patient-reported measures of pain, knee-related function, and physical activity level were recorded for all participants. Normalized knee-extension maximum-voluntary-isometric-contraction (MVIC) torque (Nm/kg) and quadriceps central-activation ratio (CAR, %) were measured bilaterally in all participants. Receiver-operator-characteristic (ROC) curves were used to establish thresholds for unilateral measures of normalized knee-extension MVIC torque and quadriceps CAR, as well as limb-symmetry indices (LSI). ROC curves then established clinical thresholds for normalized knee-extension MVIC torque and quadriceps CAR LSIs associated with healthy knee-related function. Involved-quadriceps CAR above 89.3% was the strongest unilateral indicator of healthy-group membership, while quadriceps CAR LSI above 0.996 and knee-extension MVIC torque above 0.940 were the strongest overall indicators. Unilateral normalized knee-extension MVIC torque above 3.00 Nm/kg and quadriceps CAR LSI above 0.992 were the best indicators of good patient-reported knee-related outcomes. Threshold values established in this study may provide a guide for clinicians when making return

  2. Arthrofibrosis after anterior cruciate ligament reconstruction in children and adolescents.

    Science.gov (United States)

    Nwachukwu, Benedict U; McFeely, Eric D; Nasreddine, Adam; Udall, John H; Finlayson, Craig; Shearer, David W; Micheli, Lyle J; Kocher, Mininder S

    2011-12-01

    Arthrofibrosis is a known complication after anterior cruciate ligament (ACL) reconstruction. ACL reconstruction is being performed with increased frequency in the pediatric population. The purpose of this study was to determine the prevalence of arthrofibrosis in children and adolescents and to identify risk factors for arthrofibrosis. The study design was a retrospective case series. Medical records for 1016 consecutive ACL reconstructions in patients aged 7 to 18 years old between 1995 to 2008 at a major tertiary care children's hospital were reviewed to identify cases of postoperative arthrofibrosis. Arthrofibrosis was defined as a loss of 5 degrees or more extension compared with the contralateral knee that required a follow-up procedure or a loss of 15 degrees or more flexion compared with the contralateral knee that required a follow-up procedure. Patient data were recorded and analyzed using bivariate models to identify predictors for arthrofibrosis. Further, we reviewed the clinical course of patients with treated arthrofibrosis to assess functional outcomes of this complication. Nine hundred two patients with 933 knees met the inclusion criteria for this study, of which 60% were female. The mean age at the time of surgery was 15 years (range, 7 to 18 y), and the average follow-up from original ACL reconstruction was 6.3 years (range, 1.6 to 14.2 y). The overall prevalence of arthrofibrosis in our cohort was 8.3%, with 77 of the 933 knees had at least 1 procedure to treat arthrofibrosis after ACL reconstruction. Risk factors for arthrofibrosis were female sex (11.1% females, P = 0.0001), patients aged 16 to 18 years [11.6%; odds ratio (OR) 3.51; P = 0 .007], patellar tendon autograft (OR, 1.7; P = 0.026), and concomitant meniscal repair (OR, 2.08; P = 0.007). Prior knee surgery and ACL reconstruction within 1 month of injury were not significantly associated with arthrofibrosis after ACL reconstruction. Fifty-three patients had a minimum of 6 months

  3. Anterior cruciate ligament deterioration correlates with patella osteoarthritis.

    Science.gov (United States)

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

    2014-04-01

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

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

    Science.gov (United States)

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

    2015-04-01

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

  5. Clinical and radiographic evaluation of a polyester prosthesis in dogs with cranial cruciate ligament rupture

    Directory of Open Access Journals (Sweden)

    Selmi André Luis

    2002-01-01

    Full Text Available Clinical and radiographic findings after intra-articular replacement of cranial cruciate ligament with a polyester prosthesis using a modified over-the-top technique were evaluated in six dogs. Seven surgeries were done due to bilateral involvement of the cranial cruciate ligament in one dog. Clinical evaluation was performed on postoperative days 3, 10 and 40, and radiographic evaluation was done at 5 and 24 months after surgery in five dogs, where signs of progressive degenerative joint disease were confirmed. Resolution of clinical signs was observed from 25 to 68 days after surgery as evaluated by dog owners. Overall function of joint movement after surgery was classified as good. Two dogs presented fraying of the implant after surgery. It was concluded that the polyester prosthesis, as implanted in these dogs, was not a satisfactory replacement for the injured ligament, as better results may be obtained with less invasive and simpler techniques.

  6. 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

  7. 前交叉韧带重建移植材料的研究与进展%Research progress of graft materials for anterior cruciate ligament reconstruction

    Institute of Scientific and Technical Information of China (English)

    赵晓亮; 章莹

    2011-01-01

    BACKGROUND: The effect of anterior cruciate ligament reconstruction is affected by many factors, including graft choice. OBJECTIVE: To retrospectively analyze the graft types, material properties, relevant experiments and clinical application in anterior cruciate ligament reconstruction.METHODS: The first author retrieved PubMed and Wanfang databases (1985/2009) for articles addressing graft materials for anterior cruciate ligament reconsiru cii on .such as auto logo us ligament, ligament a No graft, artificial ligaments, tissue engineered ligament, and heterogeneous ligaments.RESULTS AND CONCLUSION: Implants for repairing of anterior cruciate ligament injuries include autologous ligaments, ligament allograft, artificial ligaments, tissue engineered ligament. Furthermore, other materials such as xenografte are underlying testing and feasibility studies. Artificial materials and tissue engineered ligaments are the hotspots in recent years. However, the high-cost and complex process limit the clinical us e of these two kinds of implant. With the development of antigen-processrig technologies, it is impossible to efficiently eliminate the immunogenicrty of heterogeneous tendon/ligament and improve quality of bio compatibility. Xenografts with the good price and rich source are convenient to be obtained and suitable to widespread application in the future.%背景:膝关节前交叉韧带重建效果受多种因素影响,包括移植物的选择.目的:对用于前交叉韧带重建的移植材料的种类、材料性质、相关实验、临床应用等方面的研究进行回顾分析.方法:由第一作者检索1985/2009 PubMed数据及万方数据库有关前交叉韧带重建的移植材料如自体韧带、同种异体韧带、人工韧带、组织工程韧带、异种韧带等方面的文献.结果与结论:目前国内外修复前交叉韧带损伤可供选择的移植物有自体组织替代物、同种异体韧带、人工韧带、生物组织工程韧带等.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nadia F. El Ameen

    2014-09-01

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

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

    OpenAIRE

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

    2014-01-01

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

  11. 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

  12. Anatomical relationships between Wrisberg meniscofemoral and posterior cruciate ligament's femoral insertions

    Directory of Open Access Journals (Sweden)

    Heetor Campora de Sousa Oliveira

    2013-09-01

    Full Text Available OBJECTIVE: To evaluate the frequency and morphometry of the Wrisberg's ligament and its relationships with the posterior cruciate ligament's femoral insertion. STUDY DESIGN: Controlled laboratory study. METHODS: 24 unpaired knee pieces, 12 right and 12 left were submitted to a deep dissection of the Wrisberg and posterior cruciate ligaments. The pieces were photographed with a digital camera and ruler; the Image J software was used to measure the ligaments' insertion areas, in square millimeters. RESULTS: The Wrisberg ligament was present in 91.6% of the studied pieces. In those its shape was elliptical in 12 pieces (54.54%. In 68% of the knees, the WL insertion was proximal to the medial intercondilar ridge, close to the PCL posteromedial bundle. The average area for the WL was 20.46 ± 6.12 mm2. This number corresponded to 23.3% of the PCL's average area. CONCLUSIONS: WL ligament is a common structure in knees. There is a wide variation of its insertion area. Proportionally to the PCL's insertion area the WL ones suggests that it may contribute to the posterior stability of the knee joint.

  13. Knee model sensitivity to cruciate ligaments parameters: a stability simulation study for a living subject.

    Science.gov (United States)

    Bertozzi, Luigi; Stagni, Rita; Fantozzi, Silvia; Cappello, Angelo

    2007-01-01

    If the biomechanic function of the different anatomical sub-structures of the knee joint was needed in physiological conditions, the only possible way is a modelling approach. Subject-specific geometries and kinematic data, acquired from the same living subject, were the foundations of the 3D quasi-static knee model developed. Each cruciate ligament was modelled by means of 25 elastic springs, paying attention to the anatomical twisting of the fibres. The sensitivity of the model to the cross-sectional area was performed during the anterior/posterior tibial translations, the sensitivity to all the cruciate ligaments parameters was performed during the internal/external rotations. The model reproduced very well the mechanical behaviour reported in literature during anterior/posterior translations, in particular considering 30% of the mean insertional area. During the internal/external tibial rotations, similar behaviour of the axial torques was obtained in the three sensitivity analyses. The overlapping of the ligaments was assessed at about 25 degrees of internal axial rotation. The presented model featured a good level of accuracy in combination with a low computational weight, and it could provide an in vivo estimation of the role of the cruciate ligaments during the execution of daily living activities.

  14. 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.

  15. Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques.

    Science.gov (United States)

    Domnick, Christoph; Raschke, Michael J; Herbort, Mirco

    2016-02-18

    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.

  16. Editorial Commentary: Renaissance of Primary Anterior Cruciate Ligament Repair: Is History Repeating Itself?

    Science.gov (United States)

    Hohmann, Erik

    2016-12-01

    In a comparative Level III study, Achtnich et al. compared suture anchor repair of acute proximal anterior cruciate ligament avulsion tears with single-bundle anterior cruciate ligament reconstruction with the quadrupled semitendinosus tendon. Short-term follow-up at a mean of 28 months showed that the between-group differences were not different. These results are encouraging but not different from other published series 25+ years ago. Only time will tell whether the long-term outcomes are identical and whether these techniques will also die a slow death. Hopefully history is not repeating itself. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. Stifle synovial cyst in a Labrador Retriever with concurrent cranial cruciate ligament deficiency.

    Science.gov (United States)

    Franklin, A D; Havlicek, M; Krockenberger, M B

    2011-01-01

    A seven-year-old Labrador Retriever dog was presented with the complaint of chronic left hindlimb lameness. A diagnosis of partial rupture of the left cranial cruciate ligament with concurrent cranio-medial synovial cyst formation was made. This cystic structure was assumed to be communicating with the stifle joint. There was no evidence of a meniscal tear, but superficial fibrillation of the axial border was present. Surgical excision of the cyst with concurrent treatment of the cranial cruciate ligament deficiency by tibial tuberosity advancement was performed with a successful outcome. Whilst commonly encountered in humans, synovial cysts are uncommon in dogs. To the authors' knowledge this is the first reported case of synovial cyst formation in the stifle of a dog.

  18. Lesion of the anterior cruciate ligament and sagittal disalignment of the knee in weight-bearing

    Energy Technology Data Exchange (ETDEWEB)

    Egund, N.; Friden, T.

    Twenty-nine patients with late reconstructive surgery for anterior cruciate ligament lesions had a clinical and radiologic follow-up ten years after injury. Anterior sagittal displacement of the tibia was recorded on the routine standing radiographs in 16 knees all having a normal femoro-tibial alignment in the non-weight-bearing position. Five of eleven patients with sagittal displacement of between 10 and 19 mm had early osteoarthrosis, which was confirmed by magnetic resonance imaging in four cases; their ages ranged from 23 to 38 years. No radiographic signs of osteoarthrosis were observed in those with displacements of less than 10 mm. In some patients there was a discrepancy between the clinical and radiographic measurements of instability. In addition to the clinical tests of instability standing rather than non-weight-bearing lateral radiographs are suggested for the routine assessment of cruciate ligament injuries.

  19. The immediate intervention effects of robotic training in patients after anterior cruciate ligament reconstruction

    Science.gov (United States)

    Hu, Chunying; Huang, Qiuchen; Yu, Lili; Ye, Miao

    2016-01-01

    [Purpose] The purpose of this study was to examine the immediate effects of robot-assisted therapy on functional activity level after anterior cruciate ligament reconstruction. [Subjects and Methods] Participants included 10 patients (8 males and 2 females) following anterior cruciate ligament reconstruction. The subjects participated in robot-assisted therapy and treadmill exercise on different days. The Timed Up-and-Go test, Functional Reach Test, surface electromyography of the vastus lateralis and vastus medialis, and maximal extensor strength of isokinetic movement of the knee joint were evaluated in both groups before and after the experiment. [Results] The results for the Timed Up-and-Go Test and the 10-Meter Walk Test improved in the robot-assisted rehabilitation group. Surface electromyography of the vastus medialis muscle showed significant increases in maximum and average discharge after the intervention. [Conclusion] The results suggest that walking ability and muscle strength can be improved by robotic training. PMID:27512258

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1991-11-01

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

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

    Science.gov (United States)

    Culvenor, Adam G; Crossley, Kay M

    2016-04-01

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

  2. Anterior cruciate ligament femoral socket drilling with a retrograde reamer: lessons from the learning curve.

    Science.gov (United States)

    Ferraz, Victor; Westerberg, Paul; Brand, Jefferson C

    2013-01-01

    Whereas "anatomic" anterior cruciate ligament reconstruction may improve clinical results, the technique has introduced new technical challenges. The purpose of this technical note and video is to explore tips and tricks that improve femoral socket drilling with a retrograde reamer, bone-patellar tendon-bone graft passage, and interference screw fixation. The techniques for retrograde femoral socket drilling in an inside-out direction, bone-patellar tendon-bone graft passage, and interference screw fixation are described and demonstrated. Pitfalls, troubleshooting tips, and possible solutions are discussed. With the retrograde reamer, the femoral socket can be placed in the footprint of the anterior cruciate ligament with a longer and more vertical tunnel. By modifying the size of the patellar bone plug, graft passage is improved. With care and technique, interference screw fixation in the femoral socket over a guidewire is possible.

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

    Science.gov (United States)

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

    2010-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-04-15

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

  5. 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

  6. Septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee: retrospective case review.

    Science.gov (United States)

    Erice, Alejo; Neira, M Inmaculada; Vargas-Prada, Sergio; Chiaraviglio, Ana; Gutiérrez-Guisado, Javier; Rodríguez de Oya, Ricardo

    2017-06-23

    Rupture of cruciate ligaments of the knee is a common injury that is repaired by arthroscopic reconstruction, which can give rise to septic arthritis. The objective of this article is to describe the clinical and microbiological aspects of this entity. Retrospective review of cases of septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee that occurred at a single institution from 2000-2015. According to time elapsed from surgery, infections were classified as acute ( 14 days and 30 days). A descriptive and comparative analysis stratified by type of infection and causative microorganism was performed. 3,219 patients underwent arthroscopic reconstruction of cruciate ligaments of the knee and 30 (0.9%) developed septic arthritis. Seventeen (57%) were acute infections and 12 (40%) subacute; there was one late infection. The causative microorganisms were coagulase-negative Staphylococci (n=13; 43%), Staphylococcus aureus (n=12; 40%), other grampositive cocci (n=3; 10%), and gramnegative bacilli (n=2; 7%). All patients underwent arthroscopic debridement; no grafts were removed. All patients received antibiotic therapy for a median of 23.5 days (range: 14 - 78 days); all infections were cured. No significant differences were found in any of the variables analysed among the infection type or the causative microorganism. Septic arthritis after arthroscopic reconstruction of cruciate ligaments of the knee is uncommon. It generally presents within 4 weeks of surgery and is caused by Staphylococci. Its treatment consists of arthroscopic debridement (without necessarily removing the graft) and antibiotic therapy. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

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

    Science.gov (United States)

    Laible, Catherine; Sherman, Orrin H

    2014-01-01

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

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

    OpenAIRE

    Adams, Douglas; Logerstedt, David; Hunter-Giordano, Airelle; Axe, Michael J.; Snyder-Mackler, Lynn

    2012-01-01

    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 techn...

  9. Role of Physiotherapy in Preventing Failure of Primary Anterior Cruciate Ligament Reconstruction

    OpenAIRE

    Yu, Pak-him Vincent; Wun, Yiu-Chung; Yung, Shu-Hang Patrick

    2017-01-01

    Background/Purpose: Anterior cruciate ligament (ACL) reconstruction is routinely performed in sports medicine. We aimed to determine if there is any protective effect of postoperative physiotherapy in preventing graft rupture after primary ACL reconstruction (ACLR). Methods: A retrospective case–control study was carried out, with demographic data, concomitant meniscal injury, and intraoperative fixation methods matched. The number of sessions of physiotherapy attended by the rupture group...

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

    OpenAIRE

    2014-01-01

    The isolated bilateral agenesis of both cruciate ligaments is a rare congenital disorder. A 17-year-old male came to our attention due to an alteration in gait pattern, pain, and tendency to walk on the forefoot with his knee flexed. The patient did not recall previous injuries. Upon physical examination anterior and posterior chronic instability were observed. Radiographic examination of both knees showed hypoplasia of the tibial eminence, a hypoplastic lateral femoral condyle, and a narrow ...

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

    Directory of Open Access Journals (Sweden)

    Fabio J. Angelini

    2010-01-01

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

  12. Differential Effects of Two Rehabilitation Programs Following Anterior Cruciate Ligament Reconstruction

    DEFF Research Database (Denmark)

    Setuain, Igor; Izquierdo, Mikel; Idoate, Fernando

    2017-01-01

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

  13. Poor Static Balance is a Novel Risk Factor for Non-contact Anterior Cruciate Ligament Injury

    OpenAIRE

    2015-01-01

    Objectives: The anterior cruciate ligament (ACL) injury is common and affects young individuals, particularly female, who are active in sports that involve jumping, pivoting, as well as change of direction. ACL injury is associated with potential long-term complications including reduction in activity levels and osteoarthritis. In recent years, the focus on the ACL injury prevention has increased and many studies exploring risk factors for ACL injury have been published. However, the influenc...

  14. Prehabilitation: The Void in the Management of Anterior Cruciate Ligament Injuries—A Clinical Review

    OpenAIRE

    S. R. Shaarani; Moyna, N.; Moran, R.; J. M. O'Byrne

    2012-01-01

    The rehabilitation of patients undergoing anterior cruciate ligament (ACL) reconstruction requires symmetry in bilateral quadriceps strength and adequate proprioception capabilities prior to return to preoperative level of activity or sport. This is the limiting factor and can delay the time that patients can return to play. There is little literature on pre-operative physiotherapy or prehabilitation of patient with ACL injury. This paper discusses the anatomy, biomechanics, surgical decision...

  15. Anterior Cruciate Ligament Femoral Socket Drilling With a Retrograde Reamer: Lessons From the Learning Curve

    OpenAIRE

    2013-01-01

    Whereas “anatomic” anterior cruciate ligament reconstruction may improve clinical results, the technique has introduced new technical challenges. The purpose of this technical note and video is to explore tips and tricks that improve femoral socket drilling with a retrograde reamer, bone–patellar tendon–bone graft passage, and interference screw fixation. The techniques for retrograde femoral socket drilling in an inside-out direction, bone–patellar tendon–bone graft passage, and interference...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-02-15

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

  17. Dual-energy computed tomography of cruciate ligament injuries in acute knee trauma

    Energy Technology Data Exchange (ETDEWEB)

    Peltola, Erno K. [Helsinki University Hospital, Toeoeloe Trauma Center, Department of Radiology, Helsinki Medical Imaging Center, Helsinki (Finland); Koskinen, Seppo K. [Karolinska Universitetssjukhuset, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden)

    2015-09-15

    To examine dual-energy computed tomography (DECT) in evaluating cruciate ligament injuries. More specifically, the purpose was to assess the optimal keV level in DECT gemstone spectral imaging (GSI) images and to examine the usefulness of collagen-specific color mapping and dual-energy bone removal in the evaluation of cruciate ligaments and the popliteus tendon. At a level 1 trauma center, a 29-month period of emergency department DECT examinations for acute knee trauma was reviewed by two radiologists for presence of cruciate ligament injuries, visualization of the popliteus tendon and the optimal keV level in GSI images. Three different evaluating protocols (GSI, bone removal and collagen-specific color mapping) were rated. Subsequent MRI served as a reference standard for intraarticular injuries. A total of 18 patients who had an acute knee trauma, DECT and MRI were found. On MRI, six patients had an ACL rupture. DECT's sensitivity and specificity to detect ACL rupture were 79 % and 100 %, respectively. The DECT vs. MRI intra- and interobserver proportions of agreement for ACL rupture were excellent or good (kappa values 0.72-0.87). Only one patient had a PCL rupture. In GSI images, the optimal keV level was 63 keV. GSI of 40-140 keV was considered to be the best evaluation protocol in the majority of cases. DECT is a usable method to evaluate ACL in acute knee trauma patients with rather good sensitivity and high specificity. GSI is generally a better evaluation protocol than bone removal or collagen-specific color mapping in the evaluation of cruciate ligaments and popliteus tendon. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-10-15

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

  19. Tibial rotation in anterior cruciate ligament reconstructed knees during single limb hop and drop landings.

    Science.gov (United States)

    Webster, Kate E; Feller, Julian A

    2012-06-01

    Alterations in knee joint kinematics have been suggested as a potential mechanism that influences the development of osteoarthritis of the knee after anterior cruciate ligament reconstruction. Whilst previous work has shown changes in internal-external tibial rotation during level walking, many patients aim to return to high impact activities following surgery. This study examined tibial rotation during single limb hop and drop landings in anterior cruciate ligament reconstructed knees compared to a control group, and also evaluated the influence of graft type (hamstring or patellar tendon). In 48 participants (17 patellar tendon graft, 18 hamstring graft and 13 controls) internal-external rotation was measured during single limb hop and drop landings in a gait laboratory at mean of 10 months after surgery. There was no difference between the two graft types and both patient groups had less internal rotation when compared to the control group. For 60% of patients, internal rotation values were at least 5° less than the control group mean. Anterior cruciate ligament reconstructed knees with both hamstring tendon and patellar tendon grafts show altered rotational kinematic patterns during high impact dynamic load activities. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Comparison of knee laxity and isokinetic muscle strength in patients with a posterior cruciate ligament injury.

    Science.gov (United States)

    Jeon, Kyoungkyu

    2016-03-01

    [Purpose] The aim of this study was to compare knee laxity and isokinetic muscle strength in patients with an isolated posterior cruciate ligament injury. [Subjects and Methods] Twenty high school rugby players with a previous posterior cruciate ligament injury and abnormal findings higher than surgical grade I were included. Laxity with 132 N of pressure was measured using Kneelax 3 to assess the stability of the posterior cruciate ligament, and flexor and extensor torques were measured at 60°/sec, 180°/sec, and 240°/sec to measure the isokinetic muscle strength of the knee joint. The average and standard deviation values were extracted from all data to assess the measured data. [Results] Regarding the ipsilateral and contralateral laxity, the deviation value at the peak force and maximum manual drawer was statistically significant. The peak torque and peak torque per body weight in isokinetic measurements were significantly different only for knee extensor torque at 60°/sec, 180°/sec, and 240°/sec. [Conclusion] Return to normal activities post injury is important. Thus base data gathered by comparing patients' ipsilateral and contralateral sides will serve as essential criteria for structuring future rehabilitation programs to facilitate functional improvements.

  1. Comparison of knee laxity and isokinetic muscle strength in patients with a posterior cruciate ligament injury

    Science.gov (United States)

    Jeon, Kyoungkyu

    2016-01-01

    [Purpose] The aim of this study was to compare knee laxity and isokinetic muscle strength in patients with an isolated posterior cruciate ligament injury. [Subjects and Methods] Twenty high school rugby players with a previous posterior cruciate ligament injury and abnormal findings higher than surgical grade I were included. Laxity with 132 N of pressure was measured using Kneelax 3 to assess the stability of the posterior cruciate ligament, and flexor and extensor torques were measured at 60°/sec, 180°/sec, and 240°/sec to measure the isokinetic muscle strength of the knee joint. The average and standard deviation values were extracted from all data to assess the measured data. [Results] Regarding the ipsilateral and contralateral laxity, the deviation value at the peak force and maximum manual drawer was statistically significant. The peak torque and peak torque per body weight in isokinetic measurements were significantly different only for knee extensor torque at 60°/sec, 180°/sec, and 240°/sec. [Conclusion] Return to normal activities post injury is important. Thus base data gathered by comparing patients’ ipsilateral and contralateral sides will serve as essential criteria for structuring future rehabilitation programs to facilitate functional improvements. PMID:27134367

  2. Knee shape might predict clinical outcome after an anterior cruciate ligament rupture.

    Science.gov (United States)

    Eggerding, V; van Kuijk, K S R; van Meer, B L; Bierma-Zeinstra, S M A; van Arkel, E R A; Reijman, M; Waarsing, J H; Meuffels, D E

    2014-06-01

    We have investigated whether shape of the knee can predict the clinical outcome of patients after an anterior cruciate ligament rupture. We used statistical shape modelling to measure the shape of the knee joint of 182 prospectively followed patients on lateral and Rosenberg view radiographs of the knee after a rupture of the anterior cruciate ligament. Subsequently, we associated knee shape with the International Knee Documentation Committee subjective score at two years follow-up. The mean age of patients was 31 years (21 to 51), the majority were male (n = 121) and treated operatively (n = 135). We found two modes (shape variations) that were significantly associated with the subjective score at two years: one for the operatively treated group (p = 0.002) and one for the non-operatively treated group (p = 0.003). Operatively treated patients who had higher subjective scores had a smaller intercondylar notch and a smaller width of the intercondylar eminence. Non-operatively treated patients who scored higher on the subjective score had a more pyramidal intercondylar notch as opposed to one that was more dome-shaped. We conclude that the shape of the femoral notch and the intercondylar eminence is predictive of clinical outcome two years after a rupture of the anterior cruciate ligament.

  3. 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.

  4. Autograft versus non-irradiated allograft for anterior cruciate ligament reconstruction:a meta-analysis%自体与非放射线处理同种异体肌腱重建前交叉韧带的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    王伊伦; 谢东兴; 李辉; 杨拓; 邓桢翰; 杨烨; 张屹; 丁翔; 雷光华

    2014-01-01

    背景:当今,前交叉韧带重建是修复膝关节前交叉韧带损伤的常用方法,但就重建移植物的选择问题尚存在不少争议。  目的:比较自体与非放射线处理的同种异体肌腱移植重建前交叉韧带临床疗效的差异。  方法:计算机检索 PubMed/Medline 数据库以及手工检索国内外公开发表的有关自体与非放射线处理的同种异体肌腱移植重建前交叉韧带的随机对照试验,所有文献检索截止至2014年7月12日。应用RevMan5.2软件进行数据统计分析,输入数据时采取双人核对以确保准确无误。  结果与结论:共纳入6项随机对照试验,累计858例受试对象,其中自体肌腱组441例,非放射线处理的同种异体肌腱组417例。荟萃分析结果显示,自体与非放射性处理的同种异体肌腱移植重建前交叉韧带的总IKDC评分[相对危险度=1.02,95%置信区间(0.99-1.06),P=0.21];松弛度[均数差=-0.13,95%置信区间(-0.29至-0.02),P=0.09];Lachman试验[相对危险度=1.04,95%置信区间(0.95-1.13),P=0.37];pivot shift试验[相对危险度=1.00,95%置信区间(0.95-1.05),P=0.96];one-leg hop试验[相对危险度=1.01,95%置信区间(0.96-1.06),P=0.77];Lysholm评分[均数差=-0.64,95%置信区间(-1.45-0.17),P=0.12];Tegner评分[均数差=0.16,95%置信区间(-0.16-0.47), P=0.34]以及并发症发生率[相对危险度=1.42,95%置信区间(0.67-3.04),P=0.36]的差异无显著性意义。以上结果表明,自体与非放射线处理的同种异体肌腱移植重建前交叉韧带的临床疗效并无明显差异,但鉴于此研究存在一定局限性,此结论有待更多更高质量的随机对照试验进一步证实。%BACKGROUND:Reconstruction of the anterior cruciate ligament has become the gold-standard treatment for an anterior cruciate ligament rupture. Despite the popularity of the procedure, there remains a considerable

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

    Directory of Open Access Journals (Sweden)

    Tiago Lazzaretti Fernandes

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

  6. Changes in dynamic medial tibiofemoral contact mechanics and kinematics after injury of the anterior cruciate ligament: a cadaveric model.

    Science.gov (United States)

    Bedi, Asheesh; Chen, Tony; Santner, Thomas J; El-Amin, Saadiq; Kelly, Natalie H; Warren, Russell F; Maher, Suzanne A

    2013-09-01

    The effects of tears of the anterior cruciate ligament on knee kinematics and contact mechanics during dynamic everyday activities, such as gait, remains unclear. The objective of this study was to characterize anterior cruciate ligament-deficient knee contact mechanics and kinematics during simulated gait. Nine human cadaveric knees were each augmented with a sensor capable of measuring dynamic normal contact stresses on the tibial plateau, mounted on a load-controlled simulator, and subjected to physiological, multidirectional, dynamic loads to mimic gait. Using a mixed model with random knee identifiers, confidence intervals were constructed for contact stress before and after anterior cruciate ligament transection at two points in the gait cycle at which axial force peaked (14% and 45% of the gait cycle). Kinematic and contact mechanics changes after anterior cruciate ligament transection were highly variable across knees. Nonetheless, a statistically significant increase in contact stress in the posterior-central aspect of the medial tibial plateau at 45% of the gait cycle was identified, the location of which corresponds to the location of degenerative changes that are frequently found in patients with chronic anterior cruciate ligament injury. The variability in the contact stress in other regions of the medial plateau at 45% of the gait cycle was partly explained by the variations in osseous geometry across the nine knees tested. At 14% of gait, there was no significant change in peak contact stress after anterior cruciate ligament transection in any of the four quadrants, and none of the possible explanatory variables showed statistical significance. Understanding the variable effect of anterior cruciate ligament injury on contact mechanics based on geometric differences in osseous anatomy is of paramount clinical importance and may be invaluable to select the best reconstruction techniques and counsel patients on their individual risk of subsequent

  7. 兔异体冻干跟腱移植重建前交叉韧带后胶原表型的变化%Expression oftypeⅠand Ⅲ collagens in allograft freeze-dried achilles after anterior cruciate ligament reconstruction in rabbits

    Institute of Scientific and Technical Information of China (English)

    于绍斌; 董启榕; 左中男

    2010-01-01

    目的 观察兔异体冻干跟腱重建前交叉韧带(ACL)后移植物Ⅰ型及Ⅲ型胶原的表达.方法 应用兔异体冻干跟腱重建ACL,手术后3、12、26、52周取移植物,行组织学观察,并应用免疫荧光共聚焦技术(CLSM)检测移植物Ⅰ型及Ⅲ型胶原表达的平均荧光值.结果 术后52周,异体移植物组织形态与正常ACL基本一致;正常ACL细胞周围主要表达I型胶原(57.10±5.04),几乎不表达Ⅲ型胶原(6.09±1.34);术后3周,移植物Ⅲ型胶原阳性表达开始增加,12~26周达到高峰,移植后52周仍有Ⅲ型胶原阳性表达(13.17±2.26),与ACL比较差异有统计学意义(P<0.05);术后3周,移植物Ⅰ型阳性表达开始减少,12周后逐渐增加,52周Ⅰ型胶原阳性表达(52.69±2.76)仍与正常ACL比较差异有统计学意义(P<0.01).结论 异体跟腱重建ACL后,重建后移植物组织形态与正常ACL基本一致,但移植物胶原基质组成与正常ACL存在明显差异.%Objective To observe the morphological changes and the expression of Type Ⅰ and Ⅲcolbert in allograft freeze-dried achilles after anterior crueiate ligament(ACL)reconstruction(ACL)in rabbits.Methods The ACLs of rabbits were removed and reconstructed bv allograft freeze-dried achilles.The grafts were removed respectively at the 3rd.12th.26th and 52nd week after surgery.All specimens were stained by hematoxylin and eosin(HE).The confocal laser scanning microscopy(CIJsM)was used to detect the expression of type Ⅰ and Ⅲ collagen.Results Allograft freeze-dried achilles appeared nearly resemble as normalACL at 52weeks after surgeryunderHE stained.As the grafts were observed under confocal laser scanning microscopy,In normal ACL mainly expressed type Ⅰ collagen(57.10±5.04),the expression of typeⅢcollagen(6.09±1.34)nearly none.While in angraft freeze-dried achilies after 52 weeks,there were more expressions of type Ⅲ collagen(13.17±2.26).Moreover,the expressions of type Ⅲ collagen were

  8. Bilateral simultaneous anterior cruciate ligament injury: a case report and national survey of orthopedic surgeon management preference

    Directory of Open Access Journals (Sweden)

    Ehsan Saadat

    2014-12-01

    Full Text Available Unilateral anterior cruciate ligament (ACL tear is a common injury seen by sports medicine orthopedic surgeons. However, a bilateral simultaneous ACL injury is extremely rare and has been reported only three times in the literature. We present a young female skier with simultaneous bilateral ACL tears that were managed with staged ACL reconstruction. We then conducted a nationwide survey (United States to determine the prevalence of simultaneous bilateral ACL tear and preferred management strategies by sports medicine orthopedic surgeons. Sports medicine fellowship directors were contacted and asked to send an 8-item survey to colleagues (sports medicine fellowship trained surgeons asking about overall number of ACL reconstructions performed, number of bilateral simultaneous ACL injuries seen and optimal management strategies of such an injury. Out of 43 responses, only 22 (51.2% surgeons had seen a bilateral simultaneous ACL injury. Of these, 16 (76.2% preferred staged reconstruction. Graft choice was mixed between autograft and allograft, but a large majority preferred either patellar tendon autograft (58% or hamstring autograft (41% were the most common choice. Staged reconstruction is the treatment of choice by surgeons surveyed in our study.

  9. Septic arthritis of the knee following anterior cruciate ligament reconstruction: results of a survey of sports medicine fellowship directors.

    Science.gov (United States)

    Matava, M J; Evans, T A; Wright, R W; Shively, R A

    1998-10-01

    To determine the incidence of joint sepsis following anterior cruciate ligament (ACL) reconstruction and the prevailing attitudes toward its treatment, we surveyed the directors of Sports Medicine Fellowship programs about their practices in treating and preventing this complication. Of the 74 surgeons surveyed, 61 (82%) responded. These 61 surgeons performed an average of 98 ACL reconstructions yearly; 31 (51 %) routinely used a drain after ACL surgery, 18 (30%) had treated an ACL infection within the past 2 years, and 26 (43%) had treated an infection within the past 5 years. There was no significant difference in the number of infections and the surgeons' case load, graft choice, or method of reconstruction. Fifty-two surgeons (85%) selected culture-specific intravenous (IV) antibiotics and surgical irrigation of the joint with graft retention as initial treatment for the infected patellar tendon autograft, and 39 (64%) chose this regimen to treat the infected allograft. For the resistant infection unresponsive to initial treatment, IV antibiotics with surgical irrigation and graft retention were also selected as the most common treatment combination for 25 (39%) of the 61 respondents. After graft removal, the earliest a revision procedure would be considered was 6 to 9 months. The results of this survey confirm the widely held belief that septic arthritis of the knee is a relatively rare complication following ACL reconstruction. Once an infection is encountered, culture-specific IV antibiotics and surgical joint irrigation with graft retention are recommended as initial treatment. Graft excision and hardware removal is considered only for those infections resistant to initial treatment and for the infected allograft.

  10. Assessment of anterior cruciate ligament reconstruction using 3D ultrashort echo-time MR imaging.

    Science.gov (United States)

    Rahmer, Jürgen; Börnert, Peter; Dries, Sebastian P M

    2009-02-01

    This work demonstrates the potential of ultrashort TE (UTE) imaging for visualizing graft material and fixation elements after surgical repair of soft tissue trauma such as ligament or meniscal injury. Three asymptomatic patients with anterior cruciate ligament (ACL) reconstruction using different graft fixation methods were imaged at 1.5T using a 3D UTE sequence. Conventional multislice turbo spin-echo (TSE) measurements were performed for comparison. 3D UTE imaging yields high signal from tendon graft material at isotropic spatial resolution, thus facilitating direct positive contrast graft visualization. Furthermore, metal and biopolymer graft fixation elements are clearly depicted due to the high contrast between the signal-void implants and the graft material. Thus, the ability of UTE MRI to visualize short-T(2) tissues such as tendons, ligaments, or tendon grafts can provide additional information about the status of the graft and its fixation in the situation after cruciate ligament repair. UTE MRI can therefore potentially support diagnosis when problems occur or persist after surgical procedures involving short-T(2) tissues and implants.

  11. How Anterior Cruciate Ligament Injury was averted during Knee Collapse in a NBA Point Guard.

    Science.gov (United States)

    Schilaty, Nathan D; Bates, Nathaniel A; Krych, Aaron J; Hewett, Timothy E

    2017-01-01

    Non-contact anterior cruciate ligament (ACL) injuries occur with rapid decelerations and pivoting. A recent injury to a high-level National Basketball Association (NBA) player demonstrated neuromuscular control and injury-sparing mechanisms that resulted in only minor ligament injury to the medial collateral ligament. We analyzed biomechanical mechanisms via publically available orthogonal 2-D video to demonstrate how this potential ACL injury was averted. Analysis of the knee injury mechanism demonstrated that the NBA player experienced low ground reaction force, high sagittal plane flexion, and maintenance of frontal plane stability with neuromuscular control. The outcome of these factors inhibited dynamic valgus collapse of the knee throughout the fall, avoiding ACL injury - a potentially career-altering injury. Many athletes, professional and recreational, will be subjected to similar mechanisms of injury and will have improved outcomes if they can successfully utilize preventive strategies of neuromuscular control to limit injury mechanisms.

  12. Ten year follow-up study comparing conservative versus operative treatment of anterior cruciate ligament ruptures. A matched-pair analysis of high level athletes

    NARCIS (Netherlands)

    D.E. Meuffels (Duncan); M.M. Favejee (Marein); M.M. Vissers (Maaike); M.P. Heijboer (Rien); M. Reijman (Max); J.A.N. Verhaar (Jan)

    2009-01-01

    textabstractOBJECTIVE: To compare long term outcome of highly active patients with anterior cruciate ligament ruptures treated operatively versus non-operatively. DESIGN: We reviewed high level athletes with an anterior cruciate ligament rupture on either MRI or arthroscopic evaluation more than 10

  13. 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 C; de Alcantara Sousa, Luiz V; de Melo Lucena, Diego M; dos Santos Figueiredo, Francisco W; Valenti, Vitor E; da Silva Paiva, Laércio; de Abreu, Luiz C; 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...

  14. Comparative study of double-bundle anterior cruciate ligament reconstruction with hamstring tendon autografts versus semitendinosus allografts%自体腘绳肌腱和同种异体半腱肌腱双束重建前十字韧带的比较研究

    Institute of Scientific and Technical Information of China (English)

    刘彩龙; 赵金忠; 陈雷; 皇甫小桥

    2010-01-01

    目的 对比自体腘绳肌腱和同种异体半腱肌腱双束重建前十字韧带的初期临床疗效.方法 2006年2月至8月,对单纯前十字韧带完全断裂患者分别采用自体腘绳肌腱(简称自体组,38例)和同种异体半腱肌腱(简称异体组,23例)行前十字韧带双束重建手术.客观指标包括:双侧膝关节前向松弛度差异、Lachman试验、轴移试验和双下肢周径差别;应用Tegner评分表、Lysholm评分表和IKDC评分表进行膝关节功能的主观评估.结果 自体组平均随访27个月,异体组平均随访26个月.末次随访时Lachman试验:自体组35例阴性,3例Ⅰ度阳性;异体组20例阴性,2例Ⅰ度阳性,1例Ⅲ度阳性.两组各有1例轴移试验阳性.双侧膝关节前向松弛度差异:自体组34例差异范围0~2 mm,4例3~5mm;异体组20例0~2mm,2例3~5 mm,1例>10 mm.双下肢周径差别:自体组(0.62±0.43)cm,异体组(0.57±0.42)cm.Tegner评分:自体组(6.21±0.84)分,异体组为(6.17±1.15)分.Lysholm评分:自体组(95.00±4.40)分.异体组(94.57±8.83)分.IKDC评分:自体组(90.26±2.92)分,异体组(89.48±7.27)分.结论 应用自体腘绳肌腱和同种异体半腱肌腱双束重建前十字韧带均能取得优良的初期临床结果.%Objective To compare the primary clinical results of double-bundle anterior crueiate ligament reconstruction (ACLR) with hamstring tendon autografts versus semitendinosus allografts. Methods From February to August of 2006,61 patients with isolated ACL rupture were treated with hamstring tendon autografts (38 patients) and with semitendinosus allografts (23 patients). To all the patients" objective clinical examinations, including stability of the knee, Lachman test, Pivot Shift Test and leg circumference were taken. International Knee Documentation Committee (IKDC) scores, Tegner scores and Lysholm scores were used to evaluate the clinical results. At 2 years follow-up, MR imaging of the operated knee were taken to evaluate

  15. INITIAL THERAPEUTIC EVALUATION OF ARTHROSCOPIC RECONSTRUCTION OF ANTERIOR AND POSTERIOR CRUCIATE LIGAMENT INJURY WITH ANTERIOR TIBIALIS TENDON ALLOGRAFT%关节镜下同种异体胫前肌肌腱重建膝关节前后交叉韧带损伤的疗效观察

    Institute of Scientific and Technical Information of China (English)

    王洪; 孟春庆; 段德宇; 杨述华; 叶树南; 邵增务

    2009-01-01

    目的 探讨关节镜下同种异体胫前肌肌腱移植重建前交叉韧带(anterior erueiate ligament,ACL)和后交叉韧带(posterior cruciate ligament,PCL)的手术方法及疗效.方法 2005年2月-2006年7月,收治10例ACL及PCL同时断裂患者.男7例,女3例;年龄18~45岁,平均30.2岁.左膝6例,右膝4例.均有明确外伤史.病程1~3周,平均1.8周.关节镜下取26~28 cm同种异体胫前肌肌腱重建ACL及PCL.术后伸膝位支具制动4周,4周后开始0~900主动屈膝功能锻炼,6周后主动屈膝>90°.结果 手术均顺利完成,术中未发生血管、神经损伤.手术时间90~110min,平均100 min.切口均Ⅰ期愈合,无早期并发症发生.10例均获随访,随访时间12~15个月,平均13.5个月.行走步态正常,关节活动度为0~135°.10例膝关节前抽屉试验及内外侧应力试验均为阴性;后抽屉试验8例阴性,2例分级Ⅰ度.2例术后4 d出现膝关节积液,经抽液和注射透明质酸钠后消失.Lysholm膝关节功能评分由术前(24.89 ± 5.39)分升至术后12个月的(96.00±4.59)分,差异有统计学意义(P<0.05).结论 关节镜下同种异体胫前肌肌腱重建ACL及PCL,手术时间短、并发症少、临床效果好.

  16. Arthroscopic management of mucoid degeneration of anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Chirag H Chudasama

    2012-01-01

    Conclusions: Mucoid hypertrophy of the ACL should be suspected in elderly persons presenting pain on terminal extension or flexion without preceding trauma, especially when there is no associated meniscal lesion or ligamentous insufficiency. They respond well to a judicious arthroscopic release of the ACL with notchplasty.

  17. LARS人工韧带同时重建前、后交叉韧带%Reconstruction of both the anterior cruciate ligament and posterior cruciate ligament with ligament advanced reinforcement system artificial ligament transplantation under knee arthroscopy

    Institute of Scientific and Technical Information of China (English)

    尚平; 贺宪; 江永发; 刘志祥; 才忠民; 杨俊龙

    2007-01-01

    目的 探讨关节镜下LARS(Ligament Advanced Reinforcement System,LARS)人工韧带同时重建前(Anterior cruciate ligament,ACL)、后交叉韧带(posterior cruciate ligament,PCL)的方法和临床疗效.方法 从2006年1月至2007年4月,用LARS人工韧带同时重建ACL、PCL2例.应用Lysholm功能评分表评估膝关节功能,采用抽屉实验检查膝关节前后松弛度.结果 2例均获得随访,随访时间分别为8月、3月.2例患者术后患膝关节不稳定症状消失,胫骨后坠征阴性,前、后抽屉试验阴性.膝关节功能评估采用Lysholm功能评分标准,术前平均分别为45.6±7.6分,术后平均为80.3±9.1分.结论 关节镜下应用LARS人工韧带同时重建ACL、PCL可更好地恢复膝关节的稳定性,且创伤小,并发症少,近期疗效满意,但远期效果仍需进一步观察.

  18. Reconstruction of the medial patellofemoral ligament: Evaluation of the clinical results of autografts versus allografts.

    Science.gov (United States)

    Calvo Rodríguez, R; Figueroa Poblete, D; Anastasiadis Le Roy, Z; Etchegaray Bascur, F; Vaisman Burucker, A; Calvo Mena, R

    2015-01-01

    The purpose of the study was to evaluate the functional results after medial patellofemoral ligament (MPFL) reconstruction in patients using auto- and allograft. A retrospective study was conducted on 28 patients with recurrent patellar dislocation, with 13 patients (13 knees) undergoing MPFL reconstruction with hamstring autograft, and 15 patients (16 knees) with reconstruction surgery with allograft. The total group included 13 males and 15 females, with an age range of 15 to 38 years. The graft-related morbidity was studied and a clinical assessment was performed using the pre- and postoperative Kujala score. Associated complications were reported for each group. All the patients had more than 12 months of follow up. No recurrent dislocations or graft related complications were reported in either group. The post-operative Kujala subjective knee score was 89.2 in the autograft group, and 92.6 in the allograft group (p >.05). One patient in the allograft group received a revision surgery due to poor positioning of anchors. Another patient in the allograft group had non-displaced patella fracture related to the bone tunnels and another patient had flexion deficit and needed mobilization under anesthesia. There were no significant differences between both groups, and the results were comparable. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  19. A Technique of Improved Medial Meniscus Visualization by Anterior Cruciate Ligament Graft Placement in Chronic Anterior Cruciate Deficient Knees.

    Science.gov (United States)

    Vertullo, Christopher J; Wijenayake, Lahann; Grayson, Jane E

    2016-04-01

    It is customary to perform medial meniscus repair before anterior cruciate ligament (ACL) graft placement when undertaken as a combined procedure. However, in chronic ACL-deficient knees, intraoperative anterior tibiofemoral translation can cause the medial meniscus repair to be more technically challenging. Intraoperative anterior tibiofemoral translation can both reduce the visualization of the medial meniscus and make its reduction unstable. An operative sequence alteration of ACL graft placement and tensioning before medial meniscal repair improves medial meniscus visualization in chronically ACL-deficient knees by using the ACL graft's ability to prevent anterior tibiofemoral translation. The technique sequence is as follows: (a) the medial meniscus is reduced, (b) ACL reconstruction is undertaken using a hamstring graft without final tibia fixation,

  20. Simultaneous reconstruction of anterior cruciate ligament and posterior cruciate ligament by using allogeneic patellar tendon under arthroscopy

    Institute of Scientific and Technical Information of China (English)

    ZHOU Li-ping; ZHEN Min-qing; XU Zhong-he

    2005-01-01

    Objective: To evaluate operative effects of a new method to reconstruct anterior crucial ligament (ACL) and posterior crucial ligament (PCL) simultaneously by using patellar tendon under arthroscopy.Methods: From November 1999 to November 2003,the injured ACL and PCL of 11 patients were fixated with compressed screws and reconstructed under arthroscopy with the bone-patellar tendon-bone treated with deep hypothermia and T radiation. At the same time, 2 patients were treated with medial collateral ligament (MCL)reconstruction, 3 with lateral collateral ligament (LCL)reconstruction, 1 with meniscus suture and 4 with whole or partial resection.Results: All patients were followed up for 12-26months (average 16.5 months ). The Lysholm score method was employed to evaluate the knee function. The average preoperative score was 45.3 and the postoperative score was 86.4. Anterior drawer test (ADT) was positive in 11 knees preoperatively and feeble positive in one knee postoperatively. Lachman test was positive in 11 knees preoperatively and in one postoperatively, and feebly positive in two postoperatively. Posterior drawer test was positive in 11 knees preoperatively and feebly positive in 2postoperatively. There were 2 knees with tolerable pain and 2 with knee flexion of 5°-20°.Conclusions: As for simultaneous reconstruction of ACL and PCL under arthroscopy, ailogeneic bone-patellar tendon-bone can not only avoid injury and complication caused by autografting, but also help rehabilitation of the knee function.

  1. 3D Printing Surgical Implants at the clinic: A Experimental Study on Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Liu, An; Xue, Guang-huai; Sun, Miao; Shao, Hui-feng; Ma, Chi-yuan; Gao, Qing; Gou, Zhong-ru; Yan, Shi-gui; Liu, Yan-ming; He, Yong

    2016-02-15

    Desktop three-dimensional (3D) printers (D3DPs) have become a popular tool for fabricating personalized consumer products, favored for low cost, easy operation, and other advantageous qualities. This study focused on the potential for using D3DPs to successfully, rapidly, and economically print customized implants at medical clinics. An experiment was conducted on a D3DP-printed anterior cruciate ligament surgical implant using a rabbit model. A well-defined, orthogonal, porous PLA screw-like scaffold was printed, then coated with hydroxyapatite (HA) to improve its osteoconductivity. As an internal fixation as well as an ideal cell delivery system, the osteogenic scaffold loaded with mesenchymal stem cells (MSCs) were evaluated through both in vitro and in vivo tests to observe bone-ligament healing via cell therapy. The MSCs suspended in Pluronic F-127 hydrogel on PLA/HA screw-like scaffold showed the highest cell proliferation and osteogenesis in vitro. In vivo assessment of rabbit anterior cruciate ligament models for 4 and 12 weeks showed that the PLA/HA screw-like scaffold loaded with MSCs suspended in Pluronic F-127 hydrogel exhibited significant bone ingrowth and bone-graft interface formation within the bone tunnel. Overall, the results of this study demonstrate that fabricating surgical implants at the clinic (fab@clinic) with D3DPs can be feasible, effective, and economical.

  2. Magnetic resonance imaging for the diagnosis of chondral, meniscal and cruciate ligaments injuries of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Karam, Francisco Consoli; Fridmann, Marcos William; Arbo, Rodrigo Di Mare; Vieira, Jose Francisco [Pontificia Univ. Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, RS (Brazil). Faculty of Medicine]. E-mail: franciscokaram@terra.com.br; Silva, Jefferson Luis Braga da; Pires, Luiz Antonio Simoes [Pontificia Univ. Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, RS (Brazil). Faculty of Medicine. Hospital Sao Lucas; Abreu, Armando; Abreu, Marcelo [Hospital Mae de Deus, Porto Alegre, RS (Brazil). Servico de Radiologia

    2007-05-15

    Objective: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) of the knee. Materials and methods: Seventy-two patients have been submitted to MRI previously to arthroscopy of the knee performed by a single surgeon and utilized as a comparative standard method. Sensitivity, specificity, values of likelihood and rate of interobserver agreement have been evaluated. Results: The kappa agreement coefficient between MRI and arthroscopy was very good for lesions in the anterior cruciate ligament (0.84), good for lateral meniscus (0.75), reasonable for medial meniscus (0.50) and poor for chondral lesions (< 0.50). MRI has demonstrated high sensitivity for tears in the anterior cruciate ligament (94%) and in the medial meniscus (92%), good sensitivity for lesions in the lateral meniscus (80%), and low sensitivity for lesions in all of the chondral zones (< 50%), while the specificity has been excellent for all the chondral, and ligamentous structures, besides the lateral menisci analyzed (more than 97%), and reasonable (65%) for the medial meniscus. Conclusion: MRI is an useful tool in the clinical diagnosis of intra-articular knee lesions, as already demonstrated by similar results reported both in the Brazilian and international literature. (author)

  3. 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.

  4. Inter-Segmental Coordination Pattern in Patients with Anterior Cruciate Ligament Deficiency during a Single-Step Descent.

    Science.gov (United States)

    Nematollahi, Mohammadreza; Razeghi, Mohsen; Mehdizadeh, Sina; Tabatabaee, Hamidreza; Piroozi, Soraya; Rojhani Shirazi, Zahra; Rafiee, Ali

    2016-01-01

    Anterior cruciate ligament injury is a debilitating pathology which may alter lower limb coordination pattern in both intact and affected lower extremities during activities of daily living. Emerging evidence supports the notion that kinematic variables may not be a good indicator to differentiate patients with anterior cruciate ligament deficiency during step descent task. The aim of the present study was to examine alterations in kinematics as well as coordination patterns and coordination variability of both limbs of these patients during a single step descent task. Continuous relative phase technique was used to measure coordination pattern and coordination variability between a group of anterior cruciate ligament deficient (n = 23) and a healthy control group (n = 23). A third order polynomial Curve fitting was utilized to provide a curve that best fitted to the data points of coordination pattern and coordination variability of the healthy control group. This was considered as a reference to compare to that of patient group using nonlinear regression analysis. The results of the present study demonstrated an altered coordination pattern of the supporting shank-thigh and the stepping foot-shank couplings in anterior cruciate ligament deficient subjects. It was further noticed that there was an increased coordination variability in foot-shank and shank-thigh couplings of both supporting and stepping legs. There was no significant difference in the hip, knee and ankle joints kinematics in either side of these patients. Anterior cruciate ligament deficient individuals showed altered strategies in both intact and affected legs, with increased coordination variability. Kinematic data did not indicate any significant difference between the two groups. It could be concluded that more sophisticated dynamic approach such as continuous relative phase would uncover discrepancies between the healthy and anterior cruciate ligament deficient individuals.

  5. Single-leg postural stability deficits following anterior cruciate ligament reconstruction in pediatric and adolescent athletes.

    Science.gov (United States)

    Sugimoto, Dai; Howell, David R; Micheli, Lyle J; Meehan, William P

    2016-07-01

    The objective of this study was to compare the postural stability of pediatric and adolescent athletes without anterior cruciate ligament injury with those who underwent anterior cruciate reconstruction (ACLR). Postural stability ratings derived from a video-force plate system during the three stances of the modified Balance Error Scoring System were collected from pediatric and adolescent athletes who underwent ACLR (N=24; mean 1.2 years after surgery) and from uninjured controls (N=479). The postural control rating was calculated as the mean of the displacement and variance of the torso and center of pressure data, normalized on a scale from 0 to 100. A higher rating indicates greater postural stability. Participants who underwent ACLR showed lower postural stability ratings during single-leg stance compared with uninjured controls (40.0 vs. 48.7; P=0.037). ACLR is associated with deficits in postural stability.

  6. MR imaging of anterior cruciate ligament tears: is there a gender gap?

    Energy Technology Data Exchange (ETDEWEB)

    Fayad, Laura M. [Morgan Department of Radiology and Radiological Science, John Hopkins Medical Institutions, Baltimore, MD (United States); Parellada, J.Antoni; Parker, Laurence; Schweitzer, Mark E. [Department of Radiology, Thomas Jefferson University Hospital, Gibbon Building Suite 3390, 111 South 11th St., 19107-5098, Philadelphia, PA (United States)

    2003-11-01

    Clinically, females receive anterior cruciate ligament (ACL) tears more commonly than males. We explored whether gender differences exist in MR imaging patterns of ACL tears. At 1.5T, two observers evaluated MR examinations of 84 consecutive age-matched patients (42 males, 42 females, aged 16-39) with ACL tears, for mechanism of injury, extent and type of tear, the presence of secondary signs and associated osseous, meniscal and ligamentous injuries. The most common mechanism of injury for both females and males was the pivot shift mechanism (67 and 60%, respectively). Females were more commonly imaged in the acute stage of tear than males (98 and 67%, respectively, p=0.001) and more commonly possessed the typical posterolateral tibial bone contusion pattern (88 and 62%, respectively, p=0.0131). Males exhibited a deeper femoral notch sign (2.7 and 2.0 mm, p=0.007) and medial meniscal, lateral collateral ligament and posterior cruciate ligament injuries more commonly than females (48 and 24%, p=0.009, 30 and 7%, p=0.035, 17 and 0%, p=0.035). There was no significant difference between genders for the presence of other secondary signs and contusion patterns, associated lateral meniscal tears, presence of O'Donoghue's triad or associated medial collateral ligament injuries. Gender differences in MR imaging patterns of ACL tears exist: females are more commonly imaged in the acute stage and more commonly possess posterolateral tibial bone contusions; males have a more severe presentation than females, associated with more severe lateral femoral condyle and soft tissue injuries. (orig.)

  7. Minimal effect of patella eversion on ligament balancing in cruciate-retaining total knee arthroplasty.

    Science.gov (United States)

    Aunan, Eirik; Kibsgård, Thomas; Röhrl, Stephan M

    2017-03-01

    The effect of patellar eversion on ligament laxity measurements is still unclear. The purpose of this study was to investigate the influence of patellar eversion on medial and lateral ligament laxity measurements performed intra-operatively in total knee arthroplasty (TKA). A total of 49 knees (27 female) with mean age 70 years (42-83) and mean body mass index of 28.5 were operated consecutively with a cruciate-retaining prosthesis. Medial and lateral ligament laxity in extension and in 90° of flexion was measured with the spatula-method intra-operatively after implantation of the prosthetic components with the patella everted and thereafter with the patella repositioned. The corresponding changes in gap height and inclination were calculated. A statistically significant increase of 0.6 mm (p patella repositioned compared to everted. No differences were found in extension or medially in flexion. Correspondingly, the flexion gap increased by 0.4 mm (p patella was repositioned. Earlier research has shown that ligament laxity must be at least 1-2 mm to cause inferior function after TKA. In the current study, we found that the effect of patellar eversion on ligament laxity measurements is too small to be considered clinically relevant. PROSPECTIVE STUDY EVALUATING THE EFFECT OF PATIENT CHARACTERISTICS: Level II.

  8. Surgical treatment of acute and chronic anterior and posterior cruciate ligament and medial-side injuries of the knee.

    Science.gov (United States)

    Hubert, Mark G; Stannard, James P

    2011-06-01

    KD-IIIM knee injuries are challenging injuries that can do well when anatomic reconstruction techniques are used. This article describes the authors preferred reconstructions, timing of surgery, and rehabilitation techniques. The reconstructions are generally initiated 3 or 4 weeks after the injury when the local soft tissue injury allows and associated fractures have already been stabilized. The posterior cruciate ligament, posteromedial corner, and meniscus injuries are addressed in the initial operation. The corresponding author prefers to come back 6 weeks later and reconstruct the anterior cruciate ligament and assure that acceptable progress has been made regarding knee motion.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  10. Gait adaptation in ACL deficient patients before and after anterior cruciate ligament reconstruction surgery.

    Science.gov (United States)

    Knoll, Zsolt; Kiss, Rita M; Kocsis, László

    2004-06-01

    The objective of this study is to determine how kinematical parameters and electromyography data of selected muscles may change as a result of anterior cruciate ligament (ACL) deficiency and following ACL reconstruction. The study was conducted on 25 anterior cruciate ligament deficient subjects prior to and 6 weeks, 4 months, 8 months and 12 months following ACL reconstructive surgery using the bone-patellar tendon-bone technique. Gait analysis was performed by applying the zebris three-dimensional ultrasound-based system with surface electromyograph (zebris). Kinematic data were recorded for the lower limb. The muscles surveyed include vastus lateralis and medialis, biceps femoris and adductor longus. The results obtained from the injured subjects were compared with those of 51 individuals without any ACL damage whatsoever. Acute ACL deficient patients exhibited a quadriceps avoidance pattern prior to and 6 weeks following surgery. No quadriceps avoidance phenomenon develops in chronic ACL deficient patients. In operated individuals, tempo-spatial parameters and the knee angle regained a normal pattern for the ACL-deficient limb during gait as early as 4 months following surgery. However, the relative ACL movement parameter, which describes the tibial translation into the direction of ACL, and the EMG traces show no significant statistical difference compared with the same values of the healthy control group just 8 months following surgery. The analysis of spatial-temporal parameters and EMG traces show that the development of a quadriceps avoidance pattern is less common than previously reported. These data suggest that anterior cruciate ligament deficiency and reconstruction produce considerable changes in the lower extremity gait pattern. The results suggest that gait parameters tend to shift towards a normal value pattern; and the re-establishment of pre-injury gait patterns-including the normal biphase of muscles-takes at least 8 months to occur.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-08-15

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

  12. Pseudo-arthrosis repair of a posterior cruciate ligament avulsion fracture

    OpenAIRE

    2010-01-01

    A pseudo-arthrosis repair of a 4-year-old bony avulsion fracture of the PCL using a minimally invasive technique, screw fixation, and bone grafting is reported. The case presented seems to be rather unique due to the fragment size and the approach for pseudo-arthrosis repair. There was a good functional result following minimally invasive pseudo-arthrosis repair of a posterior cruciate ligament avulsion fracture. There are no previous reports of similar pseudo-arthrosis repairs, and other aut...

  13. Tibiofemoral Osteoarthritis After Surgical or Nonsurgical Treatment of Anterior Cruciate Ligament Rupture: A Systematic Review.

    Science.gov (United States)

    Harris, Kyle P; Driban, Jeffrey B; Sitler, Michael R; Cattano, Nicole M; Balasubramanian, Easwaran; Hootman, Jennifer M

    2017-06-02

      To determine if surgical or nonsurgical treatment of anterior cruciate ligament rupture affects the prevalence of posttraumatic tibiofemoral osteoarthritis (OA).   Studies published between 1983 and April 2012 were identified via EBSCOhost and OVID. Reference lists were then screened in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.   Studies were included if (a) treatment outcomes focused on a direct comparison of surgical versus nonsurgical treatment of anterior cruciate ligament rupture, (b) the prevalence of tibiofemoral OA was reported, and (c) they were written in English. Studies were excluded if (a) the included patients were treated with cast immobilization after surgery, (b) the mean follow-up was less than 10 years, or (c) the patients underwent anterior cruciate ligament revision surgery.   Two independent investigators reviewed the included articles using the Newcastle-Ottawa Scale. Frequency of OA, surgical procedure, nonsurgical treatments, and participant characteristics were extracted and summarized. We calculated prevalence (%) and 95% confidence intervals for treatment groups for each individual study and overall. We developed 2 × 2 contingency tables to assess the association between treatment groups (exposed had surgery, referent was nonsurgical treatment) and the prevalence of OA.   Four retrospective studies were identified (140 surgical patients, 240 nonsurgical patients). The mean Newcastle-Ottawa Scale score was 5 (range = 4-6 [of 10] points). Average length of follow-up was 11.8 years (range = 10-14 years). The prevalence of OA for surgically treated patients ranged from 32.6% to 51.2% (overall = 41.4%, 95% confidence interval = 35.0%, 48.1%) and for nonsurgical patients ranged from 24.5% to 42.3% (overall = 30.9%, 95% confidence interval = 24.4%, 38.3%).   Although OA prevalence was higher in the surgical treatment group at a mean follow-up of 11.8 years, no

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-02-15

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

  15. Preliminary clinical research of arthroscopic anterior cruciate ligament reconstruction using a patella tendon allograft%关节镜下同种异体髌腱组织重建膝前交叉韧带的初步临床研究

    Institute of Scientific and Technical Information of China (English)

    徐志宏; 蒋青; 陈东阳; 李文; 孙旭

    2004-01-01

    目的探讨关节镜下应用异体髌腱(骨-腱-骨组织,BPTB)重建膝关节前交叉韧带(anterior cruciate ligament,ACL)的方法及初步临床疗效.方法关节镜下应用深低温冷冻异体BPTB移植重建ACL 8例.对手术时间、手术切口及术后体温恢复、ACL体征、X-ray检查分析手术疗效;术后关节屈曲度及Lysholm-Ⅱ评分评定膝关节功能.结果关节镜下应用异体BPTB重建ACL切口小,手术时间短,术后5 d内体温恢复正常,无一例感染及免疫排斥现象.平均随访时间4个月(2~6个月),所有患者症状均有缓解,前抽屉试验(-)(anterior drawer test,ADT),Lachman(-),X-ray检查界面螺钉在位,未见骨道异常;术后2周平均屈曲度可至105°(80°~130°),术后2个月膝关节平均屈曲度可达120°(100°~130°),术前Lysholm-Ⅱ评分平均38.5分(24~50分),术后2个月Lysholm-Ⅱ评分平均88分(76~97分).结论应用深低温冷冻异体髌腱重建ACL可减少手术创伤,早期即可有效改善膝关节功能,是一种可行的重建ACL的方法,远期疗效尚需进一步的观察.

  16. A comparative MRI analysis of tibial tunnel after anterior cruciate ligament reconstruction with bone-patellar-bone from autograft and allograft%自体与同种异体骨-髌腱-骨重建前交叉韧带术后胫骨骨隧道演变过程的MRI对比研究

    Institute of Scientific and Technical Information of China (English)

    向芳友; 杨柳; 郭林; 陈光兴; 陈伟; 文亚名; 唐康来

    2005-01-01

    目的利用MRI比较自体与同种异体骨-髌腱-骨(bone-patellar tendon-bone,B-PT-B)重建前交叉韧带(anterior cruciate ligament,ACL)术后胫骨骨隧道的变化过程.方法将50例B-PT-B重建ACL患者,分成A、B两组,A组为自体组20例,B组为同种异体组30例.分别于术后1、6周、3~4、5~6、7~8、9~10、12~13、15~16、18~19、21~22个月进行磁共振(magnetic resonance image,MRI)检查,采用胫骨骨隧道斜轴状位扫描技术,扫描序列包括:T1WI、T2WI、GE-T1WI、GE-STIR.动态观察骨隧道内的MRI信号变化,并比较术后6周、3~4、5~6个月骨隧道扩大情况.结果术后6周骨隧道扩大增幅最为显著(P<0.05).术后3个时间段上比较两组骨隧道扩大程度均无显著性差异(P>0.05).MRI动态观察发现,A组术后5~8个月,移植物与骨隧道之间已发生骨性愈合;而B组将延迟到术后7~13个月.结论MRI是准确评价骨隧道的一种无创手段;同种异体B-PT-B在胫骨骨隧道内的愈合相对延迟;自体组与同种异体组术后胫骨骨隧道扩大的程度基本相当.

  17. A isometricidade do ligamento cruzado posterior Isometry of the posterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Alexandre E. V. Kokron

    2001-06-01

    Full Text Available Trabalho de revisão bibliográfica referente à isometricidade do ligamento cruzado posterior. São avaliados doze artigos que estudam a isometricidade do ligamento, constatando que a maioria destes é concorde com a maior importância da inserção femoral na isometricidade e que existe uma linha ou área mais isométrica na inserção femoral, aproximadamente perpendicular ao teto da fossa intercondilar, localizada de 10 a 14mm da abertura anterior desta fossa.The authors review 12 studies about posterior cruciate ligament isometry. The authors conclude that most studies agree that femoral insertion of the ligament is more important for isometry, and that there is a most isometric line or area inside the femoral insertion, perpendicular to the roof of the intercondilar fossa, approximately 10 to 14mm from its anterior opening.

  18. Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction With Remnant Preservation Using Outside-In Technique.

    Science.gov (United States)

    Lee, Byung-Ill; Kwon, Sai-Won; Choi, Hyung-Suk; Chun, Dong-Il; Kim, Yong-Beom; Kim, Byoung-Min

    2015-08-01

    This report describes a modified anatomic single-bundle anterior cruciate ligament (ACL) reconstruction technique using the FlipCutter guide pin (Arthrex, Naples, FL) as a retrograde drill and a cortical suspensory fixation device (TightRope; Arthrex) with an adjustable graft loop length. Preservation of the ACL remnant as a biological sleeve for the graft is an important issue from the viewpoints of acceleration of revascularization and ligamentization, preservation of the proprioceptive nerve fibers, enhancement of the biological environment for healing, and maintenance of the anchor point at the native tibial attachment, in addition to yielding a lower incidence of tibial bone tunnel enlargement. The goal of our technique is to obtain some advantages of the remnant-preserving technique through an anatomic single-bundle ACL reconstruction, which is performed to minimize damage to the ACL tibial remnant.

  19. The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for 'isolated' anterior cruciate ligament rupture.

    Science.gov (United States)

    Bourke, H E; Gordon, D J; Salmon, L J; Waller, A; Linklater, J; Pinczewski, L A

    2012-05-01

    The purpose of this study was to report the outcome of 'isolated' anterior cruciate ligament (ACL) ruptures treated with anatomical endoscopic reconstruction using hamstring tendon autograft at a mean of 15 years (14.25 to 16.9). A total of 100 consecutive men and 100 consecutive women with 'isolated' ACL rupture underwent four-strand hamstring tendon reconstruction with anteromedial portal femoral tunnel drilling and interference screw fixation by a single surgeon. Details were recorded pre-operatively and at one, two, seven and 15 years post-operatively. Outcomes included clinical examination, subjective and objective scoring systems, and radiological assessment. At 15 years only eight of 118 patients (7%) had moderate or severe osteo-arthritic changes (International Knee Documentation Committee Grades C and D), and 79 of 152 patients (52%) still performed very strenuous activities. Overall graft survival at 15 years was 83% (1.1% failure per year). Patients aged surgery and patients with > 2 mm of laxity at one year had a threefold increase in the risk of suffering a rupture of the graft (p = 0.002 and p = 0.001, respectively). There was no increase in laxity of the graft over time. ACL reconstructive surgery in patients with an 'isolated' rupture using this technique shows good results 15 years post-operatively with respect to ligamentous stability, objective and subjective outcomes, and does not appear to cause osteoarthritis.

  20. Arthroscopic single-bundle reconstruction of posterior cruciate ligament with quadrupled hamstring tendon

    Institute of Scientific and Technical Information of China (English)

    SUN Lei; NING Zhi-jie; ZHANG Hui; TIAN Min; NING Ting-min

    2007-01-01

    Objective:To evaluate the technique and outcome of arthroscopic single-bundle reconstruction of posterior cruciate ligament (PCL) with quadrupled hamstring tendon. Methods:From April 2001 to October 2004,49 knees with PCL tears in 49 patients were verified with arthroscope in this department. Of them, 13 were combined with anterior cruciate ligament tears,14 with disruptions of the posterolateral corner,6 with ruptures of the posteromedial corner and medial collateral ligament,9 with lateral meniscus tears,5 with medial meniscus tears and 2 with popliteal vascular tears.All the damaged PCLs were reconstructed with single-bundle of autogenous quadrupled hamstring tendons under arthroscope.Biodegradable interference screws or blunt titanium interference screws were used for direct anatomic fixation of the reconstructed ligament. Results:After operation,no severe complications occurred at early stage in the 49 patients.All of them were followed up for 10-52 months with an average of 22.0 months±10.7 months.Lysholm score was remarkably improved from 30-60 ( mean:47.96 ± 8.16) preoperatively to 70-95 ( mean:89.08 ± 6.10) at the last postoperative follow-up (P < 0.01 ).Furthermore,there was a significant improvement in International Knee Documentation Committee (IKDC) score from abnormal ( Grade C) in 10 knees and severely abnormal ( Grade D ) in 39 preoperatively to normal ( Grade A) in 20,nearly normal ( Grade B) in 24 and abnormal in 5 at the last follow-up.Of the 49 patients,40 returned to the same activity level as before and 9 were under the level. Conclusions:Single-bundle reconstruction of PCL with quadrupled hamstring tendons has the advantage of minimal trauma in surgery and satisfactory outcome.

  1. Return to Sports after Acute Simultaneous Reconstruction of Anterior Cruciate Ligament Injury and Grade III Medial Collateral Ligament Injury

    Science.gov (United States)

    Bertona, Agustin; Zicaro, Juan Pablo; Viescas, Juan Manuel Gonzalez; Atala, Nicolas; Yacuzzi, Carlos; Costa-Paz, Matias

    2017-01-01

    Objectives: Combined Anterior Cruciate Ligament (ACL) injury and Medial Collateral Ligament (MCL) injury account for 20% of knee ligament lesions. Conservative treatment of MCL and surgical ACL reconstruction are generally recommended. Significant medial instability after non-surgical management of MCL can lead to ACL reconstruction failure. The optimal management for athletes with combined ACL-MCL injuries remains controversial. The purpose of this study was to analyze the functional and clinical evolution of patients who underwent combined ACL-MCL surgery and their return-to-sport level with minimum 2-years follow-up. Methods: A total of 20 athletes with acute simultaneous ACL/Grade III MCL reconstructions were treated between March 2006 and January 2014. The minimum follow-up time was 24 months. Subjective functional results (IKDC, Lysholm), range of motion, anterior-medial and rotational stability (Lachmann, Pivot Shift, valgus stress) were evaluated. The ability to return to sport (Tegner) and the level achieved was recorded. Results: All patients significantly improved functional scores and stability tests. The mean subjective IKDC score improved from 37.7 ± 12.9 (range 21-69) preoperatively to 88.21 ± 4.47 (range 80-96) postoperatively (P sports; 90% reached the level they had prior to the ligamentous injury. Of all competitive athletes, 66% achieved the same level of sport. Conclusion: In athletes with acute ACL-Grade III MCL lesions, an early simultaneous reconstruction can significantly improve the medial and sagittal stability of the knee. This procedure resulted in excellent functional outcomes, with return to the same level of sports in the majority of patients at short-term follow-up.

  2. [Injuries of the medial collateral ligament and anterior cruciate ligament of the knee joint and Lemaire surgical functional treatment. Long-term outcome].

    Science.gov (United States)

    Schmid, F

    1996-06-01

    The present paper reports the results of 112 extraarticular ligamento-plasties performed on the knee with the procedure proposed by Lemaire. The series includes isolated tears of the anterior cruciate and medical collateral ligament as well as combined tears of both ligaments. The clinical and radiological results with a mean follow-up time of 11.5 years are compared with the results obtained in a first assessment 8 years ago. Good clinical results are in contrast with increasing osteoarthrosis in 1/3 of the knees radiologically assessed. The operation for a torn anterior cruciate ligament should be performed as soon as possible to avoid secondary meniscal lesions with subsequent severe osteoarthrosis. Presence or absence of arthrotic signs in the X-rays mainly determine the long-term result after ligamento-plasties of the knee. The Lemaire plasties are well tolerated even by elderly still active people and need little postoperative care.

  3. Artificial ligament repairs the injured cruciate ligament of the knee joint%人工韧带修复膝关节交叉韧带损伤★

    Institute of Scientific and Technical Information of China (English)

    于淼; 刘忆冰

    2013-01-01

      背景:以往治疗膝关节交叉韧带损伤的主要手段是移植重建,最常用的移植材料为自体的骨髌腱骨、半腱肌腱和股薄肌腱。但由于此类移植物存在取材区并发症及韧带化过程中的各种问题,近年来人工韧带的研究受到重视。目的:认识膝关节交叉韧带的结构及血供特点,以及膝关节交叉韧带损伤后人工韧带重建治疗机制与临床应用特点。方法:①分析膝关节前、后交叉韧带的组织结构,功能学特点以及血供差异。②分析膝关节前、后交叉韧带损伤的类型及生物力学机制。③分析修复膝关节交叉韧带损伤的材料学分类及特点。④分析人工韧带修复后影响关节稳定性的因素。结果与结论:修复膝关节前、后交叉韧带损伤时,应首先考虑到前、后交叉韧带的功能及血供情况,选择合适的重建物,使重建时过程简化,操作简单,重建材料的组织相容性较好,达到修复后的解剖与功能的双重建。%BACKGROUND: The previous main methods for the treatment of cruciate ligament injury of the keen joint are transplantation and reconstruction, and the most commonly used graft materials are autologous patel ar tendon bone, semitendinosus and gracilis tendon. But grafts can lead to complications in the drawn district and a variety of issues during ligament process. In recent years, the research of artificial ligament has become a hot spot. OBJECTIVE: To understand the structure and blood supply of cruciate ligament of the keen joint, and to investigate the mechanism and clinical characteristics of artificial ligament reconstruction for cruciate ligament injury of the keen joint. METHODS: The tissue structure and functional features of anterior and posterior cruciate ligaments of the knee joint as wel as the difference of blood supply were analyzed. The type and biomechanical mechanisms of anterior and posterior cruciate ligament

  4. Microstructure Variations in the Soft-Hard Tissue Junction of the Human Anterior Cruciate Ligament.

    Science.gov (United States)

    Zhao, Lei; Lee, Peter V S; Ackland, David C; Broom, Neil D; Thambyah, Ashvin

    2017-09-01

    The role of the sub-bundles in the anterior cruciate ligament (ACL) has been defined, such that the anterior-medial bundle directly resists anterior tibial translation while the posterior lateral bundle is involved in rotational stability. With regards to this biomechanical function, much of the previous work on bundle-specific morphology has been carried out on the macroscale, with much less attention given to the micro-to-ultrastructural scalar levels. This is especially true of the enthesis and its microstructure, a biomechanically significant region that has been largely neglected in the published literature dealing with ACL sub-bundle anatomy. In this study, the human ACL tibial enthesis was investigated at multiple scalar levels using differential interference contrast and scanning electron microscopies with the aim of determining whether the sub-bundle ligament structure, and its known macroscale function, is consistent with its micro-architecture at the ligament-bone junction. The investigation found that different ligament insertion morphologies exist between the two bundles, where the AM bundle has more intense interdigitation with the bone matrix than that of the PL bundle. The results suggest that such structure-function relationships, especially across scalar-levels, provide new insight into the significance of the sub-bundle anatomy of the ACL. Anat Rec, 300:1547-1559, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  5. Synovial C-Shaped Tibial Footprint of the Anterior Cruciate Ligament

    Science.gov (United States)

    Janovsky, César; Kaleka, Camila Cohen; Alves, Maria Teresa Seixas; Ferretti, Mario; Cohen, Moises

    2016-01-01

    Background: Although numerous anatomic studies about the anterior cruciate ligament (ACL) structure and attachments have been performed, these studies have not reached consensus on the ACL footprint. Purpose: To investigate the existing controversy regarding the morphology of the tibial ACL insertion (footprint) and confirm histologically that the tibial ACL footprint is not completely filled with ligament tissue. Study Design: Descriptive laboratory study. Methods: The tibial ACL footprint was dissected from 20 different fresh-frozen cadaveric knees (all males; mean age, 68.8 ± 5.4 years [range, 55-80 years]; mean weight, 78 ± 6.6 kg [range, 45-93 kg]). Two knees, 1 with severe osteoarthritis and 1 with previous knee surgery, were excluded. The tibial ACL insertion was observed, and this area was longitudinally divided into 4 parallel slices (0%-25%, 25-50%, 50%-75%, and 75%-100%), embedded in paraffin wax, and stained with hematoxylin-eosin, alcian blue, and picrosirius-polarization. The specimens were measured using a microscope to determine the distances from the anterior to the posterior border of the ACL ligament tibial insertion and the distance from the posterior border to the end of the ligament fibers of the ACL ligament tibial insertions. Results: The 18 evaluated knee specimens confirmed the finding of a C-shaped tibial insertion of the ACL. The measurements showed that the ligament (vertical parallel collagen fibers) occupied only 30.8% of the complete insertion. The remaining area was filled with synovial tissue, demonstrating histologically the “C” shape. Conclusion: This study confirms macroscopically the C-shaped tibial insertion of the ACL and shows histologically that synovial tissue is an indirect insertion filling the major part of the footprint. Clinical Relevance: This anatomic study suggests a different shape of the ACL tibial footprint, which may be useful for new perspectives regarding ACL reconstruction surgery research. PMID

  6. Rationale and implementation of anterior cruciate ligament injury prevention warm-up programs in female athletes.

    Science.gov (United States)

    Bien, Daniel P

    2011-01-01

    The sex disparity in anterior cruciate ligament (ACL) injury risk and the subsequent adverse effects on knee joint health, psychosocial well-being, and financial costs incurred have produced a surge in research on risk factors and interventions designed to decrease this disparity and overall incidence. Biomechanical and neuromuscular differences have been identified throughout the trunk and lower extremity that may increase noncontact ACL injury risk in female athletes. Evidence demonstrates that many risk factors are modifiable with intervention programs and that athletic performance measures can be enhanced. No universally accepted ACL injury prevention program currently exists, and injury prevention programs are diverse. Anterior cruciate ligament injury prevention programs introduced in a warm-up format offer multiple benefits, primarily, improved compliance based on improved practicality of implementation. However, drawbacks of warm-up style formats also exist, most notably that a lack of equipment and resources may preclude measurable improvements in athletic performance that foster improved compliance among participants. The purpose of this review is to analyze the current literature researching possible biomechanical and neuromuscular risk factors in noncontact ACL injury in female athletes and the most effective means of implementing critical elements of a program to decrease ACL injury risk in female athletes while improving athletic performance. Hip and hamstring training, core stabilization, plyometrics, balance, agility, neuromuscular training with video and verbal feedback to modify technique, and stretching appear to be essential components of these programs. Further research is critical to determine ideal training program volume, intensity, duration, and frequency.

  7. Surgical treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament: functional result

    Directory of Open Access Journals (Sweden)

    Marcos Alexandre Barros

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To objectively and subjectively evaluate the functional result from before to after surgery among patients with a diagnosis of an isolated avulsion fracture of the posterior cruciate ligament who were treated surgically. METHOD: Five patients were evaluated by means of reviewing the medical files, applying the Lysholm questionnaire, physical examination and radiological examination. For the statistical analysis, a significance level of 0.10 and 95% confidence interval were used. RESULTS: According to the Lysholm criteria, all the patients were classified as poor (<64 points before the operation and evolved to a mean of 96 points six months after the operation. We observed that 100% of the posterior drawer cases became negative, taking values less than 5 mm to be negative. CONCLUSION: Surgical methods with stable fixation for treating avulsion fractures at the tibial insertion of the posterior cruciate ligament produce acceptable functional results from the surgical and radiological points of view, with a significance level of 0.042.

  8. Management of Posterior Cruciate Ligament Injuries: An Evidence-Based Review.

    Science.gov (United States)

    Bedi, Asheesh; Musahl, Volker; Cowan, James B

    2016-05-01

    Isolated injuries of the posterior cruciate ligament are uncommon, are often caused by a posteriorly directed force to the proximal tibia, and result in abnormal knee kinematics and function. A thorough clinical evaluation, including history, physical examination, and imaging, is required to rule out a concomitant structural knee injury. No clear prognostic factors predict outcomes, and ideal management remains uncertain. Nonsurgical management is advocated for isolated grade I or II posterior cruciate ligament injuries or for grade III injuries in patients with mild symptoms or low activity demands. Surgical management is reserved for high-demand athletes or patients in whom nonsurgical management has been unsuccessful. Although biomechanical studies have identified differences between single-bundle, double-bundle, transtibial, and tibial inlay reconstruction techniques, the optimal surgical technique has not been established. No high-quality evidence is available regarding immobilization, weight-bearing, bracing, or rehabilitation protocols for patients treated either nonsurgically or surgically. Additional long-term clinical studies with homogeneous patient populations are needed to identify the ideal management of these injuries.

  9. Evaluation of vertical forces in the pads of Pitbulls with cranial cruciate ligament rupture.

    Science.gov (United States)

    Souza, Alexandre Navarro Alves; Tatarunas, Angelica Cecilia; Matera, Julia Maria

    2014-03-01

    Cranial cruciate ligament rupture (CCLR) is one of the most important stifle injuries and a common cause of lameness in dogs. Our objective was to measure the vertical forces in the pads of Pitbulls with cranial cruciate ligament rupture (CCLR) using a pressure sensitive walkway. A pressure sensitive walkway was used to collect vertical force data from the pads of 10 Pitbulls affected with unilateral CCLR. Ten healthy Pitbulls were included in the study as controls. Velocity varied between 1.3 and 1.6 m/s and acceleration was kept below ± 0.1 m/s2. Differences between groups and between pads in the same limb within groups were investigated using ANOVA and the Tukey test. The paired Student t-test was employed to assess gait symmetry (p < 0.05). Peak vertical forces (PVF) were lower in the affected limb, particularly in the metatarsal pad. Increased PVF values in the forelimb and the contralateral hind limb pads of affected dogs suggest a compensatory effect. A consistent pattern of vertical force distribution was observed in the pads of dogs with CCLR. These data are important for increased understanding of vertical force distribution in the limb of dogs with CCLR disease. Kinetic analysis using pressure sensitive walkways can be useful in follow-up assessment of surgically treated dogs regardless of the surgical technique employed.

  10. Classification of Cruciate Ligament Dysplasia and the Severity of Congenital Fibular Deficiency.

    Science.gov (United States)

    Walker, Janet L; Milbrandt, Todd A; Iwinski, Henry J; Talwalkar, Vishwas R

    2016-12-22

    Dysplasia of the cruciate ligaments has been found in many patients with congenital fibular deficiency. A recent classification system has shown that radiographic tibial spine changes can predict the hypoplasia and aplasia of the cruciate ligaments. We used this radiographic classification to determine the frequency of these abnormalities and how they correlate with the severity of fibular deficiency and lateral femoral condylar hypoplasia. Using a hospital database search for fibular deficiency, 99 patients ≥6 years with unilateral fibular deficiency were identified. Existing radiographs of both knees were available for 75 patients and reviewed for the tibial spine changes and Achterman and Kalamchi classification of the fibular deficiency. Measurements of femoral condyle heights in 74 of 75 patients were recorded before any surgery to the distal femoral physis to assess lateral femoral condylar hypoplasia. Twenty-two patients had hypoplasia of the lateral tibial spine+normal medial spine, 29 had absence of the lateral tibial spine+hypoplastic medial spine, and 11 had absence of both tibial spines. Five tibial spines were normal and 8 were unclassifiable. The severity of the tibial spine dysplasia, particularly absence of the lateral tibial spine, correlated with the severity of the fibular deficiency. (Pdysplasia in fibular deficiency is directly correlated with the severity of fibular absence, lateral femoral condylar hypoplasia, and the absence of foot rays. This suggests that the embryological factors involved have a complex interplay for all of these clinical findings. Level III.

  11. Relationship between retention of the posterior cruciate ligament and postoperative flexion in total knee arthroplasty.

    Directory of Open Access Journals (Sweden)

    Yokoyama,Yoshiki

    1995-12-01

    Full Text Available This study was conducted to retrospectively analyzed the outcome of 192 total knee arthroplasties in 132 patients with rheumatoid arthritis (118 women, 14 men. The Okayama Mark II prosthesis, which requires the posterior cruciate ligament (PCL to be resected, was used in 83 knees (group I, the Mark II prosthesis, which allows the PCL to be retained, was used in 68 knees (group II, and the new Okayama PCL-R prosthesis, which also allows the PCL to be retained, was used in 41 (group III. According to the Japanese Orthopaedic Association knee scoring system, the clinical outcome of groups I, II and III at 1 year after the operation were 64.9, 71.2 and 72.3 points, respectively, and the average flexion angles in each group at 1 year were 78.4, 92.6 and 101.3 degrees. Postoperative flexion in groups III was significantly greater than in groups I and II. These results suggest that postoperative flexion is greater when the posterior cruciate ligament is retained.

  12. 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.

  13. Visualization of torn anterior cruciate ligament using 3-dimensional computed tomography

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    Hiroaki Uozumi

    2013-07-01

    Full Text Available Recently, a remnant-preserving anterior cruciate ligament (ACL reconstruction technique has been developed. However, the pre-operative condition of remnant ACL is occasionally difficult to evaluate by magnetic resonance imaging. The purpose of this study is to evaluate the accuracy of pre-operative visualization of remnant ACL using three-dimensional computed tomography (3D-CT. The remnant ACL in 25 patients was examined by 3D-CT before ACL reconstruction surgery. Findings on 3D-CT images and arthroscopy were compared. The 3D-CT images were classified into 4 groups: Group A, remnant fibers attached to the posterior cruciate ligament (PCL; Group B, those located between the PCL and the lateral wall; Group C, those attached to the lateral wall; and Group D, no identifiable remnant fibers on the tibial side. These groups were made up of 4, 3, 9 and 9 patients, respectively. Findings on 3D-CT images were identical to those during arthroscopy in 20 of 25 cases (80%. Remnant ACL can be accurately evaluated using 3D-CT in 80% of cases of torn ACL. This novel method is a useful technique for pre-operative assessment of remnant ACL.

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

    Science.gov (United States)

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

    2017-01-01

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

  15. Partial and complete tear of the anterior cruciate ligament. Direct and indirect MR signs

    Energy Technology Data Exchange (ETDEWEB)

    Chen, W.T.; Tu, H.Y.; Chen, R.C. [Taipei Municipal Jen-Ai Hospital, TW (China). Dept. of Radiology; Shih, T.T.F. [Medical College and Hospital, National Taiwan Univ., TW (China). Dept. of Radiology; Shau, W.Y. [The Graduate Inst. of Clinical Medicine, National Taiwan Univ., Taipei, TW (China). Dept. of Radiology

    2002-09-01

    Purpose: To analyze MR direct and indirect signs for knees with anterior cruciate ligament (ACL) partial or complete tear. Material and Methods: According to documented MR direct and indirect signs for ACL tear, we retrospectively reviewed the incidence of those signs in 15 partial ACL tear and 17 complete ACL tear patients. The findings were also compared with duration of injury (less or more than 6 weeks, as acute or chronic stages). Results: A residual straight and tight ACL fiber in at least one pulse sequence was more frequently detected in partial ACL tears. The empty notch sign, a wavy contour of ACL, bone contusion at lateral compartment and lateral meniscus posterior horn tear were significantly more frequently seen in complete tear cases. The posterior cruciate ligament angle in chronic complete ACL tear cases (109 deg {+-}20 deg) had a tendency to be less than in chronic partial ACL tear cases (119 deg {+-}18 deg). Conclusion: The empty notch sign, a wavy ACL, bone contusion, and posterior horn of lateral meniscus tears are suggestive of a complete ACL tear. A residual straight and tight ACL fiber seen in at least one image section is a helpful sign to diagnosis of partial ACL tear. In the acute ACL injury stage, a focal increase of the ACL signal intensity is more suggestive of a partial ACL tear.

  16. Long-term interventions effects of robotic training on patients after anterior cruciate ligament reconstruction

    Science.gov (United States)

    Hu, Chunying; Huang, Qiuchen; Yu, Lili; Zhou, Yue; Gu, Rui; Ye, Miao; Ge, Meng; Xu, Yanfeng; Liu, Jianfeng

    2016-01-01

    [Purpose] The aim of this study was to examine the long-term interventions effects of robot-assisted therapy rehabilitation on functional activity levels after anterior cruciate ligament reconstruction. [Subjects and Methods] The subjects were 8 patients (6 males and 2 females) who received anterior cruciate ligament reconstruction. The subjects participated in robot-assisted therapy lasting for one month. The Timed Up-and-Go test, 10-Meter Walk test, Functional Reach Test, surface electromyography of the vastus lateralis and vastus medialis, and extensor strength of isokinetic movement of the knee joint were evaluated before and after the intervention. [Results] The average value of the of vastus medialis EMG, Functional Reach Test, and the maximum and average extensor strength of the knee joint isokinetic movement increased significantly, and the time of the 10-Meter Walk test decreased significantly. [Conclusion] These results suggest that walking ability and muscle strength can be improved by robotic walking training as a long-term intervention. PMID:27630396

  17. Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: a systematic review and meta-analysis.

    Science.gov (United States)

    Bates, Nathaniel A; Myer, Gregory D; Shearn, Jason T; Hewett, Timothy E

    2015-01-01

    Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined.

  18. Evaluation of the walking pattern in two types of patients with anterior cruciate ligament deficiency: copers and non-copers

    DEFF Research Database (Denmark)

    Alkjaer, T; Simonsen, Erik B; Jørgensen, Uffe

    2003-01-01

    The purpose of the present study was to investigate whether different walking patterns in healthy subjects and in coper and non-coper subjects with deficient anterior cruciate ligaments could be quantified. An inverse dynamics approach was used to calculate joint kinematics and kinetics for flexi...

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

    NARCIS (Netherlands)

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

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

  20. Bilateral Successive Cranial Cruciate Ligament Rupture Treated by Extracapsular Stabilization Surgery in a Pet Rabbit (Oryctolagus cuniculus)

    NARCIS (Netherlands)

    van Zuijlen, Michiel A.; Vrolijk, Patricia W. F.; van der Heyden, Marcel A. G.

    2010-01-01

    A 4.1 kg, 4-month-old female pet rabbit was presented twice within a 4 month period for cranial cruciate ligament rupture of its right, then left stifle joint Stifle joint stabilization was performed with an extracapsular technique after both events. Immediately after stabilization, the rabbit regai

  1. Combined sciatic femoral nerve block in a case of restrictive cardiomyopathy for arthroscopy and anterior cruciate ligament (ACL reconstruction

    Directory of Open Access Journals (Sweden)

    Gaurab Maitra

    2007-01-01

    Full Text Available Restrictive cardiomyopathy is a rare heart muscle disease resulting in impaired ventricular filling, low cardiac output and a propensity for development of heart failure with minimal fluid overload. Here, we present the management of a case of restrictive cardiomyopathy undergoing arthroscopy and anterior cruciate liga-ment (ACL reconstruction.

  2. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care

    NARCIS (Netherlands)

    Wagemakers, H.P.; Luijsterburg, P.A.; Boks, S.S.; Heintjes, E.M.; Berger, M.Y.; Verhaar, J.A.; Koes, B.W.; Bierma-Zeinstra, S.M.

    2010-01-01

    Wagemakers HP, Luijsterburg PA, Boks SS, Heintjes EM, Berger MY, Verhaar JA, Koes BK, Bierma-Zeinstra SM. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care. Arch Phys Med Rehabil 2010;91:1452-9. Objective: To a

  3. Numerical analysis of variations in posterior cruciate ligament properties and balancing techniques on total knee arthroplasty loading.

    NARCIS (Netherlands)

    Zelle, J.; Heesterbeek, P.J.; De Waal Malefijt, M.; Verdonschot, Nicolaas Jacobus Joseph

    2010-01-01

    Total knee arthroplasty (TKA) is a widely used and successful orthopaedic procedure. During TKA, the posterior cruciate ligament (PCL) can either be retained or substituted by a post-cam mechanism. One of the main functions of the PCL is to facilitate femoral rollback during knee flexion. For adequa

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  5. Five-year follow-up of knee joint cartilage thickness changes after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Eckstein, F; Wirth, W; Lohmander, Stefan

    2015-01-01

    Objective: Anterior cruciate ligament (ACL) rupture involves increased risk of osteoarthritis. We explored cartilage thickness changes over five years after ACL rupture. Methods: 121 young active adults (26% women, age 18-35 years) with acute traumatic ACL rupture were studied (the KANON...

  6. Coordination and stability of one-legged hopping patterns in patients with anterior cruciate ligament reconstruction: preliminary results.

    NARCIS (Netherlands)

    Uden, C. van; Bloo, J.K.C.; Kooloos, J.G.M.; Kampen, A. van; Witte, J.H. de; Wagenaar, R.C.

    2003-01-01

    OBJECTIVES: To investigate whether the intralimb coordination of the lower extremity during one-legged hopping in patients with anterior cruciate ligament reconstruction is different and less stable compared to control subjects. DESIGN: Measures of coordination dynamics are applied to study the coor

  7. Association between sensory function and hop performance and self-reported outcomes in patients with anterior cruciate ligament injury

    DEFF Research Database (Denmark)

    Cronström, Anna; Roos, Ewa M.; Ageberg, Eva

    2017-01-01

    BACKGROUND: In patients with anterior cruciate ligament (ACL) deficiency (ACLD) or reconstruction (ACLR), sensory deficits are commonly assessed as knee kinesthesia using time-consuming laboratory equipment. Portable equipment such as that used for evaluation of vibration sense would be preferabl...

  8. CT arthrography and virtual arthroscopy in the diagnosis of the anterior cruciate ligament and meniscal abnormalities of the knee joint

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Whal; Chung, Jin-Wook; Kang, Heung-Sik; Hong, Sung-Hwan; Choi, Ja-Young [Seoul National University, Seoul (Korea, Republic of); Kim, Ho-Sung; Kim, Seok-Jung; Kim, Hyung-Ho [Aeromedical Center, Seoul (Korea, Republic of)

    2004-03-15

    To determine the diagnostic accuracy of CT arthrography and virtual arthroscopy in the diagnosis of anterior cruciate ligament and meniscus pathology. Thirty-eight consecutive patients sho underwent CT arthrography and arthroscopy of the knee were included in this study. The ages of the patients ranged from 19 to 52 years and all of the patients were male. Sagittal, coronal, transverse and oblique coronal multiplanar reconstruction images were reformatted from CT arthrography. Virtual arthroscopy was performed from 6 standard views using a volume rendering technique. Three radiologists analyzed the MPR images and two orthopedic surgeons analyzed the virtual arthroscopic images. The sensitivity and specificity of CT arthrography for the diagnosis of anterior cruciate ligament abnormalities were 87.5%-100% and 93.3%-96.7%, respectively and those for meniscus abnormalities were 91.7%-100% and 98.1%, respectively. The sensitivity and specificity of virtual arthroscopy for the diagnosis of anterior cruciate ligament abnormalities were 87.5% and 83.3%-90%, respectively, and those for meniscus abnormalities were 83.3%-87.5% and 96.1-98.1%, respectively. CT arthrography and virtual arthroscopy showed good diagnostic accuracy for anterior cruciate ligament and meniscal abnormalities.

  9. The Clinical and Radiological Evaluation of Canine Cranial Cruciate Ligament Rupture Treatment with Tibial Plateau Leveling Osteotomy

    Directory of Open Access Journals (Sweden)

    Didar AYDIN KAYA

    2016-01-01

    Full Text Available Tibial plateau leveling osteotomy (TPLO is one of the tibial osteotomy techniques for canine cranial cruciate ligament rupture. The purpose of this study is to evaluate the clinically and radiologically findings of the patients with cranial cruciate ligament rupture treated by tibial plateau leveling osteotomy. In our clinical study, treatment of cranial cruciate ligament rupture in 18 dogs with a total of 20 stifles was performed. Cases were diagnosed with cranial cruciate ligament rupture, technical measurements for the operations are determined and the cases were prepared for the operation during the preoperative period of the clinical and radiological examinations. Following the operation, postoperative clinical and radiological evaluations were performed on the 10th, 30th, 60th, 90th and 120th days. At the end of the study, it was observed that the dogs retained stifle joint motion ability, early healing of the osteotomy side in the postoperative period, all stifle joint functions were retained after a period. It was determined that this method of operation can securely (in regards to joint stabilization be performed on especially in large breed dogs.

  10. Mechanical stretch increases CCN2/CTGF expression in anterior cruciate ligament-derived cells

    Energy Technology Data Exchange (ETDEWEB)

    Miyake, Yoshiaki [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Furumatsu, Takayuki, E-mail: matino@md.okayama-u.ac.jp [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Kubota, Satoshi; Kawata, Kazumi [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Ozaki, Toshifumi [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Takigawa, Masaharu [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)

    2011-06-03

    Highlights: {yields} CCN2/CTGF localizes to the ligament-to-bone interface, but is not to the midsubstance region of human anterior cruciate ligament (ACL). {yields} Mechanical stretch induces higher increase of CCN2/CTGF gene expression and protein secretion in ACL interface cells compared with ACL midsubstance cells. {yields} CCN2/CTGF treatment stimulates the proliferation of ACL interface cells. -- Abstract: Anterior cruciate ligament (ACL)-to-bone interface serves to minimize the stress concentrations that would arise between two different tissues. Mechanical stretch plays an important role in maintaining cell-specific features by inducing CCN family 2/connective tissue growth factor (CCN2/CTGF). We previously reported that cyclic tensile strain (CTS) stimulates {alpha}1(I) collagen (COL1A1) expression in human ACL-derived cells. However, the biological function and stress-related response of CCN2/CTGF were still unclear in ACL fibroblasts. In the present study, CCN2/CTGF was observed in ACL-to-bone interface, but was not in the midsubstance region by immunohistochemical analyses. CTS treatments induced higher increase of CCN2/CTGF expression and secretion in interface cells compared with midsubstance cells. COL1A1 expression was not influenced by CCN2/CTGF treatment in interface cells despite CCN2/CTGF stimulated COL1A1 expression in midsubstance cells. However, CCN2/CTGF stimulated the proliferation of interface cells. Our results suggest that distinct biological function of stretch-induced CCN2/CTGF might regulate region-specific phenotypes of ACL-derived cells.

  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. Clinical and Arthroscopic Findings of Acute Anterior Cruciate Ligament Tears of the Knee

    Directory of Open Access Journals (Sweden)

    Kenji Shirakura

    1995-01-01

    Full Text Available Clinical, arthrographic, and arthroscopic findings in 53 patients with acutely torn anterior cruciate ligaments (ACLs were documented. Arthroscopy and instability tests under anesthesia were performed on all patients within 2 weeks after the initial injury. Twenty-three patients complained of extension blocks, and localized tenderness on the medial side was revealed in 26 patients at the initial examination. Aspiration from joints exhibited hemarthrosis in 52 patients. Arthroscopy revealed ACL ruptures in all patients. Four Segond's fractures, 26 meniscus tears (8 medial and 18 lateral, 1 osteochondral fracture, and 19 medial collateral ligament ruptures were revealed. Arthroscopy detected only 1 of the 5 ruptures of the posteromedial corner of the medial meniscus, which were noted on arthrography. Three ACL stumps were protruding among the femorotibial joint, which seemed to be restricting full extension. Statistical analysis showed that tenderness on the medial side was not revealed more frequently in knees with medial collateral ligament injuries than in the others. The volume of aspirated fluids in knees with no leakage in arthrography significantly increased over those with leakages (p < 0.05. Diagnosis of ACL injuries should be completed by clinical, arthrographic, and arthroscopic examinations.

  13. Biology of anterior cruciate ligament injury and repair: Kappa delta ann doner vaughn award paper 2013.

    Science.gov (United States)

    Murray, Martha Meaney; Fleming, Braden C

    2013-10-01

    Anterior cruciate ligament (ACL) injuries are currently treated by removing the injured ligament and replacing it with a tendon graft. Recent studies have examined alternative treatment methods, including repair and regeneration of the injured ligament. In order to make such an approach feasible, a basic understanding of ACL biology and its response to injury is needed. Identification of obstacles to native ACL healing can then be identified and potentially resolved using tissue engineering strategies-first, with in vitro screening assays, and then with in vivo models of efficacy and safety. This Perspectives paper outlines this path of discovery for optimizing ACL healing using a bio-enhanced repair technique. This journey required constructing indices of the functional tissue response, pioneering physiologically based methods of biomechanical testing, developing, and validating clinically relevant animal models, and creating and optimizing translationally feasible scaffolds, surgical techniques, and biologic additives. Using this systematic translational approach, "bio-enhanced" ACL repair has been advanced to the point where it may become an option for future treatment of acute ACL injuries and the prevention of subsequent post-traumatic osteoarthritis associated with this injury.

  14. Finite Element Modelling of a Novel Anterior Cruciate Ligament Repairing Device

    Directory of Open Access Journals (Sweden)

    A.Vairis

    2014-07-01

    Full Text Available The knee anterior cruciate ligament which connects the femur to the tibia is often torn during sudden twisting motions resulting in knee instability with surgery being an effective treatment where the torn ligament is replaced with a graft. This study provides qualitative stress information on a restored knee which has been repaired using a novel device. This device has been designed to reduce graft damage and to minimize post-surgery complications. The device as well as the intact knee have been modelled in 3D and studied using finite elements to assess the mechanical behaviour of the device under different loads. Results are evaluated and compared to equivalent published works. They showed that high stresses appear where tendons wrap around objects like the securing pin of the knee ligament repair device, while the highest stresses are away from the repair device components indicating that the device design does not affect the graft. Developed stresses were within the tendon elastic range, and load case direction does not affect significantly the developed stresses on the circumference of tendons in the most stressed region.

  15. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus

    NARCIS (Netherlands)

    Melick, N. van; Cingel, R.E. van; Brooijmans, F.; Neeter, C.; Tienen, T. van; Hullegie, W.; Sanden, M.W. van der

    2016-01-01

    AIM: The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction. DESIGN: Clinical practice guideline underpinned by systematic review and exper

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

    Directory of Open Access Journals (Sweden)

    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

  17. Meniscal and cruciate ligaments tears diagnosed with MR imaging versus arthroscopy; Uszkodzenie lakotek i wiazadel krzyzowych w stawie kolanowym w badaniu MR i artroskopii

    Energy Technology Data Exchange (ETDEWEB)

    Ziemianski, A.; Kruczynski, J.; Bruszewski, J. [Akademia Medyczna, Poznan (Poland)

    1993-12-31

    MR studies of knee joints in 37 patients were performed. The clinical diagnostics was traumatic lesions of menisci or cruciate ligaments. Arthroscopy of the knee joint was performed in 21 patients. MR showed meniscal lesion in 25 patients and anterior cruciate ligament (ACL) lesions in 18 patients. Arthroscopy showed meniscal lesions in 16 of 21 patients and ACL lesions in 11 of 21 patients. MR correlated with arthroscopy in 16 of examined menisci and 15 of 21 examined ACL. (author).

  18. Anterior Cruciate Ligament Tear: Reliability of MR Imaging to Predict Stability after Conservative Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Hye Won; Ahn, Jin Hwan; Ahn, Joong Mo; Yoon, Young Cheol; Hong, Hyun Pyo; Yoo, So Young; Kim, Seon Woo [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2007-06-15

    The aim of this study is to evaluate the reliability of MR imaging to predict the stability of the torn anterior cruciate ligament (ACL) after complete recovery of the ligament's continuity. Twenty patients with 20 knee injuries (13 males and 7 females; age range, 20 54) were enrolled in the study. The inclusion criteria were a positive history of acute trauma, diagnosis of the ACL tear by both the physical examination and the MR imaging at the initial presentation, conservative treatment, complete recovery of the continuity of the ligament on the follow up (FU) MR images and availability of the KT-2000 measurements. Two radiologists, who worked in consensus, graded the MR findings with using a 3-point system for the signal intensity, sharpness, straightness and the thickness of the healed ligament. The insufficiency of ACL was categorized into three groups according to the KT-2000 measurements. The statistic correlations between the grades of the MR findings and the degrees of ACL insufficiency were analyzed using the Cochran-Mantel-Haenszel test (p < 0.05). The p-values for each category of the MR findings according to the different groups of the KT-2000 measurements were 0.9180 for the MR signal intensity, 1.0000 for sharpness, 0.5038 for straightness and 0.2950 for thickness of the ACL. The MR findings were not significantly different between the different KT-2000 groups. MR imaging itself is not a reliable examination to predict stability of the ACL rupture outcome, even when the MR images show an intact appearance of the ACL.

  19. 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.

  20. Surgical simulation and evaluation in anterior cruciate ligament reconstruction with image-free navigation

    Institute of Scientific and Technical Information of China (English)

    Wang Tianmiao; Hu Yan; Liu Wenyong; Sun Lei; Wang Junchen; Feng Hua; Hu Lei

    2009-01-01

    A surgical simulation and evaluation method in the anterior cruciate ligament (ACL) reconstruction with image-free navigation was presented. Firstly, video tracking module, bone surface reconstruction module and virtual simulation module of this system were discussed. Secondly, the coordinate relations of several surgery objects (including surgical instrument, anatomical, camera and screen) in the surgical environment, the tracking based on MicronTracker with two cameras and the bone surface real-time reconstruction based on the Delaunay algorithm were introduced in detail. Finally, experiments of anisometry measurement and virtual simulation on two plastics were carried out to verify the validity of the proposed method. The anisometry value of reconstructed ACL was 8.970039mm. The effectiveness of ACL reconstruction has been proved by preliminary evaluation trials.

  1. Anterior cruciate ligament injury: identification of risk factors and prevention strategies.

    Science.gov (United States)

    Acevedo, Rafael J; Rivera-Vega, Alexandra; Miranda, Gerardo; Micheo, William

    2014-01-01

    Injury to the anterior cruciate ligament (ACL) is common and affects young individuals, particularly girls, who are active in sports that involve jumping, pivoting, as well as change of direction. ACL injury is associated with potential long-term complications including reduction in activity levels and osteoarthritis. Multiple intrinsic and extrinsic risk factors have been identified, which include anatomic variations, neuromuscular deficits, biomechanical abnormalities, playing environment, and hormonal status. Multicomponent prevention programs have been shown to be effective in reducing the incidence of this injury in both girls and boys. Programs should include a combination of strengthening, stretching, aerobic conditioning, plyometrics, proprioceptive and balance training, as well as education and feedback regarding body mechanics and proper landing pattern. Preventive programs should be implemented at least 6 wk prior to competition, followed by a maintenance program during the season.

  2. Computer-assisted anterior cruciate ligament reconstruction. Four generations of development and usage.

    Science.gov (United States)

    Klos, Tiburtius V S

    2014-12-01

    The purpose of this paper is to review the literature about the contribution of navigation in anterior cruciate ligament (ACL) reconstruction. The evolution of computer-assisted surgery (CAS) for ACL reconstruction has undergone several steps. These steps were divided into 4 subsequent developments: (1) positioning of ACL graft placement; (2) laxity measurement of ACL reconstruction (quality control); (3) kinematic evaluation during ACL reconstruction (navigated pivot shift); (4) case-specific individual ACL reconstruction with adjustments and additional reconstruction options. CAS has shown to improve femoral tunnel positioning, even if clinical outcomes do not improve results of manual techniques. CAS technology has helped researchers better understand the effects of different ACL reconstruction techniques and bundles replacements on joint laxity and to describe tunnel positioning in relation to native ACL insertion. CAS in ACL surgery can improve results at time zero and can improve knowledge in this field.

  3. Anterior cruciate ligament graft tensioning. Is the maximal sustained one-handed pull technique reproducible?

    LENUS (Irish Health Repository)

    O'Neill, Barry J

    2011-07-20

    Abstract Background Tensioning of anterior cruciate ligament (ACL) reconstruction grafts affects the clinical outcome of the procedure. As yet, no consensus has been reached regarding the optimum initial tension in an ACL graft. Most surgeons rely on the maximal sustained one-handed pull technique for graft tension. We aim to determine if this technique is reproducible from patient to patient. Findings We created a device to simulate ACL reconstruction surgery using Ilizarov components and porcine flexor tendons. Six experienced ACL reconstruction surgeons volunteered to tension porcine grafts using the device to see if they could produce a consistent tension. None of the surgeons involved were able to accurately reproduce graft tension over a series of repeat trials. Conclusions We conclude that the maximal sustained one-handed pull technique of ACL graft tensioning is not reproducible from trial to trial. We also conclude that the initial tension placed on an ACL graft varies from surgeon to surgeon.

  4. Extra-Articular Lateral Tenodesis for Anterior Cruciate Ligament Deficient Knee: A Case Report

    Science.gov (United States)

    García-Germán, Diego; Menéndez, Pablo; de la Cuadra, Pablo; Rodríguez-Arozena, Ricardo

    2013-01-01

    We present the case of an extra-articular lateral tenodesis for an anterior cruciate ligament (ACL) deficient knee. A 46-year-old male patient sustained an ACL graft rupture after a motorcycle accident. He complained of rotational instability and giving-way episodes. His previous graft was fixed by an intra-articular femoral staple that was not possible to remove at the time of the ACL revision. A modified Lemaire procedure was then performed. He gained rotational stability and was able to resume his sporting activities. We believe that isolated extra-articular reconstructions may still have a role in selected indications including moderate-demand patients complaining of rotational instability after ACL graft failure. PMID:24369517

  5. Muscle reflexes during gait elicited by electrical stimulation of the posterior cruciate ligament in humans

    DEFF Research Database (Denmark)

    Fischer-Rasmussen, T; Krogsgaard, M R; Jensen, D B

    2002-01-01

    muscle activity in both the quadriceps and the hamstrings. The latency of the inhibition ranged between 78 and 148 ms in the quadriceps, between 88 and 110 ms in the hamstrings and between 189 and 258 ms in m. gastrocnemius. Stimulation of the fat pad of the knee did not influence the thigh and calf......We investigated the influence of electrical stimulation of the posterior cruciate ligament (PCL) on the motoneuron pool of the thigh and calf muscle during gait. The study group comprised eight young men without any history of injury to the knee joints. Multistranded teflon-insulated stainless...... over the vastus medialis, rectus femoris, vastus lateralis, biceps femoris caput longum, and semitendinosus muscles. The stimuli consisted of four pulses delivered at 200 Hz; the stimulus amplitude was two to three times the sensory threshold. The electrical stimulation of the PCL inhibited the ongoing...

  6. Anterior cruciate ligament graft tensioning. Is the maximal sustained one-handed pull technique reproducible?

    Directory of Open Access Journals (Sweden)

    Hirpara Kieran M

    2011-07-01

    Full Text Available Abstract Background Tensioning of anterior cruciate ligament (ACL reconstruction grafts affects the clinical outcome of the procedure. As yet, no consensus has been reached regarding the optimum initial tension in an ACL graft. Most surgeons rely on the maximal sustained one-handed pull technique for graft tension. We aim to determine if this technique is reproducible from patient to patient. Findings We created a device to simulate ACL reconstruction surgery using Ilizarov components and porcine flexor tendons. Six experienced ACL reconstruction surgeons volunteered to tension porcine grafts using the device to see if they could produce a consistent tension. None of the surgeons involved were able to accurately reproduce graft tension over a series of repeat trials. Conclusions We conclude that the maximal sustained one-handed pull technique of ACL graft tensioning is not reproducible from trial to trial. We also conclude that the initial tension placed on an ACL graft varies from surgeon to surgeon.

  7. Anterior cruciate ligament injuries in snowboarders: a quadriceps-induced injury.

    Science.gov (United States)

    Davies, Hywel; Tietjens, Barry; Van Sterkenburg, Maayke; Mehgan, Andrew

    2009-09-01

    Anterior cruciate ligament (ACL) injuries in snowboarders are rare. However, in expert boarders landing big jumps, ACL injuries are occurring more frequently. We identified 35 snowboarders with an identical injury mechanism. All these patients were landing from a jump. All described a flat landing on a flexed knee with significant knee compression. In 31 of 35 boarders, it was the front knee that was injured. Only two riders felt there was any twisting component to their injury. We postulate that the ACL rupture is due to maximal eccentric quadriceps contraction, as the boarder resists a compressive landing. Internal tibial rotation of the front knee in the snowboarding stance results in preloading of the ACL predisposing to injury.

  8. 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.

  9. ABCs of Evidence-based Anterior Cruciate Ligament Injury Prevention Strategies in Female Athletes

    Science.gov (United States)

    Sugimoto, Dai; Myer, Gregory D.; Micheli, Lyle J.; Hewett, Timothy E.

    2015-01-01

    Context Anterior cruciate ligament (ACL) injury is a major concern in physically active females. Although ACL reconstruction techniques have seen significant advances in recent years, risk associated with re-injury and future osteoarthritis remains a major concern. Thus, prevention of ACL injury is a logical step to protect and preserve healthy knee joints in young athletes. The current report aims to summarize a list of evidence-based prevention strategies to reduce ACL injury in female athletes. A list of six critical principles, which come from documented, large scale clinical trial studies and further analyses, were presented with ABC format including age, biomechanics, compliance, dosage, exercise, and feedback. Also, a grade for evidence and implications of future research is noted. Finally, in the conclusion section, importance of collaborative efforts from healthcare practitioners, researchers, and personnel associated with athletics is addressed. PMID:26042191

  10. Management of anterior cruciate ligament injury? What's in and what's out?

    Directory of Open Access Journals (Sweden)

    Benjamin Todd Raines

    2017-01-01

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

  11. Extra-Articular Lateral Tenodesis for Anterior Cruciate Ligament Deficient Knee: A Case Report

    Directory of Open Access Journals (Sweden)

    Diego García-Germán

    2013-01-01

    Full Text Available We present the case of an extra-articular lateral tenodesis for an anterior cruciate ligament (ACL deficient knee. A 46-year-old male patient sustained an ACL graft rupture after a motorcycle accident. He complained of rotational instability and giving-way episodes. His previous graft was fixed by an intra-articular femoral staple that was not possible to remove at the time of the ACL revision. A modified Lemaire procedure was then performed. He gained rotational stability and was able to resume his sporting activities. We believe that isolated extra-articular reconstructions may still have a role in selected indications including moderate-demand patients complaining of rotational instability after ACL graft failure.

  12. An analysis of the quality of canine cranial cruciate ligament disease information available on the Internet.

    Science.gov (United States)

    Taggart, Ryan; Wardlaw, Jennifer; Horstman, Christopher L; Mason, David R; Sidaway, Brian; Havas, Karyn

    2010-04-01

    To assess the quality of information available on the Internet pertaining to canine cranial cruciate ligament (CCL) disease. Survey Study. Three search phrases were entered separately into 5 search engines and the 1st page of websites from each search was analyzed. Unique websites were evaluated by 3 Diplomates of the American College of Veterinary Surgeons using standardized scales for content and information value score (IVS). Websites were further categorized by veterinary or non-veterinary authorship. The readability of each website was scored using a proven literacy scale (Flesch-Kinkaid system). Fifty-four unique websites were evaluated. Websites located using anatomically correct veterinary terminology had significantly (Padvanced literacy level for comprehension. CCL disease information on the Internet is of variable quality and can be misleading.

  13. 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 (Pbiomechanics were changed, in both males and females, compared to the Control groups (Pknee 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.

  14. Efficacy of an Intra-Operative Imaging Software System for Anatomic Anterior Cruciate Ligament Reconstruction Surgery

    Directory of Open Access Journals (Sweden)

    Xudong Zhang

    2012-01-01

    Full Text Available An imaging software system was studied for improving the performance of anatomic anterior cruciate ligament (ACL reconstruction which requires identifying ACL insertion sites for bone tunnel placement. This software predicts and displays the insertion sites based on the literature data and patient-specific bony landmarks. Twenty orthopaedic surgeons performed simulated arthroscopic ACL surgeries on 20 knee specimens, first without and then with the visual guidance by fluoroscopic imaging, and their tunnel entry positions were recorded. The native ACL insertion morphologies of individual specimens were quantified in relation to CT-based bone models and then used to evaluate the software-generated insertion locations. Results suggested that the system was effective in leading surgeons to predetermined locations while the application of averaged insertion morphological information in individual surgeries can be susceptible to inaccuracy and uncertainty. Implications on challenges associated with developing engineering solutions to aid in re-creating or recognizing anatomy in surgical care delivery are discussed.

  15. Mesenchymal Stem Cells for Enhancing Biologic Healing after Anterior Cruciate Ligament Injuries.

    Science.gov (United States)

    Jang, Ki-Mo; Lim, Hong Chul; Bae, Ji Hoon

    2015-01-01

    Arthroscopic anterior cruciate ligament (ACL) reconstruction using tendon grafts is the current gold standard for the treatment of ACL tears in active patients. However, many patients still experience residual knee instability, knee pain and progressive cartilage degeneration following ACL reconstruction. Recent developments in mesenchymal stem cell (MSC)-based approaches for treating musculoskeletal injuries have led to the application of MSCs for enhancing healing after ACL injuries. The purpose of this article is to review recent pre-clinical and clinical studies using MSCs for the enhancement of biologic healing of ACL injuries. Because of the success of pre-clinical studies, MSC-based approaches are now thought to be promising treatment options for enhancing biologic healing of ACL grafts and restoring the functional properties to the levels of the native ACL, and ultimately improving clinical outcomes.

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

    Directory of Open Access Journals (Sweden)

    Jake Sloane

    2010-01-01

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

  17. Sonographic guided insertion of electrodes into the cruciate ligaments of the knee

    DEFF Research Database (Denmark)

    Jensen, D B; Fischer-Rasmussen, T; Magnusson, S P;

    1999-01-01

    The present cadaver study examined the probability of accurate ultrasound guided insertion of electrodes into the anterior (ACL) and posterior (PCL) cruciate ligament with a fine needle. Visualisation of the structures appeared clearest from the posterior approach. From this approach 24 electrodes...... were inserted into the PCL and six into the ACL. From the anterior 16 were inserted into the ACL and six into the PCL. Twenty-one out of 24 electrodes were placed correctly into the PCL from the posterior view, and four out of six were placed correctly from the anterior view. From the posterior view...... four out of six were placed correctly in the ACL, and eight electrodes out of 16 were placed correctly from the anterior view. In conclusion, ultrasound guided insertion of electrodes from the posterior view can be performed with high accuracy into the PCL, whereas insertion into the ACL seems...

  18. Articular cartilage damage with intramedullary lesion (bone bruise) in anterior cruciate ligament rupture

    Energy Technology Data Exchange (ETDEWEB)

    Ide, Shuya; Ohdera, Toshihiro; Tokunaga, Masami; Hiroshima, Shiro; Yoshimoto, Eiji [Fukuoka Orthopaedic Hospital (Japan)

    2002-09-01

    We evaluated the relationship between the intramedullary lesion on MRI and cartilage damage in patients associated with acute anterior cruciate ligament (ACL) rupture. Thirty-two cases documented by MRI and arthroscopy within one month from injury underwent ACL reconstruction using ST-G, and arthroscopy was performed again after surgery. The mean term between reconstruction and postoperative arthroscopy was twelve months. The cartilage damage on arthroscopy was compared with the intramedullary lesion on MRI. Cartilage damage was observed in 9 cases (28.1%) during the initial arthroscopy and in 16 cases (50.0%) during the second arthroscopy. Intramedullary lesion was detected in all 32 cases (total: 73 lesions) on MRI. Intramedullary lesion leading to cartilage damage was common in the geographic-type lateral femoral condyle. There was significant difference between the lateral meniscus tear and the cartilage damage of the lateral compartment. (author)

  19. Rationale for training programs to reduce anterior cruciate ligament injuries in Australian football.

    Science.gov (United States)

    Lloyd, D G

    2001-11-01

    This commentary presents the rationale for training programs to reduce the incidence of knee injuries. Our studies have revealed that the external knee loading patterns during sidestep cutting are what put the anterior cruciate ligament at greatest risk for injury. Compared to running, sidestep cutting involves similar levels of knee flexion loading but increased loading in varus-valgus and internal rotation of the knee, and these external loads need to be stabilized or supported by the internal structures of the knee. People use a generalized hamstrings and quadriceps co-contraction to stabilize these external loads, thereby reducing ligament loading. It is proposed that perturbation of the joint receptors reinforces the use of selective hamstrings and quadriceps co-contraction patterns superimposed on a generalized co-contraction pattern. This is not by immediate ligamento-muscular protective reflex, which is too slow to provide any adequate support, but by enhanced proprioceptive information that may be used in learning. In contrast, the immediate effect of muscle stretch reflexes would be to reduce co-contraction, a possibly negative outcome for joint stabilization. The effects of different types of training on the control of joint stability are examined. It is proposed that resistance training may not be appropriate because it enhances muscle stretch reflexes, which may reduce co-contraction, and produces no reductions in voluntary activation times and time to peak torque. However, stability and balance training is thought to suppress muscle stretch reflexes and, in turn, enhance co-contraction. Also, stability and balance training that stimulates the knee joint ligament and capsular receptors may reinforce co-contraction patterns to facilitate greater improvements in joint stabilization. Stability and balance training and plyometric training produce reductions in voluntary activation times and times to peak torque, which may decrease muscle response times so

  20. Double-bundle versus single-bundle in arthroscopic anatomical reconstruction of anterior cruciate ligament with semi-tendinosus allografts%关节镜下同种异体半腱肌腱重建前交叉韧带单束与双束解剖重建的近期疗效比较

    Institute of Scientific and Technical Information of China (English)

    王宇飞; 白伦浩; 李彬

    2012-01-01

    [目的]比较关节镜下采用同种异体半腱肌腱单束与双束解剖重建前交叉韧带(anterior cruciate ligament,ACL)的近期临床疗效.[方法]回顾性分析2010年1月—2011年1月间,在中国医科大学附属盛京医院关节骨科接受ACL重建的病例及随访资料.根据手术方式的不同将病例分为单束组(n=32)和双束组(n=31),分别比较两组病例术前、术后的关节稳定度及活动度,功能评分,康复情况.[结果]63例患者术后于3~6个月(首次)和12 ~18个月(末次)获得随访.KNEELAX3:单束组平均为(2.14±1.30) mm(首次)、(1.97±1.28)mm(末次),双束组为(1.78±0.98) mm(首次)、(1.46±0.73)mm(末次);Lachman试验:与健侧相比,单束组正常者(-)占81.25%(首次)、81.25%(末次),双束组占83.87%(首次)、87.10%(末次);IKDC评分:单束组正常者(A级)占62.50%(首次)、68.75%(末次),双束组占77.42%(首次)、80.65%(末次);Tegner评分:末次随访时单束组为6.03±0.54,双束组为6.00 ±0.58;以上数据双束组与单束组比较差异无显著性意义(P>0.05).轴移试验:与健侧相比,单束组正常者(-)占62.50%(首次)、68.75%(末次),双束组占87.10%(首次)、90.32%(末次);Lysholm 评分:单束组为85.66±5.94(首次)、93.28±3.87(末次),双束组为88.77±6.13(首次)、96.23 ±2.64(末次);Tegner评分:首次随访时单束组为3.78±0.79,双束组为4.26±1.00;以上数据双束组与单束组比较差异有显著性意义(P<0.05).[结论]双束解剖重建ACL能够更好地恢复患者膝关节的稳定性;能够更早地恢复患者的运动水平;相对于单束解剖重建,双束解剖重建ACL更有助于恢复膝关节的旋转稳定性.%[ Results] The 63 patients received 2 follow - ups at about 3 to 6 months and 12 to 18 months after operation, respectively. KNEELAX3 test showed a mean of (2. 14 ± 1. 30) mm (follow - up 1) , (1. 97 ± 1. 28) mm (follow - up 2) in the single -bundle group and a mean of ( 1

  1. Intra-articular pathology associated with isolated posterior cruciate ligament injury on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Ringler, Michael D.; Collins, Mark S.; Howe, B.M. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Shotts, Ezekiel E. [NEA Baptist Clinic, Jonesboro, AR (United States)

    2016-12-15

    Unlike with anterior cruciate ligament injury, little is known about the prevalence of intra-articular pathology associated with isolated posterior cruciate ligament (PCL) injury in the knee. The objectives of this study were to characterize and identify the frequency of meniscal tears and osteochondral injuries in these patients, and to see if management might be affected. Altogether, 48 knee MRI exams with isolated PCL tears were evaluated for the presence of: grade and location of PCL tear, meniscal tear, articular chondral lesion, bone bruise, and fracture. Comparisons between PCL tear grade and location, as well as mechanism of injury when known, with the presence of various intra-articular pathologies, were made using the chi-square or Fisher's exact test as appropriate. In all, 69 % of isolated PCL tears occur in the midsubstance, 27 % proximally. Meniscal tears were seen in 25 % of knees, involving all segments of both menisci, except for the anterior horn medial meniscus. Altogether, 23 % had focal cartilage lesions, usually affecting the central third medial femoral condyle and medial trochlea, while 12.5 % of knees had fractures, and 48 % demonstrated bone bruises, usually involving the central to anterior tibiofemoral joint. The presence of a fracture (p = 0.0123) and proximal location of PCL tear (p = 0.0016) were both associated with the hyperextension mechanism of injury. There were no statistically significant associations between PCL tear grade and presence of intra-articular abnormality. Potentially treatable meniscal tears and osteochondral injuries are relatively prevalent, and demonstrable on MRI in patients with isolated acute PCL injury of the knee. (orig.)

  2. Unique Anatomic Feature of the Posterior Cruciate Ligament in Knees Associated With Osteochondritis Dissecans

    Science.gov (United States)

    Ishikawa, Masakazu; Adachi, Nobuo; Yoshikawa, Masahiro; Nakamae, Atsuo; Nakasa, Tomoyuki; Ikuta, Yasunari; Hayashi, Seiju; Deie, Masataka; Ochi, Mitsuo

    2016-01-01

    Background: Osteochondritis dissecans (OCD) of the knee is a disorder in juveniles and young adults; however, its etiology still remains unclear. For OCD at the medial femoral condyle (MFC), it is sometimes observed that the lesion has a connection with fibers of the posterior cruciate ligament (PCL). Although this could be important information related to the etiology of MFC OCD, there is no report examining an association between the MFC OCD and the PCL anatomy. Purpose: To investigate the anatomic features of knees associated with MFC OCD, focusing especially on the femoral attachment of the PCL, and to compare them with knees associated with lateral femoral condyle (LFC) OCD and non-OCD lesions. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed 39 patients (46 knees) with OCD lesions who had undergone surgical treatment. Using magnetic resonance imaging (MRI) scans, the PCL attachment at the lateral wall of the MFC was measured on the coronal sections, and the knee flexion angle was also measured on the sagittal sections. As with non-OCD knees, we reviewed and analyzed 25 knees with anterior cruciate ligament (ACL) injuries and 16 knees with meniscal injuries. Results: MRIs revealed that the femoral PCL footprint was located in a significantly more distal position in the patients with MFC OCD compared with patients with LFC OCD and ACL and meniscal injuries. There was no significant difference in knee flexion angle among the 4 groups. Conclusion: The PCL in patients with MFC OCD attached more distally at the lateral aspect of the MFC compared with knees with LFC OCD and ACL and meniscal injuries. PMID:27294170

  3. A Study on the Results of Reconstructing Posterior Cruciate Ligament Using Graft from Quadriceps Muscle Tendon

    Directory of Open Access Journals (Sweden)

    K Nazem

    2004-06-01

    Full Text Available Background: Many of the knees affected by rupture of the posterior cruciate ligament (PCL lack their desirable function. Researchers are currently seeking surgical procedures for treating PCL rupture, which can offer a reliable degree of objective and subjective knee stability after surgery. This study assesses the results of anatomical reconstruction of PCL using graft from the tendon of the quadriceps muscle. Methods: This is a descriptive prospective study involving 14 patients with clinical diagnosis of PCL rupture. The patients complained of knee discomfort in spite of conservative treatment and many sessions of physiotherapy. Subjective symptoms of knee instability, i.e. giving way, pain after long walks and pain during climbing, as well as objective knee instability symptoms as assessed by posterior drawer test at 30° and 90° knee flexion, and neutral rotation were recorded and compared prior to and after surgery. The procedure entailed anatomical reconstruction of PCL using grafts taken from the tendon of quadriceps muscle and part of proximal patella. Results: Two patients were excluded from the study due to their failure to refer for follow-up. The patients included 11 men and 1 woman with a mean age of 23 years. The patients displayed statistically significant improvement after surgery as regards subjective symptoms, i.e. giving way, pain after long walks and pain in climbing. Objective knee instability symptoms as evaluated by posterior drawer test at 30° and 90° knee flexion and neutral rotation also showed significant improvement compared to pre-operation findings. Conclusion: Reconstruction of PCL is aimed at achieving normal knee kinematics and stability. The procedure used in this study entailed anatomical reconstruction of PCL. Given the objective and subjective results obtained, the use of this procedure is recommended by authors as the method of choice for reconstructing PCL. Keywords: Posterior Cruciate Ligament, Knee

  4. Differences in hip-knee joint coupling during gait after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Gribbin, Timothy C; Slater, Lindsay V; Herb, C Collin; Hart, Joseph M; Chapman, Ryan M; Hertel, Jay; Kuenze, Christopher M

    2016-02-01

    After anterior cruciate ligament injury, patients have increased risk for developing degenerative osteoarthritis, potentially due to the kinematic changes that persist after surgical reconstruction. Current research only describes single joint kinematic differences rather than the way in which two joints behave concurrently, termed joint coupling. The purpose of this study was to compare knee motion relative to hip motion in anterior cruciate ligament reconstructed and healthy limbs during walking and jogging. Thirty-seven recreationally active volunteers (22 reconstructed, 15 healthy) walked and jogged at 4.83 km/h and 9.66 km/h respectively. Vector coding methods were used to calculate stride-to-stride variability, magnitude, and vector angle of 6 joint couples during walking and jogging: hip frontal-knee frontal planes, hip frontal-knee sagittal, hip frontal-knee transverse, hip sagittal-knee frontal, hip sagittal-knee transverse, and hip transverse-knee frontal planes. The hip sagittal-knee frontal and hip sagittal-knee transverse joint couples had decreased variability during mid-stance, and all other couples had increased variability during the stance phase in the reconstructed group. The reconstructed group had decreased magnitude of joint excursion in the hip frontal-knee sagittal couple during all phases of gait during walking. Vector angles of the hip frontal-knee transverse couple increased in the reconstructed group during the loading, middle, and terminal stance phases, and swing phase of gait during walking. The increased variability and decreased magnitude of joint excursion indicate that movement patterns were less consistent during walking gait despite employing a more constrained system during movement in the reconstructed limb compared to healthy controls. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Medio-lateral Knee Fluency in Anterior Cruciate Ligament-Injured Athletes During Dynamic Movement Trials

    Science.gov (United States)

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

    2016-01-01

    Background Correction of neuromuscular impairments after anterior cruciate ligament injury is vital to successful return to sport. Frontal plane knee control during landing is a common measure of lower-extremity neuromuscular control and asymmetries in neuromuscular control of the knee can predispose injured athletes to additional injury and associated morbidities. Therefore, this study investigated the effects of anterior cruciate ligament injury on knee biomechanics during landing. Methods Two-dimensional frontal plane video of single leg drop, cross over drop, and drop vertical jump dynamic movement trials was analyzed for twenty injured and reconstructed athletes. The position of the knee joint center was tracked in ImageJ software for 500 milliseconds after landing to calculate medio-lateral knee motion velocities and determine normal fluency, the number of times per second knee velocity changed direction. The inverse of this calculation, analytical fluency, was used to associate larger numerical values with fluent movement. Findings Analytical fluency was decreased in involved limbs for single leg drop trials (P=0.0018). Importantly, analytical fluency for single leg drop differed compared to cross over drop trials for involved (P<0.001), but not uninvolved limbs (P=0.5029). For involved limbs, analytical fluency values exhibited a stepwise trend in relative magnitudes. Interpretation Decreased analytical fluency in involved limbs is consistent with previous studies. Fluency asymmetries observed during single leg drop tasks may be indicative of abhorrent landing strategies in the involved limb. Analytical fluency differences in unilateral tasks for injured limbs may represent neuromuscular impairment as a result of injury. PMID:26895446

  6. Grading Anterior Cruciate Ligament Graft Injury after Ligament Reconstruction Surgery: Diagnostic Efficacy of Oblique Coronal MR Imaging of the Knee

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Sung Gyu; Hong, Sung Hwan; Choi, Ja Young; Jun, Woo Sun; Choi, Jung Ah; Park, Eun Ah; Kang, Heung Sik; Kwon, Jong Won [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2008-04-15

    Objective : The purpose of this study was to evaluate the diagnostic efficacy of using additional oblique coronal MRI of the knee for grading anterior cruciate ligament (ACL) graft injury after ligament reconstruction surgery. Materials and Methods : We retrospectively reviewed 51 consecutive MR knee examinations of 48 patients who underwent both ACL reconstruction and follow-up arthroscopy. The MR examinations included the orthogonal axial, sagittal, coronal images and the oblique coronal T2-weighted images, which were oriented in parallel with the course of the femoral intercondylar roof. Two radiologists independently evaluated the status of the ACL grafts with using the routine knee MRI and then with adding the oblique coronal imaging. The severity of ACL graft injury was graded using a 3-point system from MR images as intact, partial tear or complete tear, and the results were compared with the arthroscopic results. Weighted kappa statistics were used to analyze the diagnostic accuracies of the knee MRI with and without the additional oblique coronal imaging. For each evaluation, the observers reported a confidence level for grading the ACL graft injuries in the two imaging groups. Result : The weighted kappa values according to the routine knee MRI were 0.555 (reader 1) and 0.515 (reader 2). The inclusion of additional oblique coronal imaging increased the weighted kappa values to 0.666 (reader 1) and 0.611 (reader 2). The mean confidence levels by each reader were significantly higher (p < 0.01, paired t-test) with the additional oblique coronal imaging than by using the routine knee MRI alone. Conclusion : The additional use of oblique coronal MRI of the knee improves both the diagnostic accuracy and confidence for grading ACL graft injury.

  7. MRI on diagnosis of cyst of cruciate ligaments%膝关节交叉韧带囊肿的MRI诊断

    Institute of Scientific and Technical Information of China (English)

    张振勇

    2010-01-01

    Objective To explore the diagnosis valueof MRI for cruciate ligaments cyst. Methods 12 cases were retrospectively analyzed the data of the anterior cruciate ligament cyst MRI showed and arthroscopic surgery. Results Found in 12 cases of anterior cruciate ligament in 3 patients, 1 cases of after a cruciate ligament, after posterior cruciate ligament to 1. Between the an(t)erior and the posterior cruciale ligament in 7 patients. MRI diagnosis cruciate ligament cyst and arthroscopic surgery coincidence rate was 100%. Conclusion MRI can clearly show the cruciate ligaments cyst, shape, size and structure of the relationship, and the diagnosis, treatment can establish the effective means.%目的 探讨MRI对交叉韧带囊肿的诊断价值.方法 回顾性分析12例资料完整的交叉韧带囊肿MRI表现并与关节镜手术对照.结果 12例中发生于前交叉韧带内3例;后交叉韧带内1例;紧贴后交叉韧带后方1例;前后交叉韧带之间7例.MRI诊断交叉韧带囊肿与关节镜手术符合率100%.结论 MRI能清晰显示交叉韧带囊肿的部位、形态、大小以及与周围结构的关系,是唯一能够确立诊断、指导治疗的有效手段.

  8. MR for assessing anterior cruciate ligament reconstructions by tendon grafts. Die Kernspintomographie zur Beurteilung des vorderen Kreuzbandersatzes mit Sehnentransplantaten

    Energy Technology Data Exchange (ETDEWEB)

    Allgayer, B.; Lehner, K.; Gewalt, Y. (Klinikum rechts der Isar, Muenchen (Germany). Inst. fuer Roentgendiagnostik); Gradinger, R.; Flock, K. (Klinikum rechts der Isar, Muenchen (Germany). Orthopaedische Klinik und Poliklinik)

    1991-10-01

    150 patients were examined via magnetic resonance (MR) after anterior cruciate (ACL) ligament reconstruction (76 patellar tendon grafts, 53 semitendinosous tendon grafts and 21 sutures). The results of MR were compared with clinical tests (Lachman, pivot-shift and anterior drawer test), in 2 cases with the operative findings, and in one case with arthroscopy findings. In 91% of patients with a clinically stable knee we found a continuous low-intensity ligamental structure. 10 patients were examined twice or more between 8 days and 6 months after surgery. Ligamental structures of low signal intensity did not significantly change their MR characteristics. MR is a valuable noninvasive method for evaluating ligament reconstructions. (orig./GDG).

  9. The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

    Directory of Open Access Journals (Sweden)

    David Simon

    2015-01-01

    Full Text Available Anterior cruciate ligament (ACL tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the normal physiologic knee bending culminating in increased anterior tibial translation and increased internal tibial rotation. This leads to increased mean contact stresses in the posterior medial and lateral compartments under anterior and rotational loading. However, surgical reconstruction of the ACL has not been shown to reduce the risk of future OA development back to baseline and has variability based on operative factors of graft choice, timing of surgery, presence of meniscal and chondral abnormalities, and surgical technique. Known strategies to prevent OA development are applicable to patients with ACL deficiency or after ACL reconstruction and include weight management, avoidance of excessive musculoskeletal loading, and strength training. Reconstruction of the ACL does not necessarily prevent osteoarthritis in many of these patients and may depend on several external variables.

  10. Motor coordination during gait after anterior cruciate ligament injury: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Gustavo Leporace

    2013-08-01

    Full Text Available To investigate the state of art about motor coordination during gait in patients with anterior cruciate ligament (ACL injury. Searches were carried out, limited from 1980 to 2010, in various databases with keywords related to motor coordination, gait and ACL injury. From the analysis of titles and applying the inclusion/exclusion criteria 24 studies were initially selected and, after reading the abstract, eight studies remained in the final analysis. ACL deficient patients tend to have a more rigid and less variable gait, while injured patients with ACL reconstruction have less rigid and more variable gait with respect to healthy individuals. The overall results suggest the existence of differences in motor coordination between the segments with intact and those with injured knee, regardless of ligament reconstruction. ACL injured patients present aspects related to the impairment of the capability to adapt the gait pattern to different environmental conditions, possibly leading to premature knee degeneration. However, the techniques used for biomechanical gait data processing are limited with respect to obtaining information that leads to the development of intervention strategies aimed at the rehabilitation of that injury, since it is not possible to identify the location within the gait cycle where the differences could be explained.

  11. Trends in primary and revision anterior cruciate ligament reconstruction among National Basketball Association team physicians.

    Science.gov (United States)

    Mall, Nathan A; Abrams, Geoffrey D; Azar, Frederick M; Traina, Steve M; Allen, Answorth A; Parker, Richard; Cole, Brian J

    2014-06-01

    Anterior cruciate ligament (ACL) tears are common in athletes. Techniques and methods of treatment for these injuries continue to vary among surgeons. Thirty National Basketball Association (NBA) team physicians were surveyed during the NBA Pre-Draft Combine. Survey questions involved current and previous practice methods of primary and revision ACL reconstruction, including technique, graft choice, rehabilitation, and treatment of combined ACL and medial collateral ligament injuries. Descriptive parametric statistics, Fisher exact test, and logistic regression were used, and significance was set at α = 0.05. All 30 team physicians completed the survey. Eighty-seven percent indicated they use autograft (81% bone-patellar tendon-bone) for primary ACL reconstruction in NBA athletes, and 43% indicated they use autograft for revision cases. Fourteen surgeons (47%) indicated they use an anteromedial portal (AMP) for femoral tunnel drilling, whereas 5 years earlier only 4 (13%) used this technique. There was a significant (P = .009) positive correlation between fewer years in practice and AMP use. NBA team physicians' use of an AMP for femoral tunnel drilling has increased over the past 5 years.

  12. Anterior Cruciate Ligament Injury: Compensation during Gait using Hamstring Muscle Activity.

    Science.gov (United States)

    Catalfamo, Paola Formento; Aguiar, Gerardo; Curi, Jorge; Braidot, Ariel

    2010-06-10

    Previous research has shown that an increase in hamstring activation may compensate for anterior tibial transalation (ATT) in patients with anterior cruciate ligament deficient knee (ACLd); however, the effects of this compensation still remain unclear. The goals of this study were to quantify the activation of the hamstring muscles needed to compensate the ATT in ACLd knee during the complete gait cycle and to evaluate the effect of this compensation on quadriceps activation and joint contact forces. A two dimensional model of the knee was used, which included the tibiofemoral and patellofemoral joints, knee ligaments, the medial capsule and two muscles units. Simulations were conducted to determine the ATT in healthy and ACLd knee and the hamstring activation needed to correct the abnormal ATT to normal levels (100% compensation) and to 50% compensation. Then, the quadriceps activation and the joint contact forces were calculated. Results showed that 100% compensation would require hamstring and quadriceps activations larger than their maximum isometric force, and would generate an increment in the peak contact force at the tibiofemoral (115%) and patellofemoral (48%) joint with respect to the healthy knee. On the other hand, 50% compensation would require less force generated by the muscles (less than 0.85 of maximum isometric force) and smaller contact forces (peak tibiofemoral contact force increased 23% and peak patellofemoral contact force decreased 7.5% with respect to the healthy knee). Total compensation of ATT by means of increased hamstring activity is possible; however, partial compensation represents a less deleterious strategy.

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  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 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 nano-HAp. The addition of nano-HAp showed an increase in cell viability compared to scaffolds crosslinked without nanoparticles. It is concluded that attaching AuNP and nano-HAp to extracellular matrices may improve overall properties.

  15. Expression of modulators of extracellular matrix structure after anterior cruciate ligament injury.

    Science.gov (United States)

    Haslauer, Carla M; Proffen, Benedikt L; Johnson, Victor M; Murray, Martha M

    2014-01-01

    The ability of the anterior cruciate ligament (ACL) to heal after injury declines within the first 2 weeks after ACL rupture. To begin to explore the mechanism behind this finding, we quantified the expression of genes for collagen I and III, decorin, tenascin-C, and alpha smooth muscle actin, as well as matrix metalloproteinase (MMP)-1 and -13 gene expression within multiple tissues of the knee joint after ACL injury in a large animal model over a 2-week postinjury period. Gene expression of collagen I and III, decorin, and MMP-1 was highest in the synovium, whereas the highest MMP-13 gene expression levels were found in the ACL. The gene expression for collagen and decorin increased over the 2 weeks to levels approaching that in the ligament and synovium; however, no significant increase in either of the MMPs was found in the provisional scaffold. This suggests that although the ACL and synovium up-regulate both anabolic and catabolic factors, the provisional scaffold is primarily anabolic in function. The relative lack of provisional scaffold formation within the joint environment may thus be one of the key reasons for ACL degradation after injury.

  16. Quantifying in vivo laxity in the anterior cruciate ligament and individual knee joint structures.

    Science.gov (United States)

    Westover, L M; Sinaei, N; Küpper, J C; Ronsky, J L

    2016-11-01

    A custom knee loading apparatus (KLA), when used in conjunction with magnetic resonance imaging, enables in vivo measurement of the gross anterior laxity of the knee joint. A numerical model was applied to the KLA to understand the contribution of the individual joint structures and to estimate the stiffness of the anterior-cruciate ligament (ACL). The model was evaluated with a cadaveric study using an in situ knee loading apparatus and an ElectroForce test system. A constrained optimization solution technique was able to predict the restraining forces within the soft-tissue structures and joint contact. The numerical model presented here allowed in vivo prediction of the material stiffness parameters of the ACL in response to applied anterior loading. Promising results were obtained for in vivo load sharing within the structures. The numerical model overestimated the ACL forces by 27.61-92.71%. This study presents a novel approach to estimate ligament stiffness and provides the basis to develop a robust and accurate measure of in vivo knee joint laxity.

  17. Isometric exercises with elements postisometric relaxation to eliminate the knee joint contracture after arthroscopic plastics of anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Pylypenko O.V.

    2014-02-01

    Full Text Available Purpose : to determine the efficiency of isometric exercises and post isometric relaxation of character for removal and prevention of contractures and recovery of motor function after arthroscopic reconstruction of the anterior cruciate ligament in the late postoperative period. Material: The study involved 22 patients aged less than 40 years. Results: The results showed that the level of pain decreased equally in patients of main and control group from 3 to 0 points, the performance difference in the amplitude of the bending of the knee joint during the goniometry in the treatment group was 70 in the control group – 30 and the extension 10 – fixed, reaching 5 hyperextension and not changed in the control group. Conclusions: The use of isometric exercises and post isometric relaxation prevent postoperative contracture of the knee joint. Methods of their application are recommended for use in the comprehensive rehabilitation of patients after arthroscopic plastics anterior cruciate ligament.

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

    Directory of Open Access Journals (Sweden)

    Huang ME Deborah

    2012-07-01

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

  19. Retention of the posterior cruciate ligament versus the posterior stabilized design in total knee arthroplasty : a prospective randomized controlled clinical trial

    NARCIS (Netherlands)

    van den Boom, L.G.H.; Brouwer, R.W.; van den Akker-Scheek, I.; Bulstra, S.K.; van Raaij, J.J.A.M.

    2009-01-01

    Background: Prosthetic design for the use in primary total knee arthroplasty has evolved into designs that preserve the posterior cruciate ligament (PCL) and those in which the ligament is routinely sacrificed (posterior stabilized). In patients with a functional PCL the decision which design is cho

  20. Low Prevalence of Anterior and Posterior Cruciate Ligament Injuries in Patients With Achondroplasia.

    Science.gov (United States)

    Brooks, Jaysson T; Ramji, Alim F; Lyapustina, Tatyana A; Yost, Mary T; Ain, Michael C

    2017-01-01

    Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries and their subsequent reconstructions are common in the general population, but there has been no research regarding ACL or PCL injuries in patients with achondroplasia, the most common skeletal dysplasia. Our goals were to (1) evaluate the prevalence of ACL and PCL injuries in adolescents and adults with achondroplasia, (2) compare this prevalence with that reported for the general population, (3) determine how many patients with ACL or PCL injuries underwent ligament reconstruction as treatment, and (4) determine patient activity levels as they relate to the rate of ACL/PCL injuries and reconstructions. We reviewed medical records of 430 patients with achondroplasia seen in the senior author's clinic from 2002 through 2014. Demographic data were reviewed, as well as any documentation of ACL or PCL injury or reconstruction. We called all 430 patients by telephone, and 148 agreed to participate in our survey, whereas 1 declined. We asked these patients about their history of ACL or PCL injury or reconstruction, as well as current and past physical activity levels. No ACL or PCL injuries were found on chart review. One patient reached by telephone reported an ACL injury that did not require reconstruction. This yielded a theoretical prevalence of 3/430 (0.7%). Of the 148 patients surveyed, 43 (29%) reported low physical activity, 75 (51%) reported moderate physical activity, and 26 (17%) reported high physical activity. There was no significant difference in the rate of ACL injury when stratified by physical activity level (P=0.102). ACL and PCL injuries and reconstructions are extremely rare in patients with achondroplasia, which cannot be completely ascribed to a low level of physical activity. One possible explanation is that patients with achondroplasia, on an average, have a more anterior tibial slope compared with those without achondroplasia, which decreases the force generated

  1. 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...

  2. High Psychological Competitive Ability Is Related to Incidence of Anterior Cruciate Ligament Injury in High School Female Athletes

    OpenAIRE

    2014-01-01

    Objectives: In a competitive sport situation, not only the exertions of performance but also the incidence of injury can be influenced by psychological factors. In recent years, the focus on anterior cruciate ligament (ACL) injury prevention has increased and many studies exploring risk factors for ACL injury have been published. However, the influence of psychological factors on ACL injuries is poorly documented. The purpose of this study was to investigate the relationship between psycholog...

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

    OpenAIRE

    Duncan KJ; Chopp-Hurley JN; Maly MR

    2016-01-01

    Koji J Duncan, Jaclyn N Chopp-Hurley, Monica R Maly School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada Purpose: Among a variety of conservative and surgical options to treat anterior cruciate ligament (ACL) injuries, we do not understand which options could potentially prevent knee osteoarthritis (OA). The aim of this systematic review was to examine the evidence pertaining to exercise treatment of ACL injuries in the context of knee OA. Methods: Medline, Embase, CIN...

  4. Temperature Measurements in Rehabilitation in Patients with Completely Ruptured Anterior Cruciate Ligament before and after RegentK and Physiotherapy

    OpenAIRE

    Litscher, Gerhard; Litscher, Daniela; Ofner, Michael; Gaischek, Ingrid; Malliga, Daniela-Eugenia

    2014-01-01

    Acute skin surface temperature effects on the knee were investigated after a manual therapy developed by Mohamed Khalifa (RegentK) compared to standard physiotherapy in patients with completely ruptured anterior cruciate ligament (ACL). Twenty patients participated in this study. They were randomly assigned to group A (receiving RegentK) or group B (physiotherapy). Each group consisted of 10 patients. Temperature values were registered on four spots (three on the knee, one on the foot) of the...

  5. Effect of physiotherapy on the strength of tibial internal rotator muscles in males after anterior cruciate ligament reconstruction (ACLR)

    OpenAIRE

    Czamara, Andrzej; Szuba, Łukasz; Krzemińska, Aleksandra; Tomaszewski, Wiesław; Wilk-Frańczuk, Magdalena

    2011-01-01

    Summary Background The goal of this study was to evaluate the effect of physiotherapy on the strength of muscles responsible for tibial internal rotation (IR) in male patients after anterior cruciate ligament reconstruction (ACLR) using autografts of the semitendinosus and gracilis muscles (STGR). Material/Methods Fifty-nine males were examined. The first group consisted of 19 patients subjected to 4-stage physiotherapy following ACLR. The second group consisted of 20 males without knee injur...

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

    OpenAIRE

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

    2013-01-01

    Background Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after prima...

  7. Histological and biochemical characteristics of the rabbit anterior cruciate ligament in comparison to potential autografts.

    Science.gov (United States)

    Hoyer, Mariann; Meier, Carola; Kohl, Benjamin; Lohan, Anke; Kokozidou, Maria; Schulze-Tanzil, Gundula

    2016-08-01

    Tissue engineering of an anterior cruciate ligament (ACL) implant with ACL cells requires detailed analysis of the tissue characteristics that should be mimicked. Therefore, we studied the histological and biochemical properties of rabbit derived ACLs in comparison to other knee-associated tendons that are used as autografts in men. Rabbit derived ACLs and Musculus (M.) semimembranosus, M. semitendinosus tendons and patellar ligaments were explanted from adult New Zealand white rabbits and analyzed histologically for tissue organization (e.g. cellularity, nuclear shapes, elastic fibers), total collagen and sulfated glycosaminoglycan (sGAG) contents. Gene expression analysis was performed for the main extracellular matrix (ECM) components type I collagen, decorin and the glycoprotein tenomodulin. The ACLs had a dimension of 1.39x0.39x0.1 cm in situ. They were characterized by high sGAG content in comparison to the other tendons/ligaments, whereas the total collagen content did not differ. ACLs possessed higher cellularity and lower feret diameter of the cell nuclei compared with the investigated rabbit-derived tendons. In ACLs long elastic fibers were observed. Concerning the gene expression level, lower transcription of tenomodulin was detected in the ACL compared with the other tendons, without significant difference in the decorin gene expression. The M. semitendinosus tendon had a significantly higher type I collagen expression than the ACL and the other investigated tendons. This phenotypical characterization of the lapine ACL presented in this study provides some key standards to evaluate tissue engineered ACL constructs to be tested in the rabbit model.

  8. A report of the Maquet procedure for the management of cranial cruciate ligament rupture in a dog - a case report

    Directory of Open Access Journals (Sweden)

    Danilo Roberto Custódio Marques

    2017-03-01

    Full Text Available Cranial cruciate ligament rupture is the major cause of lameness and degenerative joint disease in the canine stifle. The cause of this disease is multifactorial, especially involving degenerative and inflammatory changes. Many techniques have been described for the management of this condition, and current recommendations include the use of corrective osteotomies, most recently using the Maquet (or modified Maquet procedure. This technique is fundamentally similar to the classical tibial tuberosity advancement (TTA, but without the use of the bone plate. The main advantages of using this technique are a shorter operative time and less use of implants. The main complication of this technique is an increased risk of tibial crest fracture. This report describes the Maquet technique for the treatment of a three-year-old male West White Terrier dog with rupture of the cranial cruciate ligament. Cruciate ligament rupture was diagnosed by a positive cranial tibial drawer test. Mediolateral stifle radiography performed under anesthesia with the stifle in 135° of extension demonstrated a tibial plateau angle of 22°. A cage of six millimeters was necessary to allow advancement. The Maquet technique produced excellent post-operative results, including early weight-bearing and neutralization of the cranial tibial drawer. The consolidation time of the osteotomy was 63 days.

  9. Clinical outcome of primary medial collateral ligament-posteromedial corner repair with or without staged anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Pandey, Vivek; Khanna, Vikrant; Madi, Sandesh; Tripathi, Anshul; Acharya, Kiran

    2017-06-01

    Medial collateral ligament (MCL) is a prime valgus stabilizer of the knee, and MCL tears are currently managed conservatively. However, posteromedial corner (PMC) injury along with MCL tear is not same as isolated MCL tear and the former is more serious injury and requires operative attention. However, literature is scarce about the management and outcome of PMC-MCL tear alongside anterior cruciate ligament (ACL) tear. The purpose of this study is to report the clinical outcome of primary repair of MCL and PMC with or without staged ACL reconstruction. A retrospective evaluation was performed on patients with MCL-PMC complex injury with ACL tear who underwent primary repair of MCL-PMC tear followed by rehabilitation. Further, several of them chose to undergo ACL reconstruction whereas rest opted conservative treatment for the ACL tear. A total of 35 patients of two groups [Group 1 (n=15): MCL-PMC repaired and ACL conserved; Group 2 (n=20): MCL-PMC repaired and ACL reconstructed] met the inclusion criteria with a minimum follow-up of two years. Clinical outcome measures included grade of valgus medial opening (0° extension and 30° flexion), Lysholm and International knee documentation committee (IKDC) scores, KT-1000 measurement, subjective feeling of instability, range of motion (ROM) assessment and complications. While comparing group 2 versus group 1, mean Lysholm (94.6 vs. 91.06; p=0.017) and IKDC scores (86.3 vs. 77.6; p=0.011) of group 2 were significantly higher than group 1. 60% patients of group 1 complained of instability against none in the group 2 (p<0.0001). All the knees of both the groups were valgus stable with none requiring late reconstruction. The mean loss of flexion ROM in group 1 and 2 was 12° and 9° respectively which was not statistically different (p=0.41). However while considering the loss of motion, two groups did not show any significant difference in clinical scores. Primary MCL-PMC repair renders the knee stable in coronal plane in

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

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    Parag Suresh Mahajan

    2015-01-01

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

  11. Tibial inlay press-fit fixation versus interference screw in posterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Max Ettinger

    2013-11-01

    Full Text Available Reconstruction of the posterior cruciate ligament (PCL by a tibial press-fit fixation of the patellar tendon with an accessory bone plug is a promising approach because no foreign materials are required. Until today, there is no data about the biomechanical properties of such press-fit fixations. The aim of this study was to compare the biomechanical qualities of a bone plug tibial inlay technique with the commonly applied interference screw of patellar tendon PCL grafts. Twenty patellar tendons including a bone block were harvested from ten human cadavers. The grafts were implanted into twenty legs of adult German country pigs. In group P, the grafts were attached in a press-fit technique with accessory bone plug. In group S, the grafts were fixed with an interference screw. Each group consisted of 10 specimens. The constructs were biomechanically analyzed in cyclic loading between 60 and 250 N for 500 cycles recording elongation. Finally, ultimate failure load and failure mode were analyzed. Ultimate failure load was 598.6±36.3 N in group P and 653.7±39.8 N in group S (not significant, P>0.05. Elongation during cyclic loading between the 1st and the 20th cycle was 3.4±0.9 mm for group P and 3.1±1 mm for group S. Between the 20th and the 500th cycle, elongation was 4.2±2.3 mm in group P and 2.5±0.9 mm in group S (not significant, P>0.05. This is the first study investigating the biomechanical properties of tibial press-fit fixation of the patellar tendon with accessory bone plug in posterior cruciate ligament reconstruction. The implant-free tibial inlay technique shows equal biomechanical characteristics compared to an interference screw fixation. Further in vivo studies are desirable to compare the biological behavior and clinical relevance of this fixation device.

  12. Microanatomy on blood supply system in human knee cruciate ligament%人膝关节交叉韧带血供的显微解剖学研究

    Institute of Scientific and Technical Information of China (English)

    何正; 张祚勇; 赵晓东; 张勇

    2011-01-01

    Objective To investigate the configuration of the blood supply system in human knee cruciate ligament. Methods Twelve cruciate ligaments derived from the knee joints of 6 healthy adult cadavers were observed under naked eyes, and then dissected and observed under a microscope. Three groups of anterior cruciate ligaments and posterior cruciate ligaments, randomly selected from the twelve cruciate ligaments, were observed through histotomy and HE staining. Results Blood vessels were found throughout the human knee cruciate ligaments, and the calibers of the blood vessels varied between 0.03 ±0.01 mm and 0.09 ±0.02 mm in different segments. Blood vessels and adipose tissues were abundantly found in the bands between the anterior cruciate ligaments and posterior cruciate ligaments, and the surface blood vessel calibers were not larger than 0.18 ± 0.04 mm. Conclusiorn The human knee cruciate ligaments possess enough blood vessels to show promise in self repair.%目的 探讨人类膝关节交叉韧带血供系统的具体形态.方法 对12侧交叉韧带健康成人尸体膝关节进行肉眼和手术显微镜下解剖、组织学断层切片观察.结果 交叉韧带全段均可见血管纵行交错分布,血管口径呈节段性变化,血管口径(0.03±0.01)~(0.09±0.02)mm.交叉韧带间束中存在大量的血管及脂肪组织,其表面血管口径最大为(0.18±0.04)mm.结论 交叉韧带本身拥有足够充分的血供来源,存在自我修复的可能.

  13. Use of a strontium-enriched calcium phosphate cement in accelerating the healing of soft-tissue tendon graft within the bone tunnel in a rabbit model of anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Kuang, G M; Yau, W P; Lu, W W; Chiu, K Y

    2013-07-01

    We investigated whether strontium-enriched calcium phosphate cement (Sr-CPC)-treated soft-tissue tendon graft results in accelerated healing within the bone tunnel in reconstruction of the anterior cruciate ligament (ACL). A total of 30 single-bundle ACL reconstructions using tendo Achillis allograft were performed in 15 rabbits. The graft on the tested limb was treated with Sr-CPC, whereas that on the contralateral limb was untreated and served as a control. At timepoints three, six, nine, 12 and 24 weeks after surgery, three animals were killed for histological examination. At six weeks, the graft-bone interface in the control group was filled in with fibrovascular tissue. However, the gap in the Sr-CPC group had already been completely filled in with new bone, and there was evidence of the early formation of Sharpey fibres. At 24 weeks, remodelling into a normal ACL-bone-like insertion was found in the Sr-CPC group. Coating of Sr-CPC on soft tissue tendon allograft leads to accelerated graft healing within the bone tunnel in a rabbit model of ACL reconstruction using Achilles tendon allograft.

  14. MAGNETIC RESONANCE IMAGING EVALUATION OF LIGAMENTOUS TEARS OF THE KNEE JOINT AND ASSOCIATION OF MENISCAL TEARS WITH ANTERIOR CRUCIATE LIGAMENT TEARS

    Directory of Open Access Journals (Sweden)

    Bommandapalli Madhaiah

    2016-05-01

    Full Text Available Anterior cruciate ligament tears are most commonly sustained sports injury, often occurring in association with meniscal tears and trauma to other ligamentous structures around the knee. Magnetic resonance imaging is vital in assessing acute knee injuries and plays an important role in deciding treatment options and planning surgical intervention. Magnetic Resonance (MR imaging has emerged as investigation of choice to evaluate the status of the ACL and other associated structures in the knee. AIMS AND OBJECTIVES The purpose of this study is to determine the association of subtle meniscal injury in the presence of anterior cruciate ligament injury and other associated pathology on MR imaging. MATERIAL AND METHODS A prospective cross-sectional case study done on 40 patients including both the sexes in age group of 15 to 35 years presenting with knee joint injuries and subsequently underwent MRI of the knee joint. The data was analysed and the findings on MRI were correlated with that of arthroscopy and/or operative findings. RESULTS The commonest soft tissue injury identified on MRI of the knee joint was ACL injury and it was associated with injuries of medial meniscus followed by of lateral meniscus, medial collateral ligament and lateral collateral ligament. CONCLUSION MRI is an excellent, non-invasive, radiation free imaging modality with multiplanar capabilities and excellent soft tissue delineation. It can accurately detect, localize and characterize various internal derangements of the knee joint and help in arriving at a correct anatomical diagnosis, thereby guiding further management of the patient. Medial meniscal tears were more commonly associated with ACL tear. Various patterns of meniscal injuries were identified in this study, out of which bucket handle pattern was more common among medial meniscal tears and radial pattern was common in the lateral meniscal injuries. Radiologists while interpreting MR studies of knee injuries

  15. Anatomical study and morphometric analyses on the femoral insertions of the posterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Julio Cesar Gali

    2013-04-01

    Full Text Available PURPOSE: To provide an anatomical and morphometric basis for the femoral insertions of the posterior cruciate ligament (PCL in order to aid in the creation of anatomical femoral tunnels in ligament surgical reconstruction. Study design: laboratory controlled study. MATERIAL AND METHODS: The macroscopic details of the femoral insertions of the PCL's anterolateral (AL and posteromedial (PM bundles were analyzed in 24 cadaver knees. The specimens were photographed with a digital camera and the images obtained were studied using the software ImageJ. The bundles' insertion areas were measured in square millimeters, and the length of the structures and the distances between significant points were measured in millimeters. RESULTS: The PCL's femoral insertion average total area was 87.29 ± 31.42 mm².The mean insertion's areas of the AL and PM bundles were, respectively, 47.13 ± 19.14 and 40.67 ± 16.19 mm². In 95.8% of the examined knees was verified the presence of the medial intercondylar ridge and in 83.3% of the knees was noted the medial bifurcated ridge. The average length of the medial intercondylar ridge was 20.54 ± 2.26 mm and the medial bifurcated ridge's average length was 7.62 ± 2.35 mm. CONCLUSIONS: The AL had a femoral insertion area larger than the PM bundle; these bundles' insertion areas were lower than those previously described in the literature. There were important individual variations related to the area of the bundles in the samples, suggesting that there should be an individual recommendation for anatomical reconstructions of the PCL with single or double femoral tunnels.

  16. Endothelial dysfunction and decreased vascular responsiveness in the anterior cruciate ligament-deficient model of osteoarthritis.

    Science.gov (United States)

    Miller, Daniel; Forrester, Kevin; Hart, David A; Leonard, Catherine; Salo, Paul; Bray, Robert C

    2007-03-01

    Chronic inflammation associated with osteoarthritis (OA) may alter normal vascular responses and contribute to joint degradation. Vascular responses to vasoactive mediators were evaluated in the medial collateral ligament (MCL) of the anterior cruciate ligament (ACL)-deficient knee. Chronic joint instability and progressive OA were induced in rabbit knees by surgical transection of the ACL. Under halothane anesthesia, laser speckle perfusion imaging (LSPI) was used to measure MCL blood flow in unoperated control (n = 12) and 6-wk ACL-transected knees (n = 12). ACh, bradykinin, histamine, substance P (SP), and prostaglandin E(2) (PGE(2)) were applied to the MCL vasculature in topical boluses of 100 microl (dose range 10(-14) to 10(-8) mol). In normal joints, ACh, bradykinin, histamine, and PGE(2) evoked a dilatory response. Substance P caused a biphasic response that was dilatory from 10(-14) to 10(-11) mol and constricting at higher doses. In ACL-deficient knees, ACh, bradykinin, histamine, and SP decreased perfusion, whereas PGE(2) had a biphasic response that decreased perfusion at 10(-14) to 10(-11) mol and was dilatory at higher concentrations. Sodium nitroprusside increased perfusion in resting and phenylephrine-precontracted vessels with no significant differences between ACL-transected and control knees. Femoral artery occlusion and release increased perfusion by 74.3 +/- 11.1% in control knees but only by 25.8 +/- 4.4% in ACL-deficient knees. The altered responsiveness of the MCL vasculature to these inflammatory mediators may indicate endothelial dysfunction in the MCL, which may contribute to the progression and severity of OA and to the adaptation of the joint in an altered mechanical environment.

  17. Infection after anterior cruciate ligament reconstruction%前交叉韧带重建后的感染☆

    Institute of Scientific and Technical Information of China (English)

    徐长明; 杨乐; 胡传亮; 胡玉华

    2013-01-01

    BACKGROUND: The incidence of infection after anterior cruciate ligament reconstruction is relatively low. However, this infection can lead to disastrous results, and the diagnosis and treatment of this infection have not yet achieved a consensus. OBJECTIVE: To explore the causes of infection after anterior cruciate ligament reconstruction and how to diagnosis and cure the infection, and to investigate the appropriate treatment program, in order to protect the knee functions. METHODS: The PubMed database and Wanfang database were searched for articles published between 2007 and 2012 with the key words of “anterior cruciate ligament, reconstruction, infection” in English and Chinese. Infection after anterior cruciate ligament reconstruction was used as the evaluation index. Articles related to infection after anterior cruciate ligament reconstruction were included, and repeated studies were excluded. RESULTS AND CONCLUSION: Bacterial contaminations of surgical devices or ligament grafts were the most likely causes of infection after anterior cruciate ligament reconstruction, and the fixation method of graft may be related with the infection after reconstruction. The classic clinical symptoms and signs of infection after anterior cruciate ligament reconstruction were similar to general septic arthritis. But classic symptoms of infection were frequently missing. The diagnosis of infection after anterior cruciate ligament reconstruction depended on clinical symptoms and signs, laboratory test such as erythrocyte sedimentation rate and C-reactive protein, and knee aspiration. For the treatment of the infected knee after anterior cruciate ligament reconstruction, culture-specific intravenous antibiotics and surgical joint irrigation with graft retention were considered the overwhelming treatment of choice. Graft removal was recommended if it appeared infected or if there was any difficulty control ing the infection.%  背景:前交叉韧带重建后感染的发

  18. Curative effect analysis of arthroscopic single band posterior cruciate ligament reconstruction%关节镜下单束重建后交叉韧带临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    王瑞; 徐斌; 徐洪港

    2013-01-01

    Objective To study the clinical curative effect for arthroscopic single band reconstruction of posterior cruciate ligamentwith autogenous semitendinosus and gracilies or allograft. Method 50 cases of injiued posterior cruciate ligament were reconstructed by means of semitendinosus and gracilies by autogenous or anterior tibial muscle' s tendon or achiles' s tendon by allograft fixed by endo-button system and bioabsorbable screw. Results Follow up time was 2.45 years on average for all 50 cases. Based on Lysholm score and on Tegner score to describe function of knee joint, the PCL reconstruction scores were 56. 4( Lysholm ), 3. 0( Tegner )on average before operation,and 80. 3( Lysholm ),6. 2( Tegner )on average after operation. Conclusions The bonding of four-stranded semitendinosus or allograft anterior tibial muscle are similar with anterior or posterior cruciate ligament and its strength are more stronger. Four-stranded construction and reliable fixation by absorbable screws and endo-button system is rigid with low complication.%目的 探讨、分析关节镜下利用自体腘绳肌及同种异体肌腱单束重建后交叉韧带的中期临床疗效.方法 关节镜下利用自体肌腱或异体胫前肌腱及跟腱辅以endo-button系统及生物型可吸收界面螺钉治疗50例膝关节后交叉韧带损伤患者.结果 所有患者平均随访2.45年,按Lysholm 膝关节功能评分与Tegner膝关节运动评分标准,术前患者术前平均56.4分(Lysholm),3.0分(Tegner),术后80.3分(Lysholm),6.2分(Tegner).结论 自体半腱肌、股薄肌与同种异体肌腱重建膝关节后交叉韧带强度好,植入后固定牢靠,术后并发症少.

  19. Arthroscopy-assisted anterior cruciate ligament reconstruction with patellar tendon or hamstring autografts.

    Science.gov (United States)

    Doral, M N; Leblebicioglu, G; Atay, O A; Baydar, M L; Tetik, O; Atik, S

    2000-01-01

    Isolated ACL reconstructions were performed in 138 patients between 1994 and 1998. Patellar bone-patellar tendon-bone, and hamstring tendon autografts were used in 88 patients, and allografts were used in 50 patients. Eighty-eight knees of 88 patients with autograft reconstructions (17 female, 71 male) were included in this study and evaluation of the patients with allograft reconstruction reported separately. The mean age at the time of the operation was 32 years. All ACL reconstructions were performed arthroscopically. Twenty-seven bone-patellar tendon-bone, and 61 hamstring tendon autografts were used. The mean follow-up was 29 months. In the postoperative course the Lachman test was negative in 62 patients, 1+ in 22 patients, and 2+ in 4 patients. In 17 patients, anterior drawer sign were 1+ in comparison to the contralateral side. Pivot shift test was moderately positive only in 5 cases in the bone-patellar tendon-bone and hamstring tendon autograft groups postoperatively. There were 3 patients with subjective "giving way" symptoms. Second look arthroscopy revealed rupture of the neo-ligament. Arthroscopic washout and debridement were performed, and no revision ligamentoplasties were performed. Two of these patients improved with accelerated proprioceptive physical therapy, and one had to decrease his previous level of activity. There were no cases of arthrofibrosis, infection, or extension lag. Clinical results of patellar bone-tendon-bone and hamstring groups did not show any significant clinical difference. Avoiding the disturbance of the extensor mechanism of the knee is probably the most significant advantage of the hamstring autograft.

  20. 膝交叉韧带中机械感受器的研究进展%Progress in studies on the mechanoreceptors in the cruciate ligament

    Institute of Scientific and Technical Information of China (English)

    党保平; 闫金洪; 韩一生

    2016-01-01

    Cruciate ligament of the knee lies between tibia intercondylar eminence and femoral condyle nest, presents hinged appearance and has both the function of biomechanics and proprioception, which is processed using mechanoreceptors in the tibial and femoral ligament attachment point. Mechanoreceptors could be divided into 4 groups: Ruffini ending, Pacinian body, Golgi tendon ending, and free nerve ending. The amount of mechanoreceptors of the cruciate ligament after acute injury will change in line with the duration of injury: the longer the time lasts, the less the receptors will be. But some hold the opposite view and consider that the receptors do not have evident atrophy and decline. Due to inflammation in the progression of osteoarthritis, cruciate ligament will gradually degenerate, and knee proprioception will abate as well. However, whether the amount of mechanoreceptors are associated with osteoarthritis progression and severity of the situation is not clear. The number of the damaged cruciate ligament mechanoreceptors and proprioception can recover partly after transplantation and repair, but not fully recover. Therefore, whether separated and cultured cells in vitro can be used in tissue engineering for ligament transplantation and repair, and improve proprioception, is what we need to pay attention to in the future, in order to provide more therapeutic measures for the clinic.

  1. Correlation of intra-articular osseous measurements with posterior cruciate ligament length on MRI scans.

    LENUS (Irish Health Repository)

    Orakzai, S H

    2010-01-01

    Six patients with a clinical diagnosis of chronic posterior cruciate ligament (PCL) rupture, based on a positive posterior drawer test, had a normal appearance of the PCL on an MRI scan. It is postulated that the PCL had been ruptured but healed in a lengthened state. 12 volunteers with no history of knee trauma underwent an MRI scan of the knee. In this control group (n = 12), there was a close correlation between the lateral femoral condylar width in the sagittal plane and the PCL length, with a ratio of 2:1 (95% confidence interval (CI) = 1.817-2.095). In the clinically abnormal group (n = 6), the ratio was 1.49:1 (95% CI = 1.206-1.782) (p< 0.0005). In conclusion, the ratio of the lateral femoral condylar width in the sagittal plane to the PCL length is a useful index for diagnosing PCL attenuation and lengthening in the presence of a normal morphological MR appearance.

  2. The Financial and Professional Impact of Anterior Cruciate Ligament Injuries in National Football League Athletes.

    Science.gov (United States)

    Secrist, Eric S; Bhat, Suneel B; Dodson, Christopher C

    2016-08-01

    Anterior cruciate ligament (ACL) injuries can have negative consequences on the careers of National Football League (NFL) players, however no study has ever analyzed the financial impact of these injuries in this population. To quantify the impact of ACL injuries on salary and career length in NFL athletes. Cohort study; Level of evidence, 3. Any player in the NFL suffering an ACL injury from 2010 to 2013 was identified using a comprehensive online search. A database of NFL player salaries was used to conduct a matched cohort analysis comparing ACL-injured players with the rest of the NFL. The main outcomes were the percentage of players remaining in the NFL and mean salary at 1, 2, 3, and 4 years after injury. Cohorts were subdivided based on initial salary: group A, $2,000,000. Mean cumulative earnings were calculated by multiplying the percentage of players remaining in the league by their mean salaries and compounding this each season. NFL athletes suffered 219 ACL injuries from 2010 to 2013. The 7504 other player seasons in the NFL during this time were used as controls. Significantly fewer ACL-injured players than controls remained in the NFL at each time point (P NFL at 1 to 3 seasons after injury (P NFL at 1 and 2 seasons after injury (P NFL also had a lower mean salary than controls (P NFL players. It also indicates that a player's standing within the league before injury strongly influences how much an ACL injury will affect his career.

  3. Thermography based diagnosis of ruptured anterior cruciate ligament (ACL) in canines

    Science.gov (United States)

    Lama, Norsang; Umbaugh, Scott E.; Mishra, Deependra; Dahal, Rohini; Marino, Dominic J.; Sackman, Joseph

    2016-09-01

    Anterior cruciate ligament (ACL) rupture in canines is a common orthopedic injury in veterinary medicine. Veterinarians use both imaging and non-imaging methods to diagnose the disease. Common imaging methods such as radiography, computed tomography (CT scan) and magnetic resonance imaging (MRI) have some disadvantages: expensive setup, high dose of radiation, and time-consuming. In this paper, we present an alternative diagnostic method based on feature extraction and pattern classification (FEPC) to diagnose abnormal patterns in ACL thermograms. The proposed method was experimented with a total of 30 thermograms for each camera view (anterior, lateral and posterior) including 14 disease and 16 non-disease cases provided from Long Island Veterinary Specialists. The normal and abnormal patterns in thermograms are analyzed in two steps: feature extraction and pattern classification. Texture features based on gray level co-occurrence matrices (GLCM), histogram features and spectral features are extracted from the color normalized thermograms and the computed feature vectors are applied to Nearest Neighbor (NN) classifier, K-Nearest Neighbor (KNN) classifier and Support Vector Machine (SVM) classifier with leave-one-out validation method. The algorithm gives the best classification success rate of 86.67% with a sensitivity of 85.71% and a specificity of 87.5% in ACL rupture detection using NN classifier for the lateral view and Norm-RGB-Lum color normalization method. Our results show that the proposed method has the potential to detect ACL rupture in canines.

  4. Double-bundle depiction of the anterior cruciate ligament at 3 Tesla

    Energy Technology Data Exchange (ETDEWEB)

    Adriaensen, M.E.A.P.M. [Atrium Medical Center Parkstad, Department of Radiology, Heerlen (Netherlands); Hogan, B. [Sports Surgery Clinic, Department of Radiology, Dublin (Ireland); Al-Bulushi, H.I.J. [Armed Forces Hospital, Department of Radiology, Muscat (Oman); Kavanagh, E.C. [Mater Misericordiae Hospital, Department of Radiology, Dublin (Ireland)

    2012-07-15

    Magnetic resonance imaging on 3 Tesla (3T MRI) with arthroscopic correlation has proven to adequately identify the anteromedial bundle (AMB) and posterolateral bundle (PLB) in cadaver knees. The purpose of this study was to describe the depiction of ACL bundle anatomy on 3T MRI in daily practice. In a retrospective cohort study, we included 50 consecutive patients who underwent standard 3T MRI of the knee and had an intact ACL. Two musculoskeletal radiologists independently reviewed all scans for depiction of ACL bundle anatomy using standardized forms. Descriptive statistics were used. Twenty-three right knees (46%) and 27 left knees (54%) were included in the study. Mean age of the patients was 35 years (range 12 to 68 years); 37 patients were male (74%). ACL bundle anatomy was best depicted in the axial plane in 44 knees (88%) and in the coronal plane in six knees (12%). Two bundles were seen in 47 knees (