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Sample records for ligament reconstruction surgical

  1. Outcome of surgical treatment of arthrofibrosis following ligament reconstruction.

    Science.gov (United States)

    Said, Sinan; Christainsen, Svend Erik; Faunoe, Peter; Lund, Bent; Lind, Martin

    2011-10-01

    Clinical outcome following surgical treatment and intensive physiotherapy was evaluated in patients with arthrofibrosis as a complication to varying knee-ligament reconstructions. From 2003 to 2007, 31 patients underwent surgery for arthrofibrosis as a postoperative complication following knee-ligament reconstruction. Treatment for reduced range of motion consisted of forced manipulation or arthroscopic arthrolysis followed by intensive physiotherapy. Twenty-seven patients (12 men and 15 women; median age 35(12-70) years) were followed up. Objective examination, Pain, KOOS and Tegner scores were used to evaluate the clinical outcome at follow-up. Fourteen patients were treated with forced manipulation alone, and the remaining thirteen were treated with forced manipulation and arthroscopic arthrolysis. The patients' median follow-up was 51 months (19-73 months). Median interval between primary surgery and surgical release was 4 (1-32) months. Median range of motion (ROM) improved from -0°(0 to 20) to 0°(+2-9) in extension deficit and from 90°(40-145) to 130°(90-155) in flexion. Mean KOOS score were symptoms 63, pain 72, ADL 77, sport 42, QOL 45. Median Tegner score was 4 (2-9). Surgical arthrolysis combined with intensive physiotherapy improved range of motion to nearly normal values. Subjective outcome scores revealed relatively poor outcome levels compared to uncomplicated knee-ligament reconstruction. Predictors of poor outcome were global arthrofibrosis and greater than 6-month time interval from primary reconstruction and surgical release. Retrospective clinical case series, Level IV.

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

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    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.

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

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    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.

  4. Ligament reconstruction.

    Science.gov (United States)

    Glickel, Steven Z; Gupta, Salil

    2006-05-01

    Volar ligament reconstruction is an effective technique for treating symptomatic laxity of the CMC joint of the thumb. The laxity may bea manifestation of generalized ligament laxity,post-traumatic, or metabolic (Ehler-Danlos). There construction reduces the shear forces on the joint that contribute to the development and persistence of inflammation. Although there have been only a few reports of the results of volar ligament reconstruction, the use of the procedure to treat Stage I and Stage II disease gives good to excellent results consistently. More advanced stages of disease are best treated by trapeziectomy, with or without ligament reconstruction.

  5. 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.

  6. 3D Printing Surgical Implants at the clinic: A Experimental Study on Anterior Cruciate Ligament Reconstruction.

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    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.

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

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    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.

  8. Muscle strength and functional performance in patients with anterior cruciate ligament injury treated with training and surgical reconstruction or training only: a two to five-year followup

    DEFF Research Database (Denmark)

    Ageberg, Eva; Thomeé, Roland; Neeter, Camille

    2008-01-01

    OBJECTIVE: To study muscle strength and functional performance in patients with anterior cruciate ligament (ACL) injury with or without surgical reconstruction 2 to 5 years after injury. Good muscle function is important in preventing early-onset osteoarthritis (OA), but the role of reconstructive...... surgery in restoring muscle function is unclear. METHODS: Of 121 patients with ACL injury included in a randomized controlled trial on training and surgical reconstruction versus training only (the Knee, Anterior cruciate ligament, NON-surgical versus surgical treatment [KANON] study, ISRCTN: 84752559......), 54 (mean age at followup 30 years, range 20-39, 28% women) were assessed a mean +/- SD of 3 +/- 0.9 years after injury with reliable, valid, and responsive test batteries for strength (knee extension, knee flexion, leg press) and hop performance (vertical jump, one-leg hop, side hop). The Limb...

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

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    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.

  10. Efficacy of quadriceps vastus medialis dry needling in a rehabilitation protocol after surgical reconstruction of complete anterior cruciate ligament rupture

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    Velázquez-Saornil, Jorge; Ruíz-Ruíz, Beatriz; Rodríguez-Sanz, David; Romero-Morales, Carlos; López-López, Daniel; Calvo-Lobo, Cesar

    2017-01-01

    Abstract Background: Several new rehabilitation modalities have been proposed after anterior cruciate ligament (ACL) reconstruction. Among these, trigger point dry needling (TrP-DN) might be useful in the treatment of myofascial pain syndrome associated with ACL reconstruction to reduce pain intensity, increase knee flexion range and modify the mechanical properties of the quadriceps muscle during late-stage rehabilitation. To date, this is the first randomized clinical trial to support the use of TrP-DN in the early rehabilitation process after ACL reconstruction. The aim of this study was to determine the pain intensity, range of motion (ROM), stability, and functionality improvements by adding quadriceps vastus medialis TrP-DN to the rehabilitation protocol (Rh) provided to subacute ACL reconstructed patients. Methods: This randomized, single-blinded, clinical trial (NCT02699411) included 44 subacute patients with surgical reconstruction of complete ACL rupture. The patients were randomized into 2 intervention groups: Rh (n = 22) or Rh + TrP-DN (n = 22). Pain intensity, ROM, stability, and functionality were measured at baseline (A0) and immediately (A1), 24 hours (A2), 1 week (A3), and 5 weeks (A4) after the first treatment. Results: Comparing statistically significant differences (P ≤ .001; Eta2 = 0.198–0.360) between both groups, pain intensity (at A1), ROM (at A1, A2, and A3), and functionality (at A2, A3, and A4) were increased. Nevertheless, the rest of measurements did not show significant differences (P > .05). Conclusion: Quadriceps vastus medialis TrP-DN in conjunction with a rehabilitation protocol in subacute patients with surgical reconstruction of complete ACL rupture increases ROM (short-term) and functionality (short- to mid-term). Although there was an increase in pain intensity with the addition of TrP-DN, this was not detected beyond immediately after the first treatment. Furthermore, stability does not seem to be

  11. Surgical Reconstruction with the Remnant Ligament Improves Joint Position Sense as well as Functional Ankle Instability: A 1-Year Follow-Up Study

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    Kamizato Iwao

    2014-01-01

    Full Text Available Introduction. Chronic functional instability—characterized by repeated ankle inversion sprains and a subjective sensation of instability—is one of the most common residual disabilities after an inversion sprain. However, whether surgical reconstruction improves sensorimotor control has not been reported to date. The purpose of this study was to assess functional improvement of chronic ankle instability after surgical reconstruction using the remnant ligament. Materials and Methods. We performed 10 cases in the intervention group and 20 healthy individuals as the control group. Before and after surgical reconstruction, we evaluated joint position sense and functional ankle instability by means of a questionnaire. Results and Discussion. There was a statistically significant difference between the control and intervention groups before surgical reconstruction. Three months after surgery in the intervention group, the joint position sense was significantly different from those found preoperatively. Before surgery, the mean score of functional ankle instability in the intervention group was almost twice as low. Three months after surgery, however, the score significantly increased. The results showed that surgical reconstruction using the remnant ligament was effective not only for improving mechanical retensioning but also for ameliorating joint position sense and functional ankle instability.

  12. CRUCIATE LIGAMENT RECONSTRUCTION

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    A. V. Korolev

    2016-01-01

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

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

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    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.

  14. 前交叉韧带解剖重建理念与方法%Anatomic Anterior Cruciate Ligament Reconstruction: A Surgical Technique More Original than Traditional

    Institute of Scientific and Technical Information of China (English)

    周敬滨; Zachary Working; Carola F.van Eck; Freddie H.Fu

    2011-01-01

    Anatomic anterior cruciate ligament (ACL) reconstruction is a surgical technique which is based on the principle of restoring the native ACL anatomy.Anatomic ACL reconstruction is defined as the functional restoration of the ACL to its native dimensions, collagen orientation, and insertion sites.This definition encompasses single- and double-bundle reconstruction and can be applied to primary, revision and augmentation surgery.Besides the definition of the anatomic ACL reconstruction, this paper also describes the surgical procedure that involves the visualization of the native ACL insertion site, arthroscopic measurement of the ACL and knee morphology, appropriate graft tensioning and evaluation of graft and tunnel position using MRI and 3D CT scan, as well as its outcome.The detailed differences between the “anatomic” and “classic” ACL reconstruction procedures are also emphasized.There is increasing evidence certifying the benefits of anatomic ACL reconstruction including anatomic double-bundle ACL reconstruction over traditional ACL surgery.Although there still much to learn about anatomic ACL reconstruction methods, we believe this is a helpful document for Chinese surgeons.%前交叉韧带(Anterior Cruciate Ligament,ACL)解剖重建技术是基于ACL解剖理论发展起来的一项手术技术.ACL解剖重建是根据ACL的解剖特点进行功能重建,恢复ACL原有的尺寸、韧带胶原走行方向和止点位置.解剖重建不仅包括双束和单束重建,而且包括以此理论为基础的ACL重建术后的翻修与加固.本文对ACL的解剖重建技术进行介绍,针对在关节镜下如何观察原ACL的止点位置,测量止点长宽,选择骨道位置,如何利用影像学进行评价进行了详细的阐述和解释,并介绍了该技术目前的临床评价结果.同时,本文对ACL解剖重建和传统"经典"重建方法的区别进行了重点说明与解释,为提高国内医师对ACL解剖重建技术的认识提供参考和帮助.

  15. 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.

  16. Posterior cruciate ligament and posterolateral corner reconstruction.

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    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.

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

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    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. Popliteal artery injury during posterior cruciate ligament reconstruction

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    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.

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

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

    2015-11-01

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

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

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

    2015-08-01

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

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

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    Chouhan Devendra Kumar

    2013-08-01

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

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

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    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.

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

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    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.

  4. Reconstruction of the anterior cruciate ligament of the knee

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    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

  5. Tissue engineering of ligaments for reconstructive surgery.

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    Hogan, MaCalus V; Kawakami, Yohei; Murawski, Christopher D; Fu, Freddie H

    2015-05-01

    The use of musculoskeletal bioengineering and regenerative medicine applications in orthopaedic surgery has continued to evolve. The aim of this systematic review was to address tissue-engineering strategies for knee ligament reconstruction. A systematic review of PubMed/Medline using the terms "knee AND ligament" AND "tissue engineering" OR "regenerative medicine" was performed. Two authors performed the search, independently assessed the studies for inclusion, and extracted the data for inclusion in the review. Both preclinical and clinical studies were reviewed, and the articles deemed most relevant were included in this article to provide relevant basic science and recent clinical translational knowledge concerning "tissue-engineering" strategies currently used in knee ligament reconstruction. A total of 224 articles were reviewed in our initial PubMed search. Non-English-language studies were excluded. Clinical and preclinical studies were identified, and those with a focus on knee ligament tissue-engineering strategies including stem cell-based therapies, growth factor administration, hybrid biomaterial, and scaffold development, as well as mechanical stimulation modalities, were reviewed. The body of knowledge surrounding tissue-engineering strategies for ligament reconstruction continues to expand. Presently, various tissue-engineering techniques have some potential advantages, including faster recovery, better ligamentization, and possibly, a reduction of recurrence. Preclinical research of these novel therapies continues to provide promising results. There remains a need for well-designed, high-powered comparative clinical studies to serve as a foundation for successful translation into the clinical setting going forward. Level IV, systematic review of Level IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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

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    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.)

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

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    Julio Cesar Gali

    2015-08-01

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

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

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    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.

  9. 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.

  10. Arthroscopic procedures and therapeutic results of anatomical reconstruction of the coracoclavicular ligaments for acromioclavicular Joint dislocation.

    Science.gov (United States)

    Takase, K; Yamamoto, K

    2016-09-01

    Surgical treatment is recommended for type 5 acromioclavicular joint dislocation on Rockwood's classification. We believe that anatomic repair of the coracoclavicular ligaments best restores the function of the acromioclavicular joint. We attempted to correctly reconstruct the anatomy of the coracoclavicular ligaments under arthroscopy, and describe the minimally invasive arthroscopic procedure. There were 22 patients; mean age at surgery, 38.1 years. Mean time to surgery was 13.2 days. Mean follow-up was 3 years 2 months. The palmaris longus tendon was excised from the ipsilateral side to replace the conoid ligament, while artificial ligament was used for reconstructing the trapezoid ligament. Both ligament reconstructions were performed arthroscopically. No temporary fixation of the acromioclavicular joint was performed. On postoperative radiographic evaluation, 4 patients showed subluxation and 2 showed dislocation of the acromioclavicular joint; the other 16 patients had maintained reduction at the final consultation. MR images 1year after surgery clearly revealed the reconstructed ligaments in 19 patients. Only 1 patient showed osteoarthritis of the acromioclavicular joint. Although it requires resection of the ipsilateral palmaris longus for grafting, we believe that anatomic reconstruction of both coracoclavicular ligaments best restores the function of the acromioclavicular joint. 4. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  11. Medial patellofemoral ligament reconstruction: patient selection and perspectives

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    Baer MR

    2017-09-01

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

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

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    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.

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

    Institute of Scientific and Technical Information of China (English)

    Devendra Kumar Chouhan; Uttam Chand Saini; Mandeep Singh Dhillon

    2013-01-01

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

  14. Infections after reconstructions of anterior cruciate ligament

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    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

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

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    Gobezie Reuben

    2009-01-01

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

  16. 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

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. A modified surgical technique for reconstruction of an acute acromioclavicular joint dislocation

    Science.gov (United States)

    Marchie, Anthony; Kumar, Arun; Catre, Melanio

    2009-01-01

    We report a modified surgical technique for reconstruction of coracoclavicular and acromioclavicular ligaments after acute dislocation of acromioclavicular joint using suture anchors. We have repaired 3 consecutive type III acromioclavicular dislocations with good results. This technique is simple and safe and allows anatomical reconstruction of the ligaments in acute dislocations. PMID:20671868

  2. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience☆

    Science.gov (United States)

    Hinckel, Betina Bremer; Gobbi, Riccardo Gomes; Bonadio, Marcelo Batista; Demange, Marco Kawamura; Pécora, José Ricardo; Camanho, Gilberto Luis

    2016-01-01

    Objective To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. Method The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM), apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10) and whether they would be prepared to go through this operation again. Results Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07). Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. Conclusion Reconstruction of the medial patellofemoral ligament

  3. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience

    Directory of Open Access Journals (Sweden)

    Betina Bremer Hinckel

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM, apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10 and whether they would be prepared to go through this operation again. RESULTS: Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07. Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. CONCLUSION: Reconstruction of the

  4. 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.

  5. 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...

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

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    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.

  7. 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.

  8. 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.

  9. Oblique reconstruction of the cruciate ligaments on computed tomography

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

    1984-12-01

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

  10. 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.

  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. 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.

  14. 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

  15. 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

  16. 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.

  17. Return to sport following anterior cruciate ligament reconstruction.

    Science.gov (United States)

    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.

  18. 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.

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

    Science.gov (United States)

    Mascarenhas, Randy; MacDonald, Peter B

    2008-01-01

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

  20. 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

  1. Cable-Augmented, Quad Ligament Tenodesis Scapholunate Reconstruction.

    Science.gov (United States)

    Bain, Gregory I; Watts, Adam C; McLean, James; Lee, Yu C; Eng, Kevin

    2015-11-01

    Maintaining reduction of the scapholunate interval after reconstruction can be difficult. The authors performed scapholunate reconstruction using tensionable suture anchors in 8 patients. The anchors provide a fixed cable that both fixes the graft, and reduces the scapholunate diastasis and maintains reduction. The flexor carpi radialis tendon graft stabilizes not only the volar scaphotrapezial ligament, and dorsal scapholunate ligament, but also the dorsal intercarpal and dorsal radiocarpal ligament. The Berger flap is closed using an ulnar advancement capsulodesis that further reinforces the dorsal intercarpal and dorsal radiocarpal ligament. The mean pain score improved from 5.8 to 2.1. Mean extension was 56° (91% of contralateral side), flexion 44° (70% of contralateral side), and grip strength was 41kg (95% of the contralateral side). The mean scapholunate angle was 71°, radiolunate angle 16° and scapholunate interval 3.0 mm. The cable augmented, quad ligament scapholunate ligament reconstruction offers theoretical advantages but long term follow up is required.

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

    Directory of Open Access Journals (Sweden)

    Dariusz Witoński

    2013-01-01

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

  3. 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.

  4. 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.

  5. 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.

  6. Arthroscopically assisted anatomical coracoclavicular ligament reconstruction using tendon graft.

    Science.gov (United States)

    Yoo, Yon-Sik; Seo, Young-Jin; Noh, Kyu-Cheol; Patro, Bishu Prasad; Kim, Do-Young

    2011-07-01

    We describe a method of arthroscopically assisted, mini-open, anatomical reconstruction of the coracoclavicular ligament. This method restores both components of the native ligament with the aim of achieving maximum stability with minimal disruption of the normal anatomy. Using the same principles of ligament reconstruction that are employed in other joints, transosseous tunnels are created following the native footprints of the conoid and trapezoid ligaments and an autologous graft is fixed using a PEEK screw. Adequate healing of the ligament occurs within the bone, to prevent stress risers with an appropriate working length. This procedure is unique, as it replaces the torn ligament with a natural substitute, in the appropriate location, through a minimally invasive procedure. This technique would be suitable for treatment of patients with either grade III or V acute acromioclavicular dislocations. Clinical outcomes for the first 13 consecutive patients treated with this procedure are reported, revealing excellent satisfaction rates with a Constant score of 96.6 at final follow-up.

  7. 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.

  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. 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,...

  10. Simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft.

    Science.gov (United States)

    Shin, Sang-Jin; Campbell, Sean; Scott, Jonathan; McGarry, Michelle H; Lee, Thay Q

    2014-09-01

    The purpose of this study was to introduce a novel surgical technique for simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft and to compare its biomechanical characteristics to those of a coracoid cerclage reconstruction of the coracoclavicular ligaments. Six matched pairs of human acromioclavicular joints with an average age of 54.8 ± 7.8 years were used. One shoulder from each pair received the single tendon acromioclavicular-coracoclavicular reconstruction; the contralateral shoulder received the coracoid cerclage reconstruction. Bovine extensor tendon was used for both techniques. The single tendon acromioclavicular-coracoclavicular reconstruction technique provided anatomic restoration of the two coracoclavicular ligaments and the superior and inferior acromioclavicular ligaments simultaneously using one coracoid hole, one acromion hole, and two clavicular holes with interference screws. Anterior-posterior and superior-inferior translations were quantified for all specimens before and after reconstruction, followed by load to failure testing. Following coracoid cerclage reconstruction, total anterior-posterior translation was significantly greater than intact (10.0 ± 5.7 mm; p = 0.008). Following single tendon acromioclavicular-coracoclavicular reconstruction, there was no significant difference in anterior-posterior translation compared to intact (-1.6 ± 2.2 mm; n.s.). The coracoid cerclage technique demonstrated significantly greater anterior-posterior translation than the single tendon acromioclavicular-coracoclavicular technique (p = 0.007). Both techniques restored superior-inferior translation to the intact condition (n.s.). Ultimate load, deformation at ultimate load, and energy absorbed at ultimate load were significantly greater after acromioclavicular-coracoclavicular reconstruction than after coracoid cerclage reconstruction (p

  11. 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.

  12. 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.

  13. Medial Patellofemoral Ligament Reconstruction in a Below-Knee Amputee

    Directory of Open Access Journals (Sweden)

    Sherif El-Tawil

    2015-01-01

    Full Text Available Patellar instability is a common finding in patients with below-knee amputation and yet management options are not commonly described in the literature. We describe the first reported case of a medial patellofemoral ligament reconstruction using allograft in a patient with a below-knee amputation. Clinical outcome at two-year follow-up remains very good.

  14. 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.

  15. 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...

  16. The sacrotuberous and the sacrospinous ligament--a virtual reconstruction.

    Science.gov (United States)

    Hammer, N; Steinke, H; Slowik, V; Josten, C; Stadler, J; Böhme, J; Spanel-Borowski, K

    2009-10-01

    Little is known about the morphometric properties of the sacrotuberous ligament (ST) and the sacrospinous ligament (SS). The influence of ligaments on pelvic stability and the extent of reconstruction in case of instability are controversially discussed. The ST and the SS of 55 human subjects fixed in alcohol solution and of four fresh cadavers were measured. Both ligaments were defined as geometric figures. The ST was a contorted bifrustum, while the SS was a contorted frustum, both with elliptic planes. In all cases investigated, the ST and the SS fibres were twisted. For men, the ST and the SS had a mean length of 64 and 38 mm. For women, lengths of 70 and 46 mm were measured in the ST and the SS. The ST length, height and cross-sectional area showed gender-specific differences at statistically significant level. The ST and the SS volumes correlated closely, regardless of gender or side. Measurements of fresh ligaments of four unfixed cadavers showed similar results. The data obtained were then used to generate computer-based three-dimensional models of both ligaments, using the Catia software. Conclusively, the virtually generated ST and SS are suitable models to be included in pelvic fracture simulation, using the finite element method.

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

    Science.gov (United States)

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

    2015-01-01

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

  18. 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.

  19. 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

  20. 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...

  1. 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

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

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    Fardin Mirzatolooei

    2014-03-01

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

  3. 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.

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

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

    2009-03-15

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

  5. 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.

  6. Reconstruction of the anterior cruciate ligament in skeletally immature patients: an individualized approach,

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    Osmar Valadão Lopes Júnior

    2014-06-01

    Full Text Available OBJECTIVE: to evaluate a series of skeletally immature patients who underwent three surgical techniques for anterior cruciate ligament (ACL reconstruction according to each patient's growth potential.METHODS: a series of 23 skeletally immature patients who underwent ACL reconstruction surgery at ages ranging from 7 to 15 years was evaluated prospectively. The surgical technique was individualized according to the Tanner sexual maturity score. The surgical techniques used were transphyseal reconstruction, partial transphyseal reconstruction and extraphyseal reconstruction. Four patients underwent the extraphyseal technique, seven the partial transphyseal technique and twelve the full transphyseal technique, on the ACL. The postoperative evaluation was based on the Lysholm score, clinical analysis on the knee and the presence of angular deformity or dysmetria of the lower limb.RESULTS: the mean Lysholm score was 96.34 (±2.53. None of the patients presented differences in length and/or clinical or radiographic misalignment abnormality of the lower limbs.CONCLUSION: ACL reconstruction using flexor tendon grafts in skeletally immature patients provided satisfactory functional results. Use of individualized surgical techniques according to growth potential did not give rise to physeal lesions capable of causing length discrepancies or misalignments of the lower limbs, even in patients with high growth potential.

  7. 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.

  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

    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...

  9. 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...

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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.

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

    Science.gov (United States)

    Sadigursky, David; Garcia, Lucas Cortizo; Armede, Maurício; Oliveira, Lucas Rodrigues de; Carneiro, Rogério Jamil Fernandes; Colavolpe, Paulo Oliveira

    2017-01-01

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

  16. Physiotherapy after reconstruction of anterior cruciate ligament.

    Science.gov (United States)

    Pereira, Maitê; Vieira, Neiva de Souza; Brandão, Eduardo da Rosa; Ruaro, João Afonso; Grignet, Rodrigo Juliano; Fréz, Andersom Ricardo

    2012-12-01

    The purpose of this study was to evaluate the existence of differences in the rehabilitation of patients after ACL reconstruction using bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts, through a literature revision. The researched databases were MEDLINE, EMBASE, LILACS, COCHRANE and PEDro. The inclusion criteria were published studies with methodology draw from randomized clinical trials with or without meta-analysis, individuals with ACL injury, associated or not to meniscal injury, submitted to ligamentoplasty using the bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts and physiotherapy; clinical trials comparing the differences in the rehabilitation of these patients, in Portuguese, English and Spanish, from 1990 to June, 2011. Five clinical trials were reviewed. No difference was observed between the techniques, however, with a recommendation for a less aggressive rehabilitation and greater attention to the strengthening of the hamstring when they are used as grafts.

  17. 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.

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

    Science.gov (United States)

    Cho, Jaeho

    2014-01-01

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

  19. 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.

  20. 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.

  1. Analysis of 3-dimensional finite element after reconstruction of impaired ankle deltoid ligament

    OpenAIRE

    Ji, Yunhan; Tang, Xianzhong; Li, Yifan; Xu, Wei; Qiu, Wenjun

    2016-01-01

    We compared four repair techniques for impaired ankle ligament deltoideum, namely Wiltberger, Deland, Kitaoka and Hintermann using a 3-dimensional finite element. We built an ankle ligament deltoideum model, including six pieces of bone structures, gristles and main ligaments around the ankle. After testing the model, we built an impaired ligament deltoideum model plus four reconstruction models. Subsequently, different levels of force on ankles with different flexion were imposed and ankle b...

  2. Acromioclavicular motion after surgical reconstruction.

    Science.gov (United States)

    Motta, Pierorazio; Bruno, Laura; Maderni, Alberto; Tosco, Piermario; Mariotti, Umberto

    2012-06-01

    A retrospective long-term study was carried out to determine whether there was any correlation between the clinical motion of the acromioclavicular joint evaluated by a test we set up using 90° of abduction and 0° of external rotation against resistance [90°/0°RTest] and the cross arm test (compared to the healthy side) and full return to everyday activities after surgical repair. A clinical and radiographic evaluation was carried out on 51/80 subjects at a 5.4-year mean follow-up, treated for acromioclavicular joint dislocation with an extra-articular artificial loop, between 2000 and 2006. The 25 subjects with ossifications obtained a normal acromioclavicular joint motion, on both the horizontal and vertical planes. There was a correlation between the normal motion of the reconstructed acromioclavicular joint (compared to the healthy side) in these 25 patients and full clinical recovery, whilst there was no correlation between the Constant score, the simple shoulder test, the radiographic evaluation on one hand and the clinical motion of the joint on the other. Two patients had recurrent dislocation. Three had mobilization of the screws without reduction loss, or negative clinical outcome. A postoperative radiographic evaluation should be correlated with a clinical evaluation of the acromioclavicular joint motion (normal, hypermobile, unstable). Normal acromioclavicular joint motion was observed in subjects who developed significant ossifications. The study shows that the clinical evaluation of acromioclavicular joint motion is a simple and trustworthy method to assess the clinical result of a surgical repair. Diagnostic study investigating a diagnostic test, Level III.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability.

    Science.gov (United States)

    Lind, Martin; Enderlein, Ditte; Nielsen, Torsten; Christiansen, Svend Erik; Faunø, Peter

    2016-03-01

    Medial patellofemoral ligament (MPFL) reconstruction has recently been broadly accepted as primary surgical treatment in adults. Reconstruction techniques with osseous fixation in femur cannot be used for patients with open growth plates. Operative treatment of patella instability in children therefore is a challenge and requires alternative MPFL reconstruction techniques. Limited knowledge exists concerning outcome after MPFL reconstruction in children and adolescents. This study present clinical outcome in a consecutive single clinic series of children treated with paediatric MPFL reconstruction using a soft tissue femoral fixation technique. Twenty-four MPFL reconstructions in 20 operated children aged 8-16 were included in the study. Indication for surgery was two or more patella dislocations. MPFL reconstruction was performed by looping the released gracilis tendon around the adductor magnus tendon insertion and through drill holes in the proximal medial patella edge. Clinical outcome was evaluated by Kujala score and NRS pain score preoperatively, at 1-year follow-up and final follow-up at 39 months. Outcome was compared with a cohort of 179 adult patients with recurrent patella instability operated with an adult MPFL reconstruction technique. Kujala score improved from 61 (13) to 81 (16). NRS pain score improved from 3.0 (3.1) to 1.5 (1.3) in activity. Four patients (20%) experienced redislocation within the first postoperative year compared with 5% in an adult patient population. Five patients (25%) experienced subluxations. One patient with a redislocation was re-operated with adult MPFL reconstruction technique. Cartilage injury was seen in six patients. There are clinical relevant improvements in knee function and pain after MPFL reconstruction in paediatric patients. Patella stability after MPFL reconstruction using femoral soft tissue graft fixation in paediatric patients was inferior to MPFL reconstruction using bony femoral fixation in adult patients

  8. 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...

  9. Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes.

    Science.gov (United States)

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

    2010-03-01

    We report on 22 patients with chronic grade-2 valgus laxity of the knee combined with chronic anterior cruciate ligament (ACL) insufficiency, in whom the two lesions were addressed at the same surgical setting. At a minimum follow-up of 24 months, clinical and functional variables had improved significantly (P pre-injury level. There were no operative complications in this series. In selected athletes with chronic symptomatic valgus laxity of the knee combined with ACL insufficiency, surgical repair of the MCL in association with ACL reconstruction is a suitable and reliable option to restore knee stability and allow return to pre-injury activity level.

  10. 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.

  11. Finite element study on the anatomic transtibial technique for single-bundle anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Bae, Ji Yong; Kim, Geon-Hee; Seon, Jong Keun; Jeon, Insu

    2016-05-01

    The anatomic transtibial (TT) technique is proposed as a new approach for single-bundle anterior cruciate ligament (ACL) reconstruction. Geometric models of the anatomic TT and anteromedial (AM) portal techniques were fabricated with a reconstructed knee joint model and virtual surgical operations. Grafts of 7 mm diameter were modeled and inserted into tunnels drilled in each model. In the models, the shape of the graft between the femur and the tibia, the lengths of the bone tunnels, and the femoral graft bending angles were evaluated. To evaluate the biomechanical effects of both techniques on the grafts, the contact pressures and maximum principal stresses in the grafts were calculated using the finite element method. The anatomic TT technique placed the femoral tunnel to the anatomic position of the native ACL femoral attachment site. In addition, it decreased the peak contact pressure and the maximum principal stress at the full extension position of the graft compared with the AM portal technique. The anatomic TT technique may be regarded as a superior surgical technique compared with the conventional TT and AM portal techniques. Because of the easy surgical operation involved, the technique decreases the operation time for ACL reconstruction and it provides a deformation behavior of grafts similar to that in the native ACL in a knee joint. With its few side effects, the anatomic TT technique may considerably help patients.

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

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    KH.A NAZEM

    2002-03-01

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

  13. Biomechanical comparison of posterior cruciate ligament reconstruction techniques using cyclic loading tests.

    Science.gov (United States)

    Hiraga, Yasuharu; Ishibashi, Yasuyuki; Tsuda, Eiichi; Toh, Harehiko Tsukada Satoshi

    2006-01-01

    Posterior tibial translation (PTT) of the posterior cruciate ligament (PCL) reconstructed-knee under cyclic loading of 1,000 cycles with a 100-N load was compared between four different procedures, including two reconstructions with patellar tendon graft (transtunnel and inlay techniques) and two reconstructions with hamstring tendon graft (Endobutton and EndoPearl techniques) in twelve fresh-frozen human knees. The EndoPearl technique is a direct tendon fixation using biodegradable interference screws and an anchoring device, while the Endobutton technique is an indirect tendon fixation using a titanium button and surgical tape. The change of PTT after cyclic loading in the Endobutton technique was significantly greater than in the other reconstruction technique. No graft rupture at the killer turn or complete pullout from the bone tunnel was found. The advantage of the inlay technique compared to the transtunnel technique with respect to the posterior stability could not be shown in the current study. Posterior laxity of PCL reconstructed-knees with hamstring tendon graft using the Endobutton technique increased more easily than that with patellar tendon graft. For PCL reconstruction using the hamstring tendon graft, anatomical fixation may be preferable to prevent excessive posterior laxity in the early phase of the rehabilitation protocol.

  14. 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.

  15. 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

  16. Medial collateral ligament reconstruction in the baseball Pitcher's elbow.

    Science.gov (United States)

    Erne, Holger C; Zouzias, Ioannis C; Rosenwasser, Melvin P

    2009-08-01

    Pitchers are prone to elbow injuries because of high and repetitive valgus stresses on the elbow. The anterior bundle of the medial ulnar collateral ligament (MCL) of the elbow is the primary restraint and is often attenuated with time, leading to functional incompetence and ultimate failure. Pitchers with a history of medial elbow pain, reduced velocity, and loss of command may have an MCL injury in evolution. Physical examination and imaging can confirm the diagnosis. Treatment begins with rest and activity modification. All medial elbow pain is not MCL injury. Surgery is considered only for talented athletes who wish to return to competitive play and may include elite scholastic and other collegiates and professionals. The technique for MCL reconstruction was first described in 1986. Many variations have been offered since then, which can result in predictable outcomes, allowing many to return to the same level of competitive play.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  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. 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.)

  3. Rotational and translational stability of different methods for direct acromioclavicular ligament repair in anatomic acromioclavicular joint reconstruction.

    Science.gov (United States)

    Beitzel, Knut; Obopilwe, Elifho; Apostolakos, John; Cote, Mark P; Russell, Ryan P; Charette, Ryan; Singh, Hardeep; Arciero, Robert A; Imhoff, Andreas B; Mazzocca, Augustus D

    2014-09-01

    Many reconstructions of acromioclavicular (AC) joint dislocations have focused on the coracoclavicular (CC) ligaments and neglected the functional contribution of the AC ligaments and the deltotrapezial fascia. To compare the modifications of previously published methods for direct AC reconstruction in addition to a CC reconstruction. The hypothesis was that there would be significant differences within the variations of surgical reconstructions. Controlled laboratory study. A total of 24 cadaveric shoulders were tested with a servohydraulic testing system. Two digitizing cameras evaluated the 3-dimensional movement. All reconstructions were based on a CC reconstruction using 2 clavicle tunnels and a tendon graft. The following techniques were used to reconstruct the AC ligaments: a graft was shuttled underneath the AC joint back from anterior and again sutured to the acromial side of the joint (group 1), a graft was fixed intramedullary in the acromion and distal clavicle (group 2), a graft was passed over the acromion and into an acromial tunnel (group 3), and a FiberTape was fixed in a cruciate configuration (group 4). Anterior, posterior, and superior translation, as well as anterior and posterior rotation, were tested. Group 1 showed significantly less posterior translation compared with the 3 other groups (P < .05) but did not show significant differences compared with the native joint. Groups 3 and 4 demonstrated significantly more posterior translation than the native joint. Group 1 showed significantly less anterior translation compared with groups 2 and 3. Group 3 demonstrated significantly more anterior translation than the native joint. Group 1 demonstrated significantly less superior translation compared with the other groups and with the native joint. The AC joint of group 1 was pulled apart less compared with all other reconstructions. Only group 1 reproduced the native joint for the anterior rotation at the posterior marker. Group 4 showed

  4. Femoral Condyle Fracture during Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Selahattin Ozyurek

    2015-07-01

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

  5. 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.

  6. Hip and knee joint kinematics during a diagonal jump landing in anterior cruciate ligament reconstructed females.

    Science.gov (United States)

    Delahunt, Eamonn; Prendiville, Anna; Sweeney, Lauren; Chawke, Mark; Kelleher, Judy; Patterson, Matt; Murphy, Katie

    2012-08-01

    Anterior cruciate ligament (ACL) injury is a common injury encountered by sport medicine clinicians. Surgical reconstruction is the recommended treatment of choice for those athletes wishing to return to full-contact sports participation and for sports requiring multi-directional movement patterns. The aim of ACL reconstruction is to restore knee joint mechanical stability such that the athlete can return to sporting participation. However, knowledge regarding the extent to which lower limb kinematic profiles are restored following ACL reconstruction is limited. In the present study the hip and knee joint kinematic profiles of 13 ACL reconstructed (ACL-R) and 16 non-injured control subjects were investigated during the performance of a diagonal jump landing task. The ACL-R group exhibited significantly less peak knee joint flexion (P=0.01). Significant between group differences were noted for time averaged hip joint sagittal plane (Pjoint frontal plane (Phip and knee joint kinematic profiles are present following ACL reconstruction, which could influence future injury risk.

  7. 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 ...

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

    Directory of Open Access Journals (Sweden)

    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

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

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    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.

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

    DEFF Research Database (Denmark)

    Gvozdenovic, Robert; Boeckstyns, Michel

    2014-01-01

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

  11. Cost-Effectiveness Analysis of Early Reconstruction Versus Rehabilitation and Delayed Reconstruction for Anterior Cruciate Ligament Tears.

    Science.gov (United States)

    Mather, Richard C; Hettrich, Carolyn M; Dunn, Warren R; Cole, Brian J; Bach, Bernard R; Huston, Laura J; Reinke, Emily K; Spindler, Kurt P

    2014-07-01

    An initial anterior cruciate ligament (ACL) tear can be treated with surgical reconstruction or focused rehabilitation. The KANON (Knee Anterior cruciate ligament, NON-surgical versus surgical treatment) randomized controlled trial compared rehabilitation plus early ACL reconstruction (ACLR) to rehabilitation plus optional delayed ACLR and found no difference at 2 years by an intention-to-treat analysis of total Knee injury and Osteoarthritis Outcome Score (KOOS) results. To compare the cost-effectiveness of early versus delayed ACLR. Economic and decision analysis; Level of evidence, 2. A Markov decision model was constructed for a cost-utility analysis of early reconstruction (ER) versus rehabilitation plus optional delayed reconstruction (DR). Outcome probabilities and effectiveness were derived from 2 sources: the KANON study and the Multicenter Orthopaedic Outcomes Network (MOON) database. Collectively, these 2 sources provided data from 928 ACL-injured patients. Utilities were measured by the Short Form-6 dimensions (SF-6D). Costs were estimated from a societal perspective in 2012 US dollars. Costs and utilities were discounted in accordance with the United States Panel on Cost-Effectiveness in Health and Medicine. Effectiveness was expressed in quality-adjusted life-years (QALYs) gained. Principal outcome measures were average incremental costs, incremental effectiveness (as measured by QALYs), and net health benefits. Willingness to pay was set at $50,000, which is the currently accepted standard in the United States. In the base case, the ER group resulted in an incremental gain of 0.28 QALYs over the DR group, with a corresponding lower overall cost to society of $1572. Effectiveness gains were driven by the low utility of an unstable knee and the lower utility for the DR group. The cost of rehabilitation and the rate of additional surgery drove the increased cost of the DR group. The most sensitive variable was the rate of knee instability after initial

  12. 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.

  13. 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.

  14. Surgical reconstruction in female genital mutilation.

    Science.gov (United States)

    Gültekin, İsmail Burak; Altınboğa, Orhan; Dur, Rıza; Kara, Osman Fadıl; Küçüközkan, Tuncay

    2016-06-01

    Female genital mutilation (FGM) is an unusual condition for our country. However, an increase in FGM in future days can be predicted with the increasing numbers of exchange students coming from African countries, migration of refugees and socioeconomic relations with the African countries. We want to share our experience of two FGM victims admitted to our clinic with the request of reconstructive vulvar surgery before their marriage. Both women had WHO Type III FGM. Physical examination findings and surgical reconstruction techniques were presented.

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

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    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.

  16. 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.

  17. Analysis of 3-dimensional finite element after reconstruction of impaired ankle deltoid ligament.

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    Ji, Yunhan; Tang, Xianzhong; Li, Yifan; Xu, Wei; Qiu, Wenjun

    2016-12-01

    We compared four repair techniques for impaired ankle ligament deltoideum, namely Wiltberger, Deland, Kitaoka and Hintermann using a 3-dimensional finite element. We built an ankle ligament deltoideum model, including six pieces of bone structures, gristles and main ligaments around the ankle. After testing the model, we built an impaired ligament deltoideum model plus four reconstruction models. Subsequently, different levels of force on ankles with different flexion were imposed and ankle biomechanics were compared. In the course of bending, from plantar flexion 20° to back flexion 20°, the extortion of talus decreased while the eversion increased. Four reconstruction models failed to bring back the impaired ankle to normal, with an obvious increase of extortion and eversion. The Kitaoka technique was useful to reduce the extortion angle in a consequential manner. Compared with the other three techniques, the Kitaoka technique produced better results for extortion angle and the difference was statistically significant. However, in case of eversion, there was no significant difference among the four techniques (P>0.05). Lateral ligament's stress in all the four models was different from the normal one. When the ankle was imposed with extortion moment of force, stress of anterior talofibular ligament with the Kitaoka reconstruction method was close to that of the complete deltoid ligament. When ankle was imposed with eversion moment of force, stress of anterior talofibular ligament with Kitaoka and Deland reconstruction methods were close to that of the complete deltoid ligament. We concluded that Kitaoka and Deland tendon reconstruction technique could recover impaired ankle deltoid ligament and re-established its normal biomechanics characteristics.

  18. Efficacy of an Intra-Operative Imaging Software System for Anatomic Anterior Cruciate Ligament Reconstruction Surgery

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    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.

  19. Open anatomical coracoclavicular ligament reconstruction using a tendon graft with an Endobutton loop.

    Science.gov (United States)

    Shetty, Nagraj S; Yoo, Yon S; Kim, Do Y; Lee, Sang S; Jeong, Un S

    2009-12-01

    We describe a technique of open anatomical coracoclavicular ligament reconstruction restoring both parts of the native ligament, aiming at achieving maximum stability of the acromioclavicular joint without disturbing the normal anatomy. Using the same anatomical principle of ligament reconstruction as in other joints, transosseous tunnels are created at the native footprints of the conoid and trapezoid ligaments. An autologous graft is fixed using an Endobutton continuous loop and a PEEK screw; adequate healing of the ligament is ensured with an appropriate working length. Although an open procedure, this technique offers several advantages. It can be easily reproduced using basic anatomical principles and simple cost-effective instrumentation. The implant does not have to be removed, important anatomical structures are respected, normal acromioclavicular joint kinematics are restored, the scar is cosmetically acceptable and post-operative morbidity is very low.

  20. 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...

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

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    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.

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

    Science.gov (United States)

    Bizzini, Mario; Hancock, Dave; Impellizzeri, Franco

    2012-04-01

    Successful return to play remains a challenge for a soccer player after anterior cruciate ligament reconstruction. In addition to a successful surgical intervention, a soccer-specific functional rehabilitation program is essential to achieve this goal. Soccer-like elements should be incorporated in the early stages of rehabilitation to provide neuromuscular training specific to the needs of the player. Gym-based and, later, field-based drills are gradually intensified and progressed until the player demonstrates the ability to return to team practice. In addition to the recovery of basic attributes such as mobility, flexibility, strength, and agility, the surgically repaired knee must also regain soccer-specific neuromuscular control and conditioning for an effective return to sports. The individual coaching of the player by the sports physiotherapist and compliance with the training program by the player are key factors in the rehabilitation process. To minimize reinjury risk and to maximize the player's career, concepts of soccer-specific injury prevention programs should be incorporated into the training routine during and after the rehabilitation of players post-ACL reconstruction.

  3. Pre-tibial synovial cyst after reconstruction of the anterior cruciate ligament: case report,

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    Luís Eduardo Pedigoni Bulisani

    2014-12-01

    Full Text Available Arthroscopic reconstruction of the anterior cruciate ligament has been modernized through new surgical techniques and new materials. When tibial fixation is performed using an absorbable screw, complications may occur, such as formation of a pre-tibial cyst. The case described here is about a patient who presented an anteromedial synovial cyst in his right knee, three years after having undergone ACL reconstruction. The patient did not present any pain nor any complaints other than a mass that progressively increased in size, worsened after physical activities. Imaging examinations were requested: simple radiography of the knee and magnetic resonance. Anteromedial imaging of the knee showed a mass with well-delimited borders and internal fluid content, suggestive of a synovial cyst, with communication with the joint cavity through the tibial tunnel, without presenting enlargement or absorption of the bone tunnel. The cyst was surgically resected and the tibial tunnel occlusion was performed using a bone plug. The diagnosis of a synovial cyst was subsequently confirmed through the results from the anatomopathological examination. The patient presented good clinical evolution, with disappearance of the symptoms and a return to physical activities.

  4. Cyclic Testing of 3 Medial Patellofemoral Ligament Reconstruction Techniques

    Science.gov (United States)

    Mehta, Vishal; Mandala, Cassie; Akhter, Ahmed

    2017-01-01

    Background: Several techniques are available to secure the graft to the patella during medial patellofemoral ligament (MPFL) reconstruction. The biomechanical properties of these techniques remain unknown. Purpose: To compare the biomechanical properties of 3 MPFL patellar fixation techniques: bone tunnels (BT), PushLock anchors (PL), and tenodesis screws (TS). Study Design: Controlled laboratory study. Methods: Forty-five MPFL reconstructions were performed using 3 different reconstruction techniques (BT, PL, and TS). The specimens were randomly assigned, with 15 specimens in each of the 3 groups. Cyclic loading (500 cycles) and load-to-failure testing were performed. Gap formation after 100 and 500 cycles, ultimate load to failure, and stiffness were measured. Results: Six constructs failed during cyclic loading, 5 in the PL group (33%) and 1 in the TS group (6.7%). After 100 cycles, differences in gap formation were found between the PL and BT groups (4.48 vs 3.62 mm, P < .03) and between the PL and TS groups (4.48 vs 2.28 mm, P < .0001). After 500 cycles, differences in gap formation were found between the BT and TS groups (6.63 vs 4.16 mm, P < .002) and between the PL and TS groups (7.89 vs 4.16 mm, P < .005). The PL group was found to have a lower ultimate load to failure when compared with the BT group (161.4 vs 258.3 N, P = .019) and the TS group (161.4 vs 237.1 N, P = .009). Group differences in stiffness did not reach statistical significance among the 3 groups (PL, 33.72 N/mm; BT, 37.50 N/mm; TS, 43.00 N/mm). Conclusion: The TS and BT groups have more ideal biomechanical properties than the PL group, as demonstrated by less displacement during cyclic loading and a higher load to failure. Clinical Relevance: Fixation of the patellar limbs during MPFL reconstruction may be optimized with the use of TS or BT over a PL technique. PMID:28680899

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

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    Demet Pepele

    2014-03-01

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

  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. 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.

  8. Performance outcomes of anterior cruciate ligament reconstruction in the National Basketball Association.

    Science.gov (United States)

    Busfield, Benjamin T; Kharrazi, F Daniel; Starkey, Chad; Lombardo, Stephen J; Seegmiller, Jeffrey

    2009-08-01

    The purpose of this study was to determine the rate of return to play and to quantify the effect on the basketball player's performance after surgical reconstruction of the anterior cruciate ligament (ACL). Surgical injuries involving the ACL were queried for a 10-year period (1993-1994 season through 2004-2005 season) from the database maintained by the National Basketball Association (NBA). Standard statistical categories and player efficiency rating (PER), a measure that accounts for positive and negative playing statistics, were calculated to determine the impact of the injury on player performance relative to a matched comparison group. Over the study period, 31 NBA players had 32 ACL reconstructions. Two patients were excluded because of multiple ACL injuries, one was excluded because he never participated in league play, and another was the result of nonathletic activity. Of the 27 players in the study group, 6 (22%) did not return to NBA competition. Of the 21 players (78%) who did return to play, 4 (15%) had an increase in the preinjury PER, 5 (19%) remained within 1 point of the preinjury PER, and the PER decreased by more than 1 point after return to play in 12 (44%). Although decreases occurred in most of the statistical categories for players returning from ACL surgery, the number of games played, field goal percentage, and number of turnovers per game were the only categories with a statistically significant decrease. Players in the comparison group had a statistically significant increase in the PER over their careers, whereas the study group had a marked, though not statistically significant, increase in the PER in the season after reconstruction. After ACL reconstruction in 27 basketball players, 22% did not return to a sanctioned NBA game. For those returning to play, performance decreased by more than 1 PER point in 44% of the patients, although the changes were not statistically significant relative to the comparison group. Level IV, therapeutic

  9. Factors associated with a more rapid recovery after anterior cruciate ligament reconstruction using multivariate analysis.

    Science.gov (United States)

    Scherer, Job E; Moen, Maarten H; Weir, Adam; Schmikli, Sandor L; Tamminga, Rob; van der Hoeven, Henk

    2016-01-01

    In the past, several studies investigated factors that are prognostic or associated with outcome after anterior cruciate ligament (ACL) reconstruction. A recent review showed that only limited evidence is available for most studied factors, and that insufficient analysis methods were used commonly. Therefore, the aim of this study was to add more weight to the existing evidence, about factors that are associated with a more rapid outcome after ACL reconstruction. The second aim was to use multivariate analysis to study the possible factors independently. A cohort study was conducted with a follow-up of six months. Before surgery, patient variables were scored. Surgical variables were scored during arthroscopic ACL reconstructions with a single-bundle technique and hamstring autograft. The Lysholm score and subscales of the Knee Injury Osteoarthritis Outcome Score (KOOS) were assessed six months post surgery. A multiple analysis of variance (ANOVA) model was used to identify prognostic factors for outcome. In total, 118 patients were included. Patients, aged ≤30years, with a subjective knee score ≥ six, with normal flexion range of motion (ROM) of the knee, with flexion and extension strength deficit of ≤20%, and those with no previous knee surgery in the same knee at baseline scored significantly higher on outcome after multivariate analysis. No significant effect of surgical factors could be found. Younger age, higher subjective knee score, normal knee flexion, normal knee flexion and extension strength, and no previous knee surgery in the patients' history at baseline are associated with a more rapid recovery after ACL reconstruction. Level III, prognostic study. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. The Effects of Rehabilitation Protocol on Functional Recovery After Anterior Cruciate Ligament Reconstruction

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    Dragicevic-Cvjetkovic, Dragana; Jandric, Slavica; Bijeljac, Sinisa; Palija, Stanislav; Manojlovic, Slavko; Talic, Goran

    2014-01-01

    ABSTRACT Introduction: The use of rehabilitation protocol which corresponds to surgical technique results in optimal postoperative outcome and functional recovery of patients to a pre-injury level of activity. The aim of this paper is to show the effects of the official rehabilitation protocol in our Institute on functional recovery of patients after anterior cruciate ligament (ACL) reconstruction. Patients and methods: In prospective study, we evaluated 70 males after ACL reconstruction using hamstring graft. Patients were divided into two groups according to the manner of conducting the postoperative rehabilitation. Group A consisted of 35 patients that followed postoperative rehabilitation according to the rehabilitation protocol. Group B also 35 patients, which did not undergo the rehabilitation protocol. We evaluated thigh muscle circumference and modified Tegner Lysholm Score, preoperatively and postoperatively after 1,3,6 and 12 months. In the statistical analysis, the Studentov T-test was used. Results: In the first postoperative month, the difference between groups in thigh muscle circumference is statistically significant (p<0,05). This difference between groups is statistically highly significant after 3, 6, and 12 months postoperative (p<0,01). Results of the modified Tegner Lysholm Score is statistically highly significant in 1, 3 and 6 postoperative months in patients from the experimental group (p<0,01). Conclusion: The positive effects of the rehabilitation protocol results in significant increase of the thigh muscle circumference and faster functional recovery of patients after ACL reconstruction. PMID:25568570

  11. 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.

  12. 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

  13. Ligament reconstruction with tendon interposition arthroplasty for first carpometacarpal joint osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    Yang Yong; Huey Y.Tien; Kannan K.Kumar; Chen Shanlin; Li Zhongzhe; Tian Wen; Tian Guanglei

    2014-01-01

    Background Ligament reconstruction tendon interposition (LRTI) is the most commonly performed surgical procedure for first carpometacarpal joint osteoarthdtis.The purpose of this study was to examine the radiographic and clinical outcomes of LRTI arthroplasty and document the clinical results based on metacarpal subsidence.Methods From January 2008 to January 2011,19 patients (21 thumbs) underwent surgery for thumb carpometacarpal arthritis using ligament reconstruction tendon interposition arthroplasty with flexor carpi radialis (FCR) in Kleinert Kutz Hand Care Center of Louisville University,USA.The follow-up period was an average of 13.9 months.Pain,grip strength,tip pinch strength,range of motion,and radiographic measurements were recorded.Based on first metacarpal subsidence,the cases were classified in to mild,moderate,and severe.Clinical outcomes of the groups were evaluated and compared.Results Grip strength improved from 18.6 kg to 20.5 kg,and tip pinch strength increased from 4.4 kg to 4.5 kg after the surgery.Radial abduction and palmar abduction improved after surgery.Radial abduction increased from 55.7° to 60.6° and palmar abduction improved from 56.7° to 63.5° after the procedure.Visual analogue scores (VAS) were significantly reduced,from 6.6 to 0.5.Compared with the preoperative radiographs the first metacarpal had subsided about 54.6% of the arthroplasty space.The height of arthroplasty space and index of the arthroplasty space significantly decreased from 12.4 mm to 5.6 mm and from 0.27 to 0.12 respectively.Between the various groups (mild,moderate and severe metacarpal subsidence),there was no difference in grip strength,tip pinch strength,thumb range of motion,and VAS.Conclusions Ligament reconstruction tendon interposition arthroplasty resulted in excellent relief of pain and increase in range of motion.However,LRTI cannot maintain the arthroplasty space.Compared with the preoperative radiographs,the metacarpal subsided more than 50

  14. 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.

  15. 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.

  16. 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

  17. Patellofemoral Pressure Changes After Static and Dynamic Medial Patellofemoral Ligament Reconstructions

    NARCIS (Netherlands)

    Rood, A.; Hannink, G.; Lenting, A.; Groenen, K.; Koeter, S.; Verdonschot, N.J.; Kampen, A. van

    2015-01-01

    BACKGROUND: Reconstructing the medial patellofemoral ligament (MPFL) has become a key procedure for stabilizing the patella. Different techniques to reconstruct the MPFL have been described: static techniques in which the graft is fixed rigidly to the bone or dynamic techniques with soft tissue fixa

  18. Patellofemoral pressure changes after static and dynamic medial patellofemoral ligament reconstructions

    NARCIS (Netherlands)

    Rood, A.; Hannink, G.; Lenting, A.; Groenen, K.; Koëter, S.; Verdonschot, N.J.J.; Kampen, van A.

    2015-01-01

    Background: Reconstructing the medial patellofemoral ligament (MPFL) has become a key procedure for stabilizing the patella. Different techniques to reconstruct the MPFL have been described: static techniques in which the graft is fixed rigidly to the bone or dynamic techniques with soft tissue fixa

  19. 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.

  20. Anatomic Anterolateral Ligament Reconstruction of the Knee Leads to Overconstraint at any Fixation Angle

    Science.gov (United States)

    Schon, Jason; Brady, Alex; Moatshe, Gilbert; Cruz, Raphael; Chahla, Jorge; Dornan, Grant; Turnbull, Travis L.; Engebretsen, Lars

    2016-01-01

    Objectives: Anterior cruciate ligament (ACL) tears are one of the most common injuries among athletes. However, the ability to fully restore rotational stability with ACL reconstruction (ACLR) remains a challenge because up to 25% of patients may present with a residual pivot shift following surgery. Advocacy for reconstruction of the anterolateral ligament (ALL) is rapidly increasing because biomechanical studies have reported that the ALL is a significant contributor to internal rotational stability of the knee. Although several graft fixation angles for the anatomic ALL reconstruction (ALLR) have been reported in literature, none have been biomechanically validated. Therefore, the purpose of this study was to assess the effect of ALLR graft fixation angle on knee joint kinematics in the clinically relevant setting of a concomitant ACLR. The goal was to find the optimal knee flexion angle for fixation of the ALLR graft that would most accurately restore native knee kinematics without introducing overconstraint to the knee. It was hypothesized that all fixation angles would significantly reduce rotational laxity compared to the sectioned ALL state and that fixation at 30° would best reproduce native joint kinematics. Methods: Eight non-paired fresh-frozen human cadaveric knees with no prior injury, surgical history, or gross anatomic abnormality were evaluated with a 6 degree-of-freedom robotic system. Each specimen underwent a full kinematic assessment in each of the following states: 1) intact, 2) anatomic single-bundle (SB) ACLR with intact ALL, 3) anatomic SB ACLR with sectioned ALL, 4) 7 anatomic SB ACLR and ALLR states utilizing ALL graft fixation knee flexion angles of 0°, 15°, 30°, 45°, 60°, 75° and 90°, and 5) sectioned ACL and ALL. Internal rotation during a 5 N-m internal rotation torque and anterior displacement during an 88 N anterior load were recorded at 15° intervals between 0° and 120° of knee flexion. Axial plane displacement and

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    Studies suggest that the anterolateral ligament (ALL) is important for knee stability. The purpose was to clarify ALL's effect on rotatory and anterior-posterior stability in the anterior cruciate ligament (ACL)-insufficient and reconstructed knees and the effect of reconstruction of an insuffici......Studies suggest that the anterolateral ligament (ALL) is important for knee stability. The purpose was to clarify ALL's effect on rotatory and anterior-posterior stability in the anterior cruciate ligament (ACL)-insufficient and reconstructed knees and the effect of reconstruction...... of an insufficient ALL. Eighteen cadaveric knees were included. Stability was tested for intact (+ALL), detached (-ALL) and reconstructed (+ reALL) ALL, with ACL removed (-ACL) and reconstructed (+ACL) in six combinations. All were tested in 0, 30, 60, and 90 °C flexion. Anterior-posterior stability was measured...... with a rolimeter. Rotation with a torque of 8.85 Nm was measured photographically. The ALL was well defined in 78% of knees. ACL reconstruction had a significant effect on anterior-posterior stability. Detaching the ALL had a significant effect on internal rotatory stability and on anterior-posterior stability...

  2. Tissue Engineering Applications for Ligament and Tendon Reconstruction

    Institute of Scientific and Technical Information of China (English)

    J.C.H.; GOH; H.W.; OU; YANG; Z.G.; GE; S.L.; TOH

    2005-01-01

    Tendons and ligaments are subjected to high physiological loads. As such, injuries due to high impact activities are common. Due to the avascular nature of these connective tissues, the healing rate is rather slow. Currently the therapeutic options to treat tendon and ligament injuries are autografts, allografts and prosthetic devices. However, there are many disadvantages in using biological grafts, as well as concerns over long-term performance of synthetic prostheses. Therefore, further research for alte...

  3. 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.

  4. 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.

  5. 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

  6. 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

  7. Scapholunate interosseus ligament reconstruction on a cadaver A technique

    Directory of Open Access Journals (Sweden)

    Joan Arenas Prat

    2014-01-01

    Full Text Available Background: Acute rupture of the scapholunate interosseus ligament is a relatively frequent occurrence which can be repaired primarily by direct suturing. However, patients are often seen a few weeks after injury when most of the ligament fibers have degenerated. This poses a challenge because direct repair can be difficult and long term results have not been satisfying. In the present study, a technique is presented to address this problem and its possible advantages are discussed. Materials and Methods: A fresh frozen wrist cadaver specimen, thawed to room temperature, was used to carry out the procedure. The scapholunate joint was exposed through a dorsal approach and stabilized using two percutaneous Kirschner wires. Using a U shaped chisel, a groove along the scapholunate articular margin was created to accommodate a strip from the extensor retinaculum as a ligament plasty. This has been secured using six anchor sutures and several pictures taken during the procedure to expose the key steps. Results: The ligamentoplasty presented in this article preserves most of the articular surface of proximal carpus and at the same time stabilizes the scapholunate joint. However, more in vivo research should be carried out to validate this treatment. Conclusion: The technique suggests a possible way to repair a ruptured scapholunate interosseus ligament that cannot be repaired primarily. Because osteointegration of the ligament strips is not possible in the present experiment, biomechanics of the construct cannot be fully tested.

  8. 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.

  9. FUNCTIONAL OUTCOME OF ARTHROSCOPICALLY ASSISTED ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING PATELLAR BTB GRAFT: A PROSPECTIVE STUDY OF 45 CASES

    Directory of Open Access Journals (Sweden)

    Suresh

    2014-09-01

    Full Text Available : In today’s world high velocity road traffic accidents, sports activities and increased fitness awareness, ACL injuries is a common clinical problem. Once upon a time ACL rupture led to a relatively safe existence and was thought to be of less significance. Now with improved knee kinematics and clinical skills, it has been established that post ACL injury, the prevalence of clinically significant meniscal damage increases with time and is associated with increasing disability and arthrosis. Ligament reconstruction has not been shown to prevent arthrosis, but studies show that it appears to reduce the risk of subsequent meniscal injury and improve anteroposterior knee motion and facilitates return to high level sporting activities. As surgical techniques like Arthroscopy improve the ability to tackle complex problems, complex decisions regarding Meniscal repair and transplantation, Cartilage repair and regeneration are now commonplace, as are decisions regarding the need for Osteotomies in Arthritically unstable knees. Arthroscopic reconstruction of the Anterior Cruciate Ligament with patellar bone - tendon - bone graft is minimally invasive and is relatively quick and simple to perform, although attention to detail as required for good results. Thus arthroscopy helps in diagnosis and treatment of internal derangement and on extra articular reconstruction.

  10. 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.

  11. A novel use for suture button suspension: reconstruction of the dorsal ulnar ligament to treat thumb metacarpal dislocation.

    Science.gov (United States)

    Shah, Ajul; Martin, Garry; Thomson, James Grant

    2015-01-01

    There are numerous treatment algorithms that have been developed to treat thumb carpometacarpal (CMC) arthritis. A newer treatment option for these patients is CMC stabilization using suture button suspensionplasty. The authors of this case report have extensive experience with the suture-button suspensionplasty using the Mini TightRope CMC technique (Arthrex). We present a novel usage of the suture-button suspensionplasty to reconstruct the dorsal ulnar ligament (in contrast to the usual reconstruction of the volar beak ligament) to treat a patient with persistent thumb metacarpal dislocation at the CMC joint. Two separate patients are presented. One patient demonstrates volar beak ligament instability, and the other demonstrates dorsal ulnar ligament instability. Both patients' demographics and operative indications are described. The operative technique for the novel usage of the suture-button suspensionplasty is described. Operative results of the dorsal ulnar ligament reconstruction are reviewed. After suture-button suspension of the thumb metacarpal to the trapezium, the dorsal ulnar ligament has been reconstructed. The patient demonstrated stability of the thumb CMC joint without dorsal or radial dislocation. The authors of this case report present a novel usage of the suture-button suspensionplasty to treat a patient with proximal thumb metacarpal dislocation at the trapezial-metacarpal interface. This method, in contrast to the referenced method of volar beak ligament reconstruction, allows reconstruction of the dorsal ulnar ligament. This allows stabilization of the joint by preventing dorsal and radial dislocation of the metacarpal.

  12. 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 +/-

  13. 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…

  14. 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

  15. 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...

  16. Pain and negative mood during rehabilitation after anterior cruciate ligament reconstruction: a daily process analysis.

    Science.gov (United States)

    Brewer, B W; Cornelius, A E; Sklar, J H; Van Raalte, J L; Tennen, H; Armeli, S; Corsetti, J R; Brickner, J C

    2007-10-01

    Daily diary methods were used to examine changes in pain and negative mood over the first 6 weeks of rehabilitation after surgical reconstruction of the anterior cruciate ligament (ACL). Participants (58 men and 33 women) completed measures of personal factors (i.e., age, athletic identity, neuroticism, optimism) before surgery and indices of daily pain, negative mood, and stress for 42 days after surgery. Multilevel modeling revealed that, as would be expected, daily pain ratings decreased significantly over the course of the study and that the rate of decline in pain ratings decreased over time. Age and daily negative mood were positively associated with daily pain ratings. Daily negative mood also decreased significantly over the course of the study and was positively associated with neuroticism, daily pain, and daily stress. Athletic identity and optimism interacted with time since surgery in predicting daily negative mood such that participants with high levels of athletic identity and low levels of optimism reported greater decreases in daily negative mood over time. Overall, the findings reveal a pattern of improved psychological functioning over the early stages of post-operative ACL rehabilitation.

  17. Arthroscopically Assisted Acromioclavicular and Coracoclavicular Ligament Reconstruction for Chronic Acromioclavicular Joint Instability.

    Science.gov (United States)

    Martetschläger, Frank; Tauber, Mark; Habermeyer, Peter; Hawi, Nael

    2016-12-01

    Acromioclavicular (AC) joint injuries are common injuries, especially in the young and active, male population. AC joint injuries account for 12% of all injuries of the shoulder girdle in the overall population. Although conservative treatment is recommended for Rockwood type I and type II injuries, there is controversial debate about optimal treatment for type III injuries. High-grade injuries are typically treated operatively to avoid painful sequelae. A vast number of different surgical methods have been described over the past few decades. Recent advances in arthroscopic surgery have enabled the shoulder surgeon to treat acute and chronic AC lesions arthroscopically assisted. Clinical studies have already shown good and reliable results. Although surgeons agree that a biological augmentation is required to minimize the risk of recurrent instability in chronic cases, a gold standard still needs to be defined. We present an arthroscopically assisted biological augmentation technique to reconstruct the AC and coracoclavicular ligaments, protected by a button-suture tape construct for chronic AC joint instability. The presented arthroscopic biological augmentation technique uses less and/or smaller drill holes in the clavicle and coracoid than previously described, thus reducing weakening of the bony structures. At the same time it enhances both horizontal and vertical stability.

  18. 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.

  19. 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...

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    Tajima Takuya

    2012-10-01

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

  2. Biomechanical jumping differences among elite female handball players with and without previous anterior cruciate ligament reconstruction: a novel inertial sensor unit study.

    Science.gov (United States)

    Setuain, Igor; Millor, Nora; González-Izal, Miriam; Gorostiaga, Esteban M; Gómez, Marisol; Alfaro-Adrián, Jesús; Maffiuletti, Nicola A; Izquierdo, Mikel

    2015-09-01

    Persistent biomechanical and jumping capacity alterations have been observed among female athletes who have sustained anterior cruciate ligament (ACL) injuries. The purpose of this study was to examine if biomechanical jumping differences persist among a cohort of elite female handball players with previous ACL reconstruction several years after return to top-level competition. In order to achieve this goal, a direct mechanics simplified analysis by using a single Inertial Sensor Unit (IU) was used. Twenty-one elite female (6 anterior cruciate ligament reconstructed and 15 uninjured control players) handball players were recruited and evaluated 6.0 ± 3.5 years after surgical anterior cruciate ligament reconstruction. Bilateral and unilateral vertical jumps were performed to evaluate the functional performance and a single inertial sensor unit was employed in order to collect 3D acceleration and 3D orientation data. Previously ACL-reconstructed analysed athletes demonstrated significant (p reconstruction. Identification of the encountered deficits through the use of an IU devise could provide clinicians with a new reliable tool for movement analysis in a clinical setting.

  3. 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.

  4. Antecedent anterior cruciate ligament reconstruction surgery and optimal duration of supervised physiotherapy.

    Science.gov (United States)

    Darain, Haider; Alkitani, Abdulhameed; Yates, Christopher; Bailey, Andrea; Roberts, Simon; Coutts, Fiona; Gleeson, Nigel

    2015-01-01

    A 22-year-old patient undergoing unilateral surgical reconstruction of the anterior cruciate ligament (ACL) of the right knee volunteered for the research project and followed an established contemporary hospital-based rehabilitation programme. The patient was supervised post-surgically by an experienced and clinically specialized physiotherapist. The clinical outcomes of rehabilitation were assessed by selected validated patient-reported and objectively-measured outcomes of functional performance capability on four different occasions (pre-surgery, 6th, 12th and 24th week post-surgery). The patient scored 30, 56, 60 and 85 on IKDC (maximum score, 100); 46, 53, 90 and 91 on Lysholm (maximum score, 100); 141, 73, 128 and 175 on K-SES (maximum score, 220); 17, 12, 6 and 6 on the symptom subsection of KOOS (maximum score, 28); 7, 7, 5 and 5 on the pain subsection (maximum score, 36); 1, 0, 3 and 1 on the daily function subsection (maximum score, 68); 0, 0, 5 and 5 on the sport and recreation function subsection (maximum score, 20); 13, 11, 15 and 13 on the quality of life subsection (maximum score, 16) of KOOS at pre-surgery and at the 6th, 12th and 24th week following ACL reconstruction, respectively. Moreover, the patient scored 1.96 m, 1.92 m and 1.99 m on single-leg hop (injured leg) when assessed at pre-surgery and at the 12th and 24th week post-surgery, respectively, following ACL reconstruction. The total time spent in supervised rehabilitation by the patient (675 minutes) was computed as the aggregate patient-reported time spent in exercise during each hospital-based rehabilitation session (verified by physiotherapist evaluation) across the total number of sessions. The patient managed to return to the sport in which he had participated prior to the injury, immediately after the completion of the contemporary rehabilitation programme, at 24 weeks post-surgery. A total of fifteen physiotherapy sessions supervised by the physiotherapist, were attended by the

  5. Do pre-operative knee laxity values influence post-operative ones after anterior cruciate ligament reconstruction?

    Science.gov (United States)

    Signorelli, C; Bonanzinga, T; Lopomo, N; Marcheggiani Muccioli, G M; Bignozzi, S; Filardo, G; Zaffagnini, S; Marcacci, M

    2013-08-01

    The objective of this study was to verify whether pre-reconstruction laxity condition effects post-reconstruction outcome. A total of 100 patients who underwent navigated Anterior Cruciate Ligament (ACL) reconstruction were included in the study and knee laxity analysed retrospectively. The knee was assessed in six different laxity tests before and after ACL reconstruction, namely antero-posterior (AP) and internal-external (IE) at 30° and 90°, and varus-valgus (VV) rotations at 0° and 30° of flexion. For each test, the least square (LS) fitting line based on pre-operative-to-post-operative laxity value was calculated. To what degree the post-operative laxity value is explainable by the corresponding pre-operative condition was evaluated by the LS line slope. Post-operatively, for each single patient, the grade of laxity decreased at any evaluated test. The strongest influence of pre-operative-to-post-operative laxity values was found during IE30 and IE90 tests. While AP30 and VV0 tests seem to be those in which the post-reconstruction laxity was barely affected by the pre-surgery condition. The analysis of the global laxity reduction confirms the previous results. Following this hypothesis, our study remarks on the importance of combined lesions to secondary restraints and the importance of fully understanding the residual laxity to optimize the surgical technique.

  6. 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.

  7. 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

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

    Directory of Open Access Journals (Sweden)

    Fabiano Kupczik

    2013-09-01

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

  9. 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.

  10. PHYSICAL THERAPY INTERVENTION FOR MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION AFTER REPEATED LATERAL PATELLAR SUBLUXATION/DISLOCATION

    Science.gov (United States)

    Mooney, Brianne; Vitale, Ashley; Apergis, Demitra; Wirth, Stephen; Grossman, Mark G.

    2016-01-01

    ABSTRACT Background The incidence of patellar subluxation or dislocation has been documented up to 43/100,000 with females more prevalent then males. There are many contributing factors involving the hip, knee, and ankle that lead to patellar subluxation. A patellar position of lateral tilt with lateral glide may indicate weakness of the vastus medialis oblique (VMO) and adductors, increased tightness in the iliotibial band, and overpowering of the vastus lateralis. Patella alta can predispose an individual to lateral dislocation due to the patella placement outside of the femoral trochlear groove with a disadvantage of boney stability. Other factors that may cause the patella to laterally sublux or dislocate during a functional activity or sporting activity include a position of femoral external rotation, tibial internal rotation, and excessive contraction of the vastus lateralis. The medial patellofemoral ligament (MPFL) aids in the prevention of a lateral patellar subluxation or dislocation. In cases where there is recurrent subluxation/dislocation and Magnetic Resonance Imaging confirms a MPFL tear, a reconstruction may be the treatment of choice. Purpose The purpose of this case series is to describe the post-surgical physical therapy management of MPFL reconstructions, outcomes using the Modified Cincinnati Knee Outcome Measure (MCKOM) and to propose staged physical therapy interventions for this pathology in the form of a treatment progression. Methods Post-operative management data and outcomes were retrospectively collected using a detailed chart review methodology from seven subjects who underwent MPFL reconstruction. Findings The Modified Cincinnati Knee Outcome Measure (MCKOM) was analyzed for each participant in four sections that were most important to the return and maintenance of participation in sport. At follow-up the mean scores for the seven subjects in Section 3 (instability) was 19.3/20, Section 4 (overall activity level) was 17.3/20, Section

  11. Comparison of transtibial and transportal techniques in drilling femoral tunnels during anterior cruciate ligament reconstruction using 3D-CAD models

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    Tashiro Y

    2014-04-01

    Full Text Available Yasutaka Tashiro,1 Ken Okazaki,1 Munenori Uemura,2 Kazutaka Toyoda,2 Kanji Osaki,1 Hirokazu Matsubara,1 Makoto Hashizume,2 Yukihide Iwamoto1 1Department of Orthopaedic Surgery, 2Department of Advanced Medical Initiatives, Kyushu University Hospital, Fukuoka, Japan Purpose: The purpose of this study was to assess the differences in bone tunnel apertures between the trans-accessory medial portal (trans-AMP technique and the transtibial (TT technique in double-bundle anterior cruciate ligament reconstruction. The extent of ovalization and the frequency of overlap of the two tunnel apertures were compared. Methods: The simulation of femoral tunnel drilling with the TT and the trans-AMP techniques was performed using three-dimensional computer aided design models from two volunteers. The incidence angle of drilling against the intercondylar wall, the femoral tunnel position, the ovalization, and the overlap were analyzed. The aperture and location of the tunnels were also examined in real anterior cruciate ligament reconstruction cases (n=36. Results: The surgical simulation showed that a lower drill incident angle induced by the TT technique made the apertures of two tunnels more ovalized, located anteromedial tunnels in a shallower position to prevent posterior wall blow out, and led to a higher frequency of tunnel overlap. The trans-AMP group had tunnel places within the footprint and had less ovalization and overlap. The results of analysis for tunnels in the clinical cases were consistent with results from the surgical simulation. Conclusion: In the TT technique, the shallow anteromedial tunnel location and more ovalized tunnel aperture can lead to a higher frequency of tunnel overlap. Compared with the TT technique, the trans-AMP technique was more useful in preparing femoral tunnels anatomically and avoiding tunnel ovalization and overlapping in double-bundle anterior cruciate ligament reconstruction. Keywords: anterior cruciate ligament

  12. Arthroscopic anatomical reconstruction of the lateral ankle ligaments: A technical simplification.

    Science.gov (United States)

    Lopes, R; Decante, C; Geffroy, L; Brulefert, K; Noailles, T

    2016-12-01

    Anatomical reconstruction of the lateral ankle ligaments has become a pivotal component of the treatment strategy for chronic ankle instability. The recently described arthroscopic version of this procedure is indispensable to ensure that concomitant lesions are appropriately managed, yet remains technically demanding. Here, we describe a simplified variant involving percutaneous creation of the calcaneal tunnel for the distal attachment of the calcaneo-fibular ligament. The rationale for this technical stratagem was provided by a preliminary cadaver study that demonstrated a correlation between the lateral malleolus and the distal footprint of the calcaneo-fibular ligament. The main objectives are simplification of the operative technique and decreased injury to tissues whose function is crucial to the recovery of proprioception. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  13. 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.

  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. 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

  16. 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.

  17. Rotational and translational laxity after computer-navigated single- and double-bundle anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Hofbauer, M; Valentin, P; Kdolsky, R; Ostermann, R C; Graf, A; Figl, M; Aldrian, S

    2010-09-01

    Based on biomechanical cadaver studies, anatomic double-bundle reconstruction of the anterior cruciate ligament (ACL) was introduced to achieve better stability in the knee, particularly in respect of rotatory loads. Previously, the success of ACL reconstruction was believed to be mainly dependent on correct positioning of the graft, irrespective of the number of reconstructed bundles for which computer-assisted surgery was developed to avoid malpositioning of the tunnel. The aim of the present study is to compare rotational and translational stability after computer-navigated standard single-bundle, and anatomic double-bundle ACL reconstruction. The authors investigated 55 consecutive patients who had undergone the single-bundle or double-bundle ACL reconstruction procedure with the use of autogenous hamstring tendon grafts and EndoButton fixation, and the patients had been followed for a minimum period of 24 months. Intraoperative, anteroposterior and rotational laxity was measured with the computer navigation system, and compared between groups. Both surgical procedures significantly reduced anteroposterior displacement (AP) and internal rotation (IR) of the tibia compared to the pre-operative ACL-deficient knee (P ACL reconstruction, which is a highly accurate method of graft placement, could be useful for inexperienced surgeons to avoid malposition. Whether double-bundle ACL reconstruction, which was associated with improved rotational laxity and significantly better IKDC and Lysholm scores compared to the standard single-bundle ACL reconstruction procedure, provide an influence in terms of avoiding osteoarthritis or meniscus degeneration, long-term results of at least 5 years are needed.

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

    Science.gov (United States)

    Janssen, Rob Paulus Augustinus; Reijman, Max; Janssen, Daan Martijn; van Mourik, Jan Bernardus Antonius

    2016-01-01

    AIM To summarize the current knowledge on vascular complications and deep venous thrombosis (DVT) prophylaxis after anterior cruciate ligament (ACL) reconstruction. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. MEDLINE, EMBASE, Cochrane, Web of Science, CINAHL, PubMed publisher, and Google scholar medical literature databases were searched up to November 10, 2015. Any arthroscopic surgical method of primary or revision intra-articular ACL reconstruction of all graft types in humans was included. A risk of bias assessment was determined. RESULTS Fourty-seven studies were included in the review. Pseudaneurysms were the most frequently reported arterial complication after ACL reconstruction, irrespective of graft type or method of graft fixation with an incidence of 0.3%. The time to diagnosis of arterial complications after ACL reconstruction varied from days to mostly weeks but even years. After ACL reconstruction without thromboprophylaxis, the incidence of DVT was 9.7%, of which 2.1% was symptomatic. The incidence of pulmonary embolism was 0.1%. Tourniquet time > 2 h was related to venous thromboembolism. Thromboprophylaxis is indicated in patients with risk factors for venous thromboembolism. CONCLUSION After ACL reconstruction, the incidence of arterial complications, symptomatic DVT and pulmonary embolism was 0.3%, 2.1% and 0.1% respectively. Arterial complications may occur with all types of arthroscopic ACL reconstruction, methods of graft fixation as well as any type of graft. Patients considered to be at moderate or high risk of venous thromboembolism should routinely receive thromboprophylaxis after ACL reconstruction. PMID:27672574

  19. The effect of graft strength on knee laxity and graft in-situ forces after posterior cruciate ligament reconstruction.

    Directory of Open Access Journals (Sweden)

    Yu-Shu Lai

    Full Text Available Surgical reconstruction is generally recommended for posterior cruciate ligament (PCL injuries; however, the use of grafts is still a controversial problem. In this study, a three-dimensional finite element model of the human tibiofemoral joint with articular cartilage layers, menisci, and four main ligaments was constructed to investigate the effects of graft strengths on knee kinematics and in-situ forces of PCL grafts. Nine different graft strengths with stiffness ranging from 0% (PCL rupture to 200%, in increments of 25%, of an intact PCL's strength were used to simulate the PCL reconstruction. A 100 N posterior tibial drawer load was applied to the knee joint at full extension. Results revealed that the maximum posterior translation of the PCL rupture model (0% stiffness was 6.77 mm in the medial compartment, which resulted in tibial internal rotation of about 3.01°. After PCL reconstruction with any graft strength, the laxity of the medial tibial compartment was noticeably improved. Tibial translation and rotation were similar to the intact knee after PCL reconstruction with graft strengths ranging from 75% to 125% of an intact PCL. When the graft's strength surpassed 150%, the medial tibia moved forward and external tibial rotation greatly increased. The in-situ forces generated in the PCL grafts ranged from 13.15 N to 75.82 N, depending on the stiffness. In conclusion, the strength of PCL grafts have has a noticeable effect on anterior-posterior translation of the medial tibial compartment and its in-situ force. Similar kinematic response may happen in the models when the PCL graft's strength lies between 75% and 125% of an intact PCL.

  20. 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.

  1. 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

  2. Operative cooperation of arthroscopic reconstruction of anterior cruciate ligament and posterior ligament with autologous tendons%关节镜下自体肌腱重建膝关节前后交叉韧带的手术配合

    Institute of Scientific and Technical Information of China (English)

    冯立文; 韩华; 安亚珍; 关冬叶

    2015-01-01

    目的 探讨关节镜下自体肌腱重建膝关节前后交叉韧带手术的效果及总结护理经验. 方法 对11例前后交叉韧带同时断裂患者行关节镜下自体肌腱重建膝关节前后交叉韧带手术,做好手术前物品准备,熟练掌握仪器性能、使用步骤、连接方式和注意事项;术中熟练、准确、敏捷的配合.结果 患者手术顺利完成,手术时间(2.7 ± 0.2)h,术中出血(32.0 ± 9.8)mL,术后无1例感染.术后Lyshlom评分(92.6 ± 3.2)分高于术前(65.5 ± 3.1)分,差异有统计学意义(P<0.01).结论 关节镜下应用自体肌腱进行膝关节前后交叉韧带的重建具有良好的临床治疗效果. 充足的术前准备、熟练的手术配合是手术成功的关键.%Objective To summarize the operative effect and nursing experience of arthroscopic reconstruction of anterior cruciate ligament (ACL) and posterior ligament (PCL) with autologous tendons. Methods Eleven patients with both ACL and PCL were treated with surgical operation by arthroscopic reconstruction of anterior cruciate ligament and posterior ligament with autologous tendons. Before operation, supplies of surgical articles, mastery of the instrument's properties, procedures, connection mode and precautions were well performed. During the operation, the nursing measure covered also accurate, skilled and agile cooperation. Results The operation was successfully completed, with the average time of (2.7 ± 0.2)h, bleed volume of (32.0 ± 9.8)mL. No infections occurred after surgery. The Lysholm score after operation was higher than that before operation (92.6 ± 3.2 vs. 65.5 ± 3.1;P<0.01). Conclusion Arthroscopic reconstruction of anterior cruciate ligament and posterior ligament with autologous tendons has good clinical therapeutic effect. Preoperative well preparation and expertly operative cooperation are critical for the success of surgery.

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

    Directory of Open Access Journals (Sweden)

    Masashi Kusano

    2015-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Mario I. Ortiz

    2014-03-01

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

  5. 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.

  6. 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

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

    Science.gov (United States)

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

    2017-01-01

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

  8. 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.

  9. 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.

  10. 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

  11. “Floating popliteus tendon injury” in a mutiple-ligament knee injury: one case report and arthroscopy-assisted reconstruction

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jin; FENG Hua; HONG Lei; WANG Xue-song; ZHANG Hui

    2011-01-01

    A patient with both a femoral attachment injury (peel-off injury) and musculotendinous junction avulsion of the popliteus,a so-called “floating popliteus tendon injury”,received arthroscopy-assisted popliteus reconstruction.The injured ligaments were addressed in the same procedure,including mini-open direct repair of the femoral avulsed fibular collateral ligament (FCL),suture repair of the grade 3 medial collateral ligament (MCL),and reconstruction of the posterior cruciate ligament (PCL).

  12. 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.

  13. 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.

  14. Lipoblastoma of the hand treated with excision and ligament reconstruction: a case report.

    Science.gov (United States)

    Estrella, Emmanuel P; Lee, Ellen Y

    2008-01-01

    Lipoblastoma of the hand is a rare benign tumour of infancy. Although benign, the tumour can present as a large mass. We present a case of a two-year-old female with a large, slowly growing soft tissue mass between the second and third metacarpal of the right hand. After excision of the mass, the deep transverse metacarpal ligament (DTML) was reconstructed using a free tendon graft from the extensor indicis propius (EIP).

  15. 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....

  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. OBJECTIVE CRITERIA ASSOCIATED WITH UNRESTRICTED RETURN TO SPORTS ACTIVITIES AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Mohammed A. Fakhro

    2016-04-01

    Full Text Available Background: After an anterior cruciate ligament reconstruction (ACLR, athletes return to full sports activities based ona clinical decision following postoperative rehabilitation. The purpose of this study wasto find if clinical decision to releaseathletes back to unrestricted sports activities afterACLR matches the findings of objective criteria of muscle strength and lower limb symmetry. Materials and Methods: The study used a cross-sectional observational design.Thirty-two athletes who were released within 1 to 7 months to full sports activities were recruited from Lebanese first, second and third sports divisions. Participants performed a battery of tests including: knee extension/flexion, single leg press to assess muscle strength and single leg hop, triple hop, cross-over hop, timed hop and single hop after fatigue for distance to assess lower limb symmetry. Results: Demographic results showed thatmean age of participants was 24.37 years. Bone-patellar tendon bone (BPTP autograft was the most used surgical technique for ACLR. Ten athletes passed the muscle strength testing, whereas twelve athletes had passed that of lower limb symmetry. Therefore, only 18.75% (six athletes out of thirty-two could be released back to full sports activities following the combined testing of muscle strength and lower limb symmetry, whereas, they all had been released previously to full sports activities based on clinical decision. Discussion and Conclusion: Despite that athletes have been released by a clinical decision in a range of one to seven months, there were still significant deficit in muscle strength and lower limb symmetry. The results of this study show noteworthy problems in muscle strength and lower limb symmetry following ACLR. Use of objectives criteria might be a useful adjunct to clinical decision before release of athletes to unrestricted sports activities.

  18. 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.

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

    Science.gov (United States)

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

    2017-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Jingxian Zhu

    2013-01-01

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

  1. 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.

  2. [Reconstructing coracoclavicular ligament in treating Rockwood - III Acromioclavicular dislocation by palmaris longus muscle with polyester suture].

    Science.gov (United States)

    Huang, Jian-lin; Mo, Huan-peng

    2015-06-01

    To explore therapeutic effects of reconstructing coracoclavicular ligament for the treatment of Rockwood-III Acromioclavicular dislocation by palmaris longus muscle with polyester suture. From August 2011 to November 2013,37 cases with Rockwood-III acromioclavicular dislocation were treated with reconstructing coracoclavicular ligament by palmaris longus muscle with polyester suture. Among patients, 24 were males and 13 were females, ranging the age from 19 to 46 years old, with an average of 32 years old. There were 11 cases on the left side and 26 cases on the right side. Twenty-nine cases were fresh dislocation and 8 cases were old dislocation. Blood loss, operative time were observed, and Karlsson evaltae standard were applied for assessing postoperative recovery of shoulder joint function. All patients were followed up from 2.5 to 5 months with an average of 3.5 months. Operative time ranged from 52 to 98 (meaned 72) min, blood loss ranged from 50 to 180 (meaned 75) ml. All operative incision were healed at the satge I . According to Karlsson standard, 32 cases obtained excellent results and 5 cases were moderate. For Rockwood-III acromioclavicular dislocation,reconstructing coracoclavicular ligament by palmaris longus muscle with polyester suture has advantages of simple operation, and rapid recovery of shoulder joint function.

  3. 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.

  4. Speed, not magnitude, of knee extensor torque production is associated with self-reported knee function early after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Hsieh, Chao-Jung; Indelicato, Peter A; Moser, Michael W; Vandenborne, Krista; Chmielewski, Terese L

    2015-11-01

    To examine the magnitude and speed of knee extensor torque production at the initiation of advanced anterior cruciate ligament (ACL) reconstruction rehabilitation and the associations with self-reported knee function. Twenty-eight subjects who were 12 weeks post-ACL reconstruction and 28 age- and sex-matched physically active controls participated in this study. Knee extensor torque was assessed bilaterally with an isokinetic dynamometer at 60°/s. The variables of interest were peak torque, average rate of torque development, time to peak torque and quadriceps symmetry index. Knee function was assessed with the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF). Peak torque and average rate of torque development were lower on the surgical side compared to the non-surgical side and controls. Quadriceps symmetry index was lower in subjects with ACL reconstruction compared to controls. On the surgical side, average rate of torque development was positively correlated with IKDC-SKF score (r = 0.379) while time to peak torque was negatively correlated with IKDC-SKF score (r = -0.407). At the initiation of advanced ACL reconstruction rehabilitation, the surgical side displayed deficits in peak torque and average rate of torque development. A higher rate of torque development and shorter time to peak torque were associated with better self-reported knee function. The results suggest that the rate of torque development should be addressed during advanced ACL reconstruction rehabilitation and faster knee extensor torque generation may lead to better knee function. III.

  5. 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.

  6. Knee stiffness following anterior cruciate ligament reconstruction: the incidence and associated factors of knee stiffness following anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Robertson, G A J; Coleman, S G S; Keating, J F

    2009-08-01

    We reviewed 100 patients retrospectively following primary ACL reconstruction with quadruple hamstring autografts to evaluate the incidence and factors associated with postoperative stiffness. Stiffness was defined as any loss of motion using the contra-lateral leg as a control. The median delay between injury and operation was 15 months. The incidence of stiffness was 12% at 6 months post-reconstruction. Both incomplete attendance at physiotherapy (pAnterior knee pain was also associated with the stiffness (p<0.029). Factors that failed to show a significant association with the stiffness included associated MCL sprain at injury (p=0.32), post-injury stiffness (p=1.00) and concomitant menisectomy at reconstruction (p=0.54). Timing of surgery also did not appear to influence the onset of stiffness (median delays: 29 months for stiff patients; 14 months for non-stiff patients). The rate of stiffness fell to 5% at 12 months postreconstruction, without operative intervention.

  7. 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.

  8. Tunnel placement in anterior cruciate ligament reconstruction: MRI analysis as an important factor in the radiological report

    Energy Technology Data Exchange (ETDEWEB)

    Tomczak, R.J. [Department of Radiology, University of Ulm, Robert-Koch-Strasse 9, D-89075 Ulm (Germany)]|[Department of Radiology, Division of Body Imaging and MRI, University of Florida, College of Medicine, 1600 Archer Road, Gainesville, FL 32610 (United States); Hehl, Gerhard [Department of Trauma Surgery, University of Ulm, Robert-Koch-Strasse 9, D-89075 Ulm (Germany); Mergo, Patricia J. [Department of Radiology, Division of Body Imaging and MRI, University of Florida, College of Medicine, 1600 Archer Road, Gainesville, FL 32610 (United States); Merkle, E. [Department of Radiology, University of Ulm, Robert-Koch-Strasse 9, D-89075 Ulm (Germany); Rieber, Andrea [Department of Radiology, University of Ulm, Robert-Koch-Strasse 9, D-89075 Ulm (Germany); Brambs, Hans-Joachim [Department of Radiology, University of Ulm, Robert-Koch-Strasse 9, D-89075 Ulm (Germany)

    1997-07-07

    Objective. Correct placement of tunnels for anterior cruciate ligament (ACL) reconstruction is of prime importance for the clinical outcome of the patient. In this study, the possibility of using MRI to document tunnel placement and provide a more comprehensive report following ACL reconstruction was explored at no additional cost in patients scheduled for routine knee MRI. Design and patients. One year after ACL reconstruction, 45 patients underwent clinical examination (IKCD score), radiographic examination, and MRI using a 1.5-T unit. Results. Twenty patients with good tibial and femoral attachment results were found at clinical examination to have a stable knee joint with a full range of motion. In 25 patients with suboptimal placements, examination showed either a stable knee with a decreased range of motion or instability with a normal range of motion. Conclusion. Patients` clinical outcome, and the radiographic and MRI findings, correlated closely with the quality of operative tunnel placement. A record of this finding is important for completeness of the radiological report. Furthermore the MRI findings can be used to improve the surgical quality of tunnel placement. Because tunnel placement can be shown adequately with radiography, however, MRI cannot be justified for this reason alone, so such assessment is advised only when MRI is needed to show all postoperative features. (orig.). With 5 figs., 4 tabs.

  9. 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.

  10. 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

  11. Recovery of gait pattern after medial patellofemoral ligament reconstruction for objective patellar instability.

    Science.gov (United States)

    Carnesecchi, O; Philippot, R; Boyer, B; Farizon, F; Edouard, P

    2016-01-01

    Gait pattern alterations were previously reported in association with objective patellar instability (OPI). Gait pattern comparison between a series of patients having undergone medial patellofemoral ligament (MPFL) reconstruction and a sample of control subjects. Thirty patients at 6 months postoperatively after MPFL reconstruction and thirty control subjects were enrolled in the study for a clinical and biomechanical assessment including gait analysis at three selected walking rates using the GAITRite(®) system. The mean raw IKDC score was 73 (± 19), and the mean Kujala knee function was 84 (± 17.5). The study of gait did not demonstrate any significant difference between the two groups at a normal and fast walking rate. At a 10 km/h running speed, the single-support phase was significantly shortened by a mean 2.33% (p clinical results in the management of OPI. At 6 months postoperatively, the patient gait pattern was similar to that observed in healthy subjects at a normal and fast walking speed. However, our study revealed persistent gait abnormalities at a 10 km/h running speed. These gait alterations seemed to be related to the ligament reconstruction in itself due to the higher strain applied on the reconstructed MPFL during running cycle (10 km/h). Level of evidence IV.

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

    Directory of Open Access Journals (Sweden)

    Navin Kumar Karn

    2015-12-01

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

  13. 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.

  14. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction with autologous hamstring grafts-isokinetic assessment with control group.

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    Tomasz Piontek

    Full Text Available OBJECTIVE: The aim of the study was to: 1 evaluate the differences in pre-post operative knee functioning, mechanical stability, isokinetic knee muscle strength in simultaneous arthroscopic patients after having undergone an anterior cruciate ligament (ACL and the posterior cruciate ligament (PCL with hamstring tendons reconstruction, 2 compare the results of ACL/PCL patients with the control group. DESIGN: Controlled Laboratory Study. MATERIALS AND METHODS: Results of 11 ACL/PCL patients had been matched with 22 uninjured control participants (CP. Prior to surgery, and minimum 2 years after it, functional assessment (Lysholm and IKDC 2000, mechanical knee joint stability evaluation (Lachman and "drawer" test and isokinetic tests (bilateral knee muscle examination had been performed. Different rehabilitation exercises had been used: isometric, passive exercises, exercises increasing the range of motion and proprioception, strength exercises and specific functional exercises. RESULTS: After arthroscopy no significant differences had been found between the injured and uninjured leg in all isokinetic parameters in ACL/PCL patients. However, ACL/PCL patients had still shown significantly lower values of strength in relative isokinetic knee flexors (p = 0.0065 and extensors (p = 0.0171 compared to the CP. There were no differences between groups regarding absolute isokinetic strength and flexors/extensors ratio. There was statistically significant progress in IKDC 2000 (p = 0.0044 and Lysholm (p = 0.0044 scales prior to (44 and 60 points respectively and after the reconstruction (61 for IKDC 2000 and 94 points for Lysholm. CONCLUSIONS: Although harvesting tendons of semitendinosus and/or gracilis from the healthy extremity diminishes muscle strength of knee flexors in comparison to the CP, flexor strength had improved. Statistically significant improvement of the knee extensor function may indicate that the recreation of joint mechanical stability is

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

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    Fabio J. Angelini

    2010-01-01

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

  16. Anatomical study of the ligamentous attachments and articular surfaces of the trapeziometacarpal joint. Consequences on surgical management of its osteoarthrosis.

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    Maes-Clavier, C; Bellemère, P; Gabrion, A; David, E; Rotari, V; Havet, E

    2014-04-01

    In the goal to optimize conservative surgical techniques of the trapeziometacarpal joint in cases of moderate osteoarthritis, we have defined the relationships between the ligamentous attachments and the articular surfaces onto the trapezium and the first metacarpal bone on the one hand, and the dorsovolar and the transverse diameters of the articular surfaces on the other hand. Thirty-six trapeziometacarpal joints (from 18 fresh cadavers) were studied. They were separated into two groups depending on the macroscopic assessment of chondral disease. Group A included stages I to III (no osteoarthritis or moderate osteoarthritis), group B included stages IV (major cartilage destruction). The dorsovolar and transverse sizes of the articular surfaces were measured. Dorsoradial ligament (DRL), posterior oblique ligament (POL), intermetacarpal ligament (IML), ulnar collateral ligament (UCL) and anterior oblique ligament (AOL) were dissected and the distance between their attachments and the articular surfaces were measured. Group A included 17 joints (71% males) and group B included 19 joints (95% females). For the first metacarpal bone, the average ratio between the dorsovolar diameter and the transverse diameter of metacarpal articular surfaces was significantly higher in group B and the average distance between the ligamentous attachments and the articular surface was more than two millimeters, except for the DRL in group B. For the trapezium, only the posterior ligaments (DRL and POL) of group A were inserted at a mean distance more than two millimeters from the articular surfaces. Dorsovolar length of the metacarpal articular surface was higher for osteoarthritis cases. This difference can be explained by the existence of a palmar osteophyte that was always found in stage IV. Describing a map of the ligamentous attachment distance from the articular surface could help surgeons to avoid the ligamentous injury during minimal osteochondral resection.

  17. MR for assessing anterior cruciate ligament reconstructions by tendon grafts. Die Kernspintomographie zur Beurteilung des vorderen Kreuzbandersatzes mit Sehnentransplantaten

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    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).

  18. 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.

  19. 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.

  20. Morden synthetic material is a safe and effective alterative for medial patellofemoral ligament reconstruction.

    Science.gov (United States)

    Lee, Paul Y F; Golding, David; Rozewicz, Sam; Chandratreya, Amit

    2017-09-19

    Medial patellofemoral ligament (MPFL) reconstruction is often performed using gracilis autografts, which may be associated with donor site morbidity and complications. The use of a synthetic material can circumvent a harvest operation and has previously been demonstrated to be effective in other types of reconstructive procedures and may be effective in MPFL reconstruction. This study reports the clinical result with the use of a morden ultra-high molecular weight polyethylene with a braided jacket of polyester tape (FT) in MPFL reconstruction compared to using standard autografts. Data were collected prospectively in 50 MPFL reconstructions. The first 27 underwent reconstruction using gracilis tendon (GT) autograft; the following 23 patients were treated with FT. All patients were clinically and radiologically assessed and underwent pre- and post-operative scoring using the Kujala score, Bartlett score, Tegner activity rating scale, SF-12 score and Lysholm score. Statistical significance was tested between groups using ANOVA with repeated measures. There were no significant differences in the pre-operative scores between the FT and GT groups (n.s.). Both groups showed significant improvements across all scoring modalities between pre- and post-operative periods 12, 24 and 48 months of follow-up (p life and related post-operative outcome measures. There were no significant differences in all knee scores compared to GT autografts. Using this technique for MPFL reconstruction, tendon harvesting is unnecessary and hence eliminates donor site morbidity-associated complications. II.

  1. Adolescent differences in knee stability following computer-assisted anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Melissa A. Christino

    2014-12-01

    Full Text Available Anterior cruciate ligament (ACL surgery is being increasingly performed in the adolescent population. Computer navigation offers a reliable way to quantitatively measure knee stability during ACL reconstruction. A retrospective review of all adolescent patients (<18 years old who underwent computer-assisted primary single bundle ACL reconstruction by a single surgeon from 2007 to 2012 was performed. The average age was 15.8 years (SD 3.3. Female adolescents were found to have higher internal rotation than male adolescents both pre- (25.6° vs 21.7°, P=0.026 and post-reconstruction (20.1° vs 15.1°, P=0.005. Compared to adults, adolescents demonstrated significantly higher internal rotation both pre- (23.3° vs 21.5°, P=0.047 and post-reconstruction (17.1° vs 14.4°, P=0.003. They also had higher total rotation both pre- (40.9° vs 38.4°, P=0.02 and post-reconstruction when compared to adults (31.56° vs 28.67°, P=0.005. In adolescent patients, anterior translation was corrected more than rotation. Females had higher pre- and residual post-reconstruction internal rotation compared to males. When compared to adults, adolescents had increased internal rotation and total rotation both pre- and post-reconstruction

  2. A Comparison between Clinical Results of Selective Bundle and Double Bundle Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Yoo, Yon-Sik; Song, Si Young; Yang, Cheol Jung; Ha, Jong Mun; Kim, Yoon Sang

    2016-01-01

    Purpose The purpose of this study was to compare the clinical outcomes of arthroscopic anatomical double bundle (DB) anterior cruciate ligament (ACL) reconstruction with either selective anteromedial (AM) or posterolateral (PL) bundle reconstruction while preserving a relatively healthy ACL bundle. Materials and Methods The authors evaluated 98 patients with a mean follow-up of 30.8±4.0 months who had undergone DB or selective bundle ACL reconstructions. Of these, 34 cases underwent DB ACL reconstruction (group A), 34 underwent selective AM bundle reconstruction (group B), and 30 underwent selective PL bundle reconstructions (group C). These groups were compared with respect to Lysholm and International Knee Documentation Committee (IKDC) score, side-to-side differences of anterior laxity measured by KT-2000 arthrometer at 30 lbs, and stress radiography and Lachman and pivot shift test results. Pre- and post-operative data were objectively evaluated using a statistical approach. Results The preoperative anterior instability measured by manual stress radiography at 90° of knee flexion in group A was significantly greater than that in groups B and C (all pACL tears offers comparable clinical results to DB reconstruction in complete ACL tears. PMID:27401652

  3. Influence of screw length and diameter on tibial strain energy density distribution after anterior cruciate ligament reconstruction

    Science.gov (United States)

    Yao, Jie; Kuang, Guan-Ming; Wong, Duo Wai-Chi; Niu, Wen-Xin; Zhang, Ming; Fan, Yu-Bo

    2014-04-01

    Postoperative tunnel enlargement has been frequently reported after anterior cruciate ligament (ACL) reconstruction. Interference screw, as a surgical implant in ACL reconstruction, may influence natural loading transmission and contribute to tunnel enlargement. The aims of this study are (1) to quantify the alteration of strain energy den sity (SED) distribution after the anatomic single-bundle ACL reconstruction; and (2) to characterize the influence of screw length and diameter on the degree of the SED alteration. A validated finite element model of human knee joint was used. The screw length ranging from 20 to 30mm with screw diameter ranging from 7 to 9 mm were investigated. In the post-operative knee, the SED increased steeply at the extra-articular tunnel aperture under compressive and complex loadings, whereas the SED decreased beneath the screw shaft and nearby the intra-articular tunnel aperture. Increasing the screw length could lower the SED deprivation in the proximal part of the bone tunnel; whereas increasing either screw length or diameter could aggravate the SED deprivation in the distal part of the bone tunnel. Decreasing the elastic modulus of the screw could lower the bone SED deprivation around the screw. In consideration of both graft stability and SED alteration, a biodegradable interference screw with a long length is recommended, which could provide a beneficial mechanical environment at the distal part of the tunnel, and meanwhile decrease the bone-graft motion and synovial fluid propagation at the proximal part of the tunnel. These findings together with the clinical and histological factors could help to improve surgical outcome, and serve as a preliminary knowledge for the following study of biodegradable interference screw. [Figure not available: see fulltext.

  4. Sacrotuberous Ligament Healing following Surgical Division during Transgluteal Pudendal Nerve Decompression: A 3-Tesla MR Neurography Study

    Science.gov (United States)

    Fritz, Jan; Fritz, Benjamin; Dellon, A. Lee

    2016-01-01

    Pelvic pain due to chronic pudendal nerve (PN) compression, when treated surgically, is approached with a transgluteal division of the sacrotuberous ligament (STL). Controversy exists as to whether the STL heals spontaneously or requires grafting. Therefore, the aim of this study was to determine how surgically divided and unrepaired STL heal. A retrospective evaluation of 10 patients who had high spatial resolution 3-Tesla magnetic resonance imaging (3T MRI) exams of the pelvis was done using an IRB-approved protocol. Each patient was referred for residual pelvic pain after a transgluteal STL division for chronic pudendal nerve pain. Of the 10 patients, 8 had the STL divided and not repaired, while 2 had the STL divided and reconstructed with an allograft tendon. Of the 8 that were left unrepaired, 6 had bilateral surgery. Outcome variables included STL integrity and thickness. Normative data for the STL were obtained through a control group of 20 subjects. STL integrity and thickness were measured directly on 3 T MR Neurography images, by two independent Radiologists. The integrity and thickness of the post-surgical STL was evaluated 39 months (range, 9–55) after surgery. Comparison was made with the native contra-lateral STL in those who had unilateral STL division, and with normal, non-divided STL of subjects of the control group. The normal STL measured 3 mm (minimum and maximum of absolute STL thickness, 2–3 mm). All post-operative STL were found to be continuous regardless of the surgical technique used. Measured at level of Alcock’s canal in the same plane as the obturator internus tendon posterior to the ischium, the mean anteroposterior STL diameter was 5 mm (range, 4–5 mm) in the group of prior STL division without repair and 8 mm (range, 8–9 mm) in the group with the STL reconstructed with grafts (p<0.05). The group of healed STLs were significantly thicker than the normal STL (p<0.05). We conclude that a surgically divided STL will heal

  5. Biomimetic tendon extracellular matrix composite gradient scaffold enhances ligament-to-bone junction reconstruction.

    Science.gov (United States)

    Liu, Huanhuan; Yang, Long; Zhang, Erchen; Zhang, Rui; Cai, Dandan; Zhu, Shouan; Ran, Jisheng; Bunpetch, Varitsara; Cai, Youzhi; Heng, Boon Chin; Hu, Yejun; Dai, Xuesong; Chen, Xiao; Ouyang, Hongwei

    2017-07-01

    Management of ligament/tendon-to-bone-junction healing remains a formidable challenge in the field of orthopedic medicine to date, due to deficient vascularity and multi-tissue transitional structure of the junction. Numerous strategies have been employed to improve ligament-bone junction healing, including delivery of stem cells, bioactive factors, and synthetic materials, but these methods are often inadequate at recapitulating the complex structure-function relationships at native tissue interfaces. Here, we developed an easily-fabricated and effective biomimetic composite to promote the regeneration of ligament-bone junction by physically modifying the tendon extracellular matrix (ECM) into a Random-Aligned-Random composite using ultrasound treatment. The differentiation potential of rabbit bone marrow stromal cells on the modified ECM were examined in vitro. The results demonstrated that the modified ECM enhanced expression of chondrogenesis and osteogenesis-associated epigenetic genes (Jmjd1c, Kdm6b), transcription factor genes (Sox9, Runx2) and extracellular matrix genes (Col2a1, Ocn), resulting in higher osteoinductivity than the untreated tendon ECM in vitro. In the rabbit anterior cruciate ligament (ACL) reconstruction model in vivo, micro-computed tomography (Micro-CT) and histological analysis showed that the modified Random-Aligned-Random composite scaffold enhanced bone and fibrocartilage formation at the interface, more efficaciously than the unmodified tendon ECM. Therefore, these results demonstrated that the biomimetic Random-Aligned-Random composite could be a promising scaffold for ligament/tendon-bone junction repair. The native transitional region consists of several distinct yet contiguous tissue regions, composed of soft tissue, non-calcified fibrocartilage, calcified fibrocartilage, and bone. A stratified graft whose phases are interconnected with each other is essential for supporting the formation of functionally continuous multi

  6. 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

  7. 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.

  8. 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

  9. Longitudinal changes in knee joint biomechanics during level walking following anterior cruciate ligament reconstruction surgery.

    Science.gov (United States)

    Webster, Kate E; Feller, Julian A; Wittwer, Joanne E

    2012-06-01

    Following anterior cruciate ligament reconstruction (ACL) patients have altered movement patterns in the reconstructed knee during walking. There is limited information about these alterations over an extended period of time. This study was designed to present a longitudinal analysis of gait patterns following ACL reconstruction surgery. Assessments of level walking were undertaken in 16 participants at a mean 10 months (initial assessment) and again at 3 years (follow-up assessment) after ACL reconstruction surgery. Kinematic and kinetic variables were analysed using a two factor (time, limb) repeated measures ANOVA. Kinematic data showed that patients were able to achieve greater extension about the reconstructed knee at follow-up than at initial assessment. The reconstructed knee was significantly less internally rotated than the contralateral knee at the initial assessment but not at follow-up. Kinetic data showed a significant increase in the external knee extension moment for the reconstructed limb over time. There were also significant increases in the external knee adduction moment for both limbs at the follow-up assessment. The external knee adduction moment was however smaller in the reconstructed knee than the contralateral knee at both assessments. The results indicate that gait variables do change over time and that measurement at a single time point may not reflect the long term outcome of ACL reconstruction surgery. The changes were however small and may not be clinically relevant. However, the consistently reduced external knee adduction moment seen about the reconstructed knee in this study may suggest that factors other than joint moments influence degenerative change over time. Copyright © 2012 Elsevier B.V. All rights reserved.

  10. Reconstruction of the medial patellofemoral ligament using autologous graft from quadriceps tendon to treat recurrent patellar dislocation☆

    Science.gov (United States)

    Calapodopulos, Constantino Jorge; Nogueira, Marcelo Corvino; Eustáquio, José Martins Juliano; Calapodopulos Júnior, Constantino Jorge; Rodrigues, Oreston Alves

    2016-01-01

    Objective The objective of this study was to evaluate the efficacy of the surgical technique using the quadriceps tendon as a graft in static reconstruction of the medial patellofemoral ligament. Methods This was a prospective case series study in which the participants were 22 patients with a diagnosis of recurrent patellar dislocation without any other anatomical alterations that required surgical treatment. The functional results from the technique were evaluated using clinical data and the Lysholm questionnaire, one year after the operation. Results It was observed that the patients were predominantly female (86%) and under 21 years of age (73%), just like in the literature. At the first annual return after the surgery, there was no significant pain on medium efforts, no loss of range of motion and a positive apprehension test. According to the questionnaire used, the results were graded as good. The patients who reported having severe pain on greater effort were involved in employment-related legal disputes. Conclusion This technique showed low morbidity and good functional results over the short term. PMID:27069888

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

    Science.gov (United States)

    Deo, Shaneel; Getgood, Alan

    2015-06-01

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

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

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

    2014-12-15

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

  13. Acromioclavicular joint reconstruction with the LARS ligament in professional versus non-professional athletes.

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    Marcheggiani Muccioli, Giulio Maria; Manning, Christopher; Wright, Philip; Grassi, Alberto; Zaffagnini, Stefano; Funk, Lennard

    2016-06-01

    To compare outcomes of acromioclavicular (AC) joint reconstruction with ligament augmentation and reconstruction system (LARS) ligament in professional and non-professional athletes at 2-year minimum follow-up. Forty-three patients (men; mean age 30, range 19-54 years) with Rockwood type III to V chronic AC joint dislocations underwent AC joint reconstruction with LARS ligament and standardized rehabilitation. Patients were divided into two groups: professionals (22) and non-professionals (21). Clinical and radiological evaluations were performed preoperatively, at 3- and 24-month follow-up. All clinical (Oxford and Constant) scores and patient satisfaction improved significantly from preoperative to follow-up intervals (p < 0.00001). However, professionals showed nonsignificant improvements from 3- to 24-month follow-up in Constant. Although groups differed preoperatively in Constant (p = 0.037), they were not different in preoperative-to-postoperative differences in clinical scores, postoperative final satisfaction and median time to return to unrestricted activity [4 (interquartiler range 3-5) months to return to full sport in professionals]. Follow-up radiographs revealed an AC joint ratio (clavicle inferior-to-superior translation as ratio of AC joint height) of 0.09 and 0.16 in 8/22 professionals, 0.19 and 0.31 in 9/21 non-professionals, 0.14 and 0.24 in 17/43 overall patients at 3- and 24-month follow-up, respectively. Slight loss of reduction (0.25 < AC joint ratio < 0.50): 21 %. There were no significant clinical-radiographic correlations. Complication: one coracoid fracture at follow-up and one wound infection. AC joint reconstruction with LARS ligament did not reveal differences in clinical outcomes between groups, with 2 % of failures (re-dislocations) at 2-year minimum follow-up. Superior radiological outcomes in professionals were not correlated to clinical results. Therapeutic study-prospective comparative study, Level II.

  14. 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.

  15. Tibiofemoral cartilage contact biomechanics in patients after reconstruction of a ruptured anterior cruciate ligament.

    Science.gov (United States)

    Hosseini, Ali; Van de Velde, Samuel; Gill, Thomas J; Li, Guoan

    2012-11-01

    We investigated the in vivo cartilage contact biomechanics of the tibiofemoral joint in patients after reconstruction of a ruptured anterior cruciate ligament (ACL). A dual fluoroscopic and MR imaging technique was used to investigate the cartilage contact biomechanics of the tibiofemoral joint during in vivo weight-bearing flexion of the knee in eight patients 6 months following clinically successful reconstruction of an acute isolated ACL rupture. The location of tibiofemoral cartilage contact, size of the contact area, cartilage thickness at the contact area, and magnitude of the cartilage contact deformation of the ACL-reconstructed knees were compared with those previously measured in intact (contralateral) knees and ACL-deficient knees of the same subjects. Contact biomechanics of the tibiofemoral cartilage after ACL reconstruction were similar to those measured in intact knees. However, at lower flexion, the abnormal posterior and lateral shift of cartilage contact location to smaller regions of thinner tibial cartilage that has been described in ACL-deficient knees persisted in ACL-reconstructed knees, resulting in an increase of the magnitude of cartilage contact deformation at those flexion angles. Reconstruction of the ACL restored some of the in vivo cartilage contact biomechanics of the tibiofemoral joint to normal. Clinically, recovering anterior knee stability might be insufficient to prevent post-operative cartilage degeneration due to lack of restoration of in vivo cartilage contact biomechanics.

  16. 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.

  17. 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

  18. Does posteromedial chondromalacia reduce rate of return to play after ulnar collateral ligament reconstruction?

    Science.gov (United States)

    Osbahr, Daryl C; Dines, Joshua S; Rosenbaum, Andrew J; Nguyen, Joseph T; Altchek, David W

    2012-06-01

    Biomechanical studies suggest ulnohumeral chondral and ligamentous overload (UCLO) explains the development of posteromedial chondromalacia (PMC) in throwing athletes with ulnar collateral ligament (UCL) insufficiency. UCL reconstruction reportedly allows 90% of baseball players to return to prior or a higher level of play; however, players with concomitant posteromedial chondromalacia may experience lower rates of return to play. The purpose of this investigation is to determine: (1) the rates of return to play of baseball players undergoing UCL reconstruction and posteromedial chondromalacia; and (2) the complications occurring after UCL reconstruction in the setting of posteromedial chondromalacia. We retrospectively reviewed 29 of 161 (18%) baseball players who were treated for the combined posteromedial chondromalacia and UCL injury. UCL reconstruction was accomplished with the docking technique, and the PMC was addressed with nothing or débridement if Grade 2 or 3 and with débridement or microfracture if Grade 4. The mean age was 19.6 years (range, 16-23 years). Most players were college athletes (76%) and pitchers (93%). We used a modified four-level scale of Conway et al. to assess return to play with 1 being the highest level (return to preinjury level of competition or performance for at least one season after UCL reconstruction). The minimum followup was 24 months (mean, 37 months; range, 24-52 months). Return to play was Level 1 in 22 patients (76%), Level 2 in four patients (14%), Level 3 in two patients (7%), and Level 4 in one (3%) patient. Our data suggest baseball players with concomitant PMC, may have lower rates of return to the same or a higher level of play compared with historical controls. Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

  19. Mohs Surgical Reconstruction Educational Activity: a resident education tool

    Science.gov (United States)

    Croley, Julie A; Malone, C Helen; Goodwin, Brandon P; Phillips, Linda G; Cole, Eric L; Wagner, Richard F

    2017-01-01

    Background Surgical reconstructive planning following Mohs surgery can be a difficult subject for dermatology residents to master. Prior research demonstrates that active learning is preferred and more effective compared to passive learning models and that dermatology residents desire greater complexity and volume in surgical training. We present a novel, active, problem-based learning tool for the education of Mohs reconstruction with the goal of improving residents’ ability to plan surgical reconstructions. Materials and methods The Mohs Surgical Reconstruction Educational Activity is an active, problem-based learning activity in which residents designed repairs for planned Mohs defects prior to surgery on an iPad application or on a printed photograph. The attending Mohs surgeon reviewed the reconstructive designs, provided feedback, guided discussion, and facilitated insight into additional issues requiring further review. Residents performed or observed the Mohs and reconstructive surgical procedures for respective repairs. Surveys were administered to participants before and after participating in the Mohs Surgical Reconstruction Educational Activity to assess the educational value of the activity. Survey responses were recorded on a 5-point Likert scale. Results Mean participant-reported confidence in flap and graft knowledge, flap and graft planning, and flap and graft performance increased 1.50–2.50 Likert scale points upon completion of the Mohs surgery rotation by residents participating in the educational activity. The observed trend was larger in the dermatology resident subset, with increases of 2.00–3.50 Likert scale points reported for these questions. Mean participant-reported likelihoods of performing flaps and grafts in the future increased 0.25–0.50 Likert scale points among all residents participating in the educational activity and 0.50–1.00 Likert scale points in the dermatology resident subset. All residents participating in the

  20. Mohs Surgical Reconstruction Educational Activity: a resident education tool.

    Science.gov (United States)

    Croley, Julie A; Malone, C Helen; Goodwin, Brandon P; Phillips, Linda G; Cole, Eric L; Wagner, Richard F

    2017-01-01

    Surgical reconstructive planning following Mohs surgery can be a difficult subject for dermatology residents to master. Prior research demonstrates that active learning is preferred and more effective compared to passive learning models and that dermatology residents desire greater complexity and volume in surgical training. We present a novel, active, problem-based learning tool for the education of Mohs reconstruction with the goal of improving residents' ability to plan surgical reconstructions. The Mohs Surgical Reconstruction Educational Activity is an active, problem-based learning activity in which residents designed repairs for planned Mohs defects prior to surgery on an iPad application or on a printed photograph. The attending Mohs surgeon reviewed the reconstructive designs, provided feedback, guided discussion, and facilitated insight into additional issues requiring further review. Residents performed or observed the Mohs and reconstructive surgical procedures for respective repairs. Surveys were administered to participants before and after participating in the Mohs Surgical Reconstruction Educational Activity to assess the educational value of the activity. Survey responses were recorded on a 5-point Likert scale. Mean participant-reported confidence in flap and graft knowledge, flap and graft planning, and flap and graft performance increased 1.50-2.50 Likert scale points upon completion of the Mohs surgery rotation by residents participating in the educational activity. The observed trend was larger in the dermatology resident subset, with increases of 2.00-3.50 Likert scale points reported for these questions. Mean participant-reported likelihoods of performing flaps and grafts in the future increased 0.25-0.50 Likert scale points among all residents participating in the educational activity and 0.50-1.00 Likert scale points in the dermatology resident subset. All residents participating in the educational activity somewhat or completely agreed

  1. 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.

  2. Good results five years after surgical management of anterior cruciate ligament tears, and meniscal and cartilage injuries.

    Science.gov (United States)

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

    2010-10-01

    In athletes with anterior cruciate ligament (ACL) tears combined with meniscal and cartilage injuries, the goals are to restore knee laxity and relieve symptoms, while long-term goals are the return to pre-injury sport activity and to prevent onset of degenerative changes. We compared the post-operative (minimum 5 years) clinical and radiological outcomes of 50 patients, similar for ACL rupture and meniscal tears, but different for the grade of cartilage lesion. The patient population was divided into two groups similar for ACL reconstruction and surgical meniscal management. Group 1 included 25 patients undergoing microfracture management of grade III-IV cartilage lesions, while Group 2 included 25 patients with grade I-II cartilage lesions, managed by radiofrequency. Comparing pre- and post-operative status, Lachman test, pivot shift values and KT 1000 side to side difference measurements improved significantly (0.05) at the intermediate and latest assessments. At both post-operative appointments, in both groups, the average Lysholm score and IKDC ranking rates improved significantly (lesions, microfractures give excellent short-term clinical and functional improvement but do not prevent the evolution of degenerative changes.

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

    Institute of Scientific and Technical Information of China (English)

    Raju Vaishya; Radhey Shyam Dhiman; Abhishek Vaish

    2014-01-01

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

  4. 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.

  5. 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.

  6. Trends in primary and revision anterior cruciate ligament reconstruction among National Basketball Association team physicians.

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    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.

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

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

    2001-02-01

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

  8. 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

  9. 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.

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

    Directory of Open Access Journals (Sweden)

    Matjaž Sajovic

    2014-04-01

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

  11. 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

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

    Science.gov (United States)

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

    2014-04-01

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

  13. Two-strand posterior cruciate ligament reconstruction with a quadriceps tendon-patellar bone autograft: technical considerations and clinical results.

    Science.gov (United States)

    Noyes, Frank R; Barber-Westin, Sue D

    2006-01-01

    In patients with complete posterior cruciate ligament (PCL) ruptures in which 10 mm or more of increased posterior tibial translation is detected, associated knee disorders must be treated at the same time as the PCL injury. Varus malalignment and any abnormal medial or lateral ligament deficiency must be corrected before or with PCL reconstruction to avoid the risk of failure of the PCL graft. Gait retraining is recommended for patients with abnormal knee hyperextension patterns before ligament reconstruction is performed. Advances in PCL reconstruction include the use of a two-strand graft that may be placed using either a tibial inlay or an all-arthroscopic tibial tunnel technique. Biomechanical studies have shown a reduction in graft tension and improved load sharing in these constructs compared with single-strand reconstructions. The tibial inlay method can be used in athletic patients, and it also is required in PCL revisions in which a prior tibial tunnel must be avoided to achieve graft fixation. The tibial tunnel technique is used to treat dislocated knees for which reconstruction of multiple knee ligaments is required or when prior arterial injury or posterior skin or muscle damage limits the indications for a posterior open approach. Postoperative rehabilitation should protect the PCL graft from high forces and repetitive cyclic knee motions during the first 4 weeks postoperatively.

  14. Predictors of Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers.

    Science.gov (United States)

    Whiteside, David; Martini, Douglas N; Lepley, Adam S; Zernicke, Ronald F; Goulet, Grant C

    2016-09-01

    Ulnar collateral ligament (UCL) reconstruction surgeries in Major League Baseball (MLB) have increased significantly in recent decades. Although several risk factors have been proposed, a scientific consensus is yet to be reached, providing challenges to those tasked with preventing UCL injuries. To identify significant predictors of UCL reconstruction in MLB pitchers. Case control study; Level of evidence, 3. Demographic and pitching performance data were sourced from public databases for 104 MLB pitchers who underwent UCL reconstruction surgery and 104 age- and position-matched controls. These variables were compared between groups and inserted into a binary logistic regression to identify significant predictors of UCL reconstruction. Two machine learning models (naïve Bayes and support vector machine) were also employed to predict UCL reconstruction in this cohort. The binary linear regression model was statistically significant (χ(2)(12) = 33.592; P = .001), explained 19.9% of the variance in UCL reconstruction surgery, and correctly classified 66.8% of cases. According to this model, (1) fewer days between consecutive games, (2) a smaller repertoire of pitches, (3) a less pronounced horizontal release location, (4) a smaller stature, (5) greater mean pitch speed, and (6) greater mean pitch counts per game were all significant predictors of UCL reconstruction. More specifically, an increase in mean days between consecutive games (odds ratio [OR], 0.685; 95% CI, 0.542-0.865) or number of unique pitch types thrown (OR, 0.672; 95% CI, 0.492-0.917) was associated with a significantly smaller likelihood of UCL reconstruction. In contrast, an increase in mean pitch speed (OR, 1.381; 95% CI, 1.103-1.729) or mean pitches per game (OR, 1.020; 95% CI, 1.007-1.033) was associated with significantly higher odds of UCL reconstruction surgery. The naïve Bayes classifier predicted UCL reconstruction with an accuracy of 72% and the support vector machine classifier with an

  15. Arthrofibrosis of the knee following ligament surgery.

    Science.gov (United States)

    DeHaven, Kenneth E; Cosgarea, Andrew J; Sebastianelli, Wayne J

    2003-01-01

    Arthrofibrosis of the knee is one of the most serious complications that can result from ligament surgery. Reported incidence of arthrofibrosis following anterior cruciate ligament reconstruction ranges from 4% to 35%. The loss of motion caused by arthrofibrosis can be even more disabling than the instability for which the reconstruction was performed, often requiring extensive physical therapy and/or surgical lysis of adhesions. With aggressive rehabilitation and modifications in the bracing of knees undergoing ligament reconstruction, the incidence of this complication has decreased significantly. Additionally, delaying anterior cruciate ligament reconstruction until the acute inflammatory period has resolved has also been shown to be a significant factor in the reduction of postoperative knee stiffness.

  16. 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.

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

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    Ashish Devgan

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  19. Surgical reconstruction in diabetic foot syndrome

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    Umid Shoyusupov

    2011-04-01

    Full Text Available Considerable morbidity upon spontaneous wound healing (phlegmons, osteomyelitis, and purulent osteoarthritis of metatarsophalangeal joint as well as loss of the diseased foot’s walking ability are among the reasons for transition to plastic surgery in management tactics. The longer foot lesion persists, the higher probability of amputation. Improvement of treatment of both wound and ulcer lesions by means of reconstructive surgery in patients with diabetic foot syndrome was the main aim of the study. Outcomes of treatment of 460 patients managed at the Center for the Scientific and Clinical Study of Endocrinology, within the period from 2001 to 2009 were analyzed. Size, form, depth and localization of a wound, tissue composition of the wound bed as well as circulation in skin flaps caused the choice of specific operation: autodermoplasty by Parin (with the split-thickness skin flap, local tissue plastic operation (with the sliding or inter-advancing skin flaps, flaps from previously amputated toe or Indian flaps, plastic operation with the controlled tissue tension or combined plastic operation. Reconstructive foot wound surgery allows restoring load-bearing function of the extremity much earlier in contrast to spontaneous healing, reducing incidence of post-operative and long-term complications, amputations and re-amputations, decreasing period of treatment.

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

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    Yuichi Hoshino

    2012-01-01

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

  1. Promising short-term results following selective bundle reconstruction in partial anterior cruciate ligament tears.

    Science.gov (United States)

    Abat, Ferran; Gelber, Pablo Eduardo; Erquicia, Juan I; Pelfort, Xavier; Tey, Marc; Monllau, Juan Carlos

    2013-10-01

    The different functions of the two anterior cruciate ligament (ACL) bundles have increased interest in tears of only one of these two bundles. The purpose of this study was to assess the outcome of selective reconstruction of an injured bundle of isolated anteromedial bundle (AMB) or posterolateral bundle (PLB) tears. Consecutive series of 147 ACL reconstructions was prospectively analyzed. Patients with partial ACL tears who underwent selective bundle reconstructions were studied. Stability was assessed with the Lachman, anterior-drawer and pivot-shift tests and KT-1000. Functional assessment was performed with Lysholm and Tegner questionnaires. The preoperative MRI was analyzed to detect differences from arthroscopic findings. Twenty-eight patients (19%) were included. The minimum follow-up period was 30months. Eighteen had AMB and 10 PLB tears. Only 19% of their MRI's were categorized as partial ACL tears. The Lysholm score improved from 66.1/65.5 to 96.6/95.2 in the AMB/PLB groups, respectively (prate of minor complications at a minimum 2.5years' follow-up. Arthroscopic examination was the most reliable tool for properly diagnosing and treating a condition observed in almost one out of every five ACL reconstructed knee in this series. Therapeutic case series; level 4. Copyright © 2013 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

    Figueroa, D; Martínez, R; Calvo, R; Scheu, M; Gallegos, M; Vaisman, A; Martínez, C; González, A

    For successful anterior cruciate ligament (ACL) reconstruction, revascularisation and histological maturation are necessary, as their failure can cause graft rupture. The purpose of this study was to describe differences in the histological maturation of early failed plasty (less than 12 months after surgery) and late failed plasty (more than 12 months after surgery) in patients with re-rupture after ACL reconstruction with hamstring tendons. A descriptive observational study was conducted on a consecutive series of 20 patients whose ACL reconstruction had failed. Graft biopsy samples were obtained during the revision surgery from the proximal, medial, and distal graft remnants. The samples were evaluated by light microscopy, and the vascularity and maturation of the samples were established by histological scoring. The most common aetiology of reconstruction failure (86.6%) was a specific event with non-contact mechanism. The patients with re-rupture of their ACL plasty less than 12 months after surgery had substance vessels that were less deep. The distal segment of the graft in those patients showed a delay in histological maturation with fewer collagen fibres. In patients whose ACL grafts failed less than 12 months after surgery, a lower distribution of blood vessels and collagen fibres was found that were less ordered in the distal graft. These results indicate a delay in maturation, which leads to a higher risk of graft failure. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

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

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

    2016-03-12

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

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

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    Ochi Mitsuo

    2011-12-01

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

  5. Outcome of combined autologous chondrocyte implantation and anterior cruciate ligament reconstruction

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    Baljinder S Dhinsa

    2015-01-01

    Full Text Available Background: Instability of the knee joint, after anterior cruciate ligament (ACL injury, is contraindication to osteochondral defect repair. This prospective study is to investigate the role of combined autologous chondrocyte implantation (ACI with ACL reconstruction. Materials and Methods: Three independent groups of patients with previous ACL injuries undergoing ACI were identified and prospectively followed up. The first group had ACI in combination with ACL reconstruction (combined group; the 2 nd group consisted of individuals who had an ACI procedure having had a previously successful ACL reconstruction (ACL first group; and the third group included patients who had an ACI procedure to a clinically stable knee with documented nonreconstructed ACL disruption (No ACL group. Their outcomes were assessed using the modified cincinnati rating system, the Bentley functional (BF rating system (BF and a visual analog scale (VAS. Results: At a mean followup of 64.24 months for the ACL first group, 63 months for combined group and 78.33 months for the No ACL group; 60% of ACL first patients, 72.73% of combined group and 83.33% of the No ACL group felt their outcome was better following surgery. There was no significant difference demonstrated in BF and VAS between the combined and ACL first groups. Results revealed a significant affect of osteochondral defect size on outcome measures. Conclusion: The study confirms that ACI in combination with ACL reconstruction is a viable option with similar outcomes as those patients who have had the procedures staged.

  6. Comparison of Short-term Complications Between 2 Methods of Coracoclavicular Ligament Reconstruction

    Science.gov (United States)

    Rush, Lane N.; Lake, Nicholas; Stiefel, Eric C.; Hobgood, Edward R.; Ramsey, J. Randall; O’Brien, Michael J.; Field, Larry D.; Savoie, Felix H.

    2016-01-01

    Background: Numerous techniques have been used to treat acromioclavicular (AC) joint dislocation, with anatomic reconstruction of the coracoclavicular (CC) ligaments becoming a popular method of fixation. Anatomic CC ligament reconstruction is commonly performed with cortical fixation buttons (CFBs) or tendon grafts (TGs). Purpose: To report and compare short-term complications associated with AC joint stabilization procedures using CFBs or TGs. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a retrospective review of the operative treatment of AC joint injuries between April 2007 and January 2013 at 2 institutions. Thirty-eight patients who had undergone a procedure for AC joint instability were evaluated. In these 38 patients with a mean age of 36.2 years, 18 shoulders underwent fixation using the CFB technique and 20 shoulders underwent reconstruction using the TG technique. Results: The overall complication rate was 42.1% (16/38). There were 11 complications in the 18 patients in the CFB group (61.1%), including 7 construct failures resulting in a loss of reduction. The most common mode of failure was suture breakage (n = 3), followed by button migration (n = 2) and coracoid fracture (n = 2). There were 5 complications in the TG group (25%), including 3 cases of asymptomatic subluxation, 1 symptomatic suture granuloma, and 1 superficial infection. There were no instances of construct failure seen in TG fixations. CFB fixation was found to have a statistically significant increase in complications (P = .0243) and construct failure (P = .002) compared with TG fixation. Conclusion: CFB fixation was associated with a higher rate of failure and higher rate of early complications when compared with TG fixation. PMID:27504468

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

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    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.

  8. 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

  9. Combined sciatic femoral nerve block in a case of restrictive cardiomyopathy for arthroscopy and anterior cruciate ligament (ACL reconstruction

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    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.

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

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    Wang, Chaoliang; Huang, Sufang; Wang, Yingzhen; Sun, Xuesheng; Zhu, Tao; Li, Qiang; Lin, Chu

    2015-01-01

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

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

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    Wang Chaoliang

    2015-01-01

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

  12. 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

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

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

    2014-11-01

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

  14. Comparison of results between hook plate fixation and ligament reconstruction for acute unstable acromioclavicular joint dislocation.

    Science.gov (United States)

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

    2015-03-01

    In the present study, we aimed to compare clinical and radiographic outcomes between hook plate fixation and coracoclavicular (CC) ligament reconstruction for the treatment of acute unstable acromioclavicular (AC) joint dislocation. Forty-two patients who underwent surgery for an unstable acute dislocation of the AC joint were included. We divided them into two groups according to the treatment modality: internal fixation with a hook plate (group I, 24 cases) or CC ligament reconstruction (group II, 18 cases). We evaluated the clinical outcomes using a visual analog scale (VAS) for pain and Constant-Murley score, and assessed the radiographic outcomes based on the reduction and loss of CC distance on preoperative, postoperative, and final follow-up plain radiographs. The mean VAS scores at the final follow-up were 1.6 ± 1.5 and 1.3 ± 1.3 in groups I and II, respectively, which were not significantly different. The mean Constant-Murley scores were 90.2 ± 9.9 and 89.2 ± 3.5 in groups I and II, respectively, which were also not significantly different. The AC joints were well reduced in both groups, whereas CC distance improved from a mean of 215.7% ± 50.9% preoperatively to 106.1% ± 10.2% at the final follow-up in group I, and from 239.9% ± 59.2% preoperatively to 133.6% ± 36.7% at the final follow-up in group II. The improvement in group I was significantly superior to that in group II (p < 0.001). Furthermore, subluxation was not observed in any case in group I, but was noted in six cases (33%) in group II. Erosions of the acromion undersurface were observed in 9 cases in group I. In cases of acute unstable AC joint dislocation, hook plate fixation and CC ligament reconstruction yield comparable satisfactory clinical outcomes. However, radiographic outcomes based on the maintenance of reduction indicate that hook plate fixation is a better treatment option.

  15. Intermediate- to Long-Term Results of Combined Anterior Cruciate Ligament Reconstruction and Autologous Chondrocyte Implantation

    Science.gov (United States)

    Pike, Andrew N.; Bryant, Tim; Ogura, Takahiro; Minas, Tom

    2017-01-01

    Background: Cartilage injury associated with anterior cruciate ligament (ACL) ruptures is common; however, relatively few reports exist on concurrent cartilage repair with ACL reconstruction. Autologous chondrocyte implantation (ACI) has been utilized successfully for treatment of moderate to large chondral defects. Hypothesis: ACL insufficiency with relatively large chondral defects may be effectively managed with concurrent ACL reconstruction and ACI. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing concurrent ACL primary or revision reconstruction with ACI of single or multiple cartilage defects were prospectively evaluated for a minimum 2 years. Pre- and postoperative outcome measures included the modified Cincinnati Rating Scale (MCRS), Western Ontario and McMaster Universities Osteoarthritis Index, visual analog pain scales, and postsurgery satisfaction surveys. ACI graft failure or persistent pain without functional improvement were considered treatment failures. Results: Twenty-six patients were included, with 13 primary and 13 revision ACL reconstructions performed. Mean defect total surface area was 8.4 cm2, with a mean follow-up of 95 months (range, 24-240 months). MCRS improved from 3.62 ± 1.42 to 5.54 ± 2.32, Western Ontario and McMaster Universities Osteoarthritis Index from 45.31 ± 17.27 to 26.54 ± 17.71, and visual analog pain scale from 6.19 ± 1.27 to 3.65 ± 1.77 (all Ps <.001). Eight patients were clinical failures, 69% of patients were improved at final follow-up, and 92% stated they would likely undergo the procedure again. No outcome correlation was found with regard to age, body mass index, sex, defect size/number, follow-up time, or primary versus revision ACL reconstruction. In subanalysis, revision ACL reconstructions had worse preoperative MCRS scores and greater defect surface areas. However, revision MCRS score improvements were greater, resulting in similar final functional scores when compared with

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

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    Sivananda

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Zhang P

    2016-01-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

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

    Science.gov (United States)

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

    2016-05-01

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

  20. 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.

  1. Reconstruction du ligament croisé antérieur et entraînement neuromusculaire

    OpenAIRE

    Cruchon, Alexandra; Samin, Christophe; Balthazard, Pierre

    2014-01-01

    Introduction La rupture du ligament croisé antérieur (LCA) est une blessure très fréquente nécessitant régulièrement une intervention chirurgicale. L’entrainement neuromusculaire fait partie intégrante de la prise en charge du physiothérapeute lors d’une reconstruction du LCA. De nombreuses études ont mis en évidence son efficacité, cependant, peu d’études s’intéressent aux modalités d’application et plus précisément au moment où il doit être entrepris. Ce travail de bachelor a pour objectif ...

  2. Glucosamine supplementation after anterior cruciate ligament reconstruction in athletes: a randomized placebo-controlled trial.

    Science.gov (United States)

    Eraslan, Ali; Ulkar, Bulent

    2015-01-01

    Although glucosamine is commonly consumed by athletes, its effectiveness in sports injuries is still under debate. We aimed to investigate the effects of glucosamine to the rehabilitation outcomes of anterior cruciate ligament (ACL) reconstructed athletes. Glucosamine-sulfate (1000 mg daily, for 8 weeks) was administered to half of the cohort of 30 male athletes, the other half used a placebo. Both groups received the same rehabilitation protocol. Knee pain and functions were evaluated by a visual analogue scale (VAS), International Knee Documentation Committee (IKDC) and Lysholm scores before and after oral administration. Additionally, an isokinetic test was performed after the administration period. The scores revealed significant improvements in both groups after 8 weeks, but no significant difference was detected between groups in any of the parameters. Glucosamine supplementation did not improve the rehabilitation outcomes of athletes after ACL reconstruction. This is the first study investigating this topic. Further studies will help to obtain clear evidence about glucosamine efficacy on ACL injured or ACL reconstructed athletes.

  3. 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.

  4. Diffuse Pigmented Villonodular Synovitis as a Rare Cause of Graft Failure Following Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Rajani, Rajiv; Ogden, Liliana; Matthews, Christopher J; Gibbs, C Parker

    2017-08-03

    This case report describes a 42-year-old woman who was diagnosed with pigmented villonodular synovitis (PVNS) in the knee. The patient had received a bone-patella tendon-bone autograft reconstruction of her anterior cruciate ligament (ACL) 22 years prior to her diagnosis of PVNS. After a traumatic event that tore her ACL graft, she underwent a second surgery to repair the initial reconstruction. However, her pain and joint instability remained unresolved. When radiolucent lesions in her tibia and femur were identified through a radiographic image, the patient was referred to the authors' orthopedic oncology clinic. Additional imaging, including magnetic resonance imaging, revealed PVNS, and she was scheduled for debridement and a complete synovectomy of the knee. After surgery, the patient's pain decreased dramatically. She continues to maintain an active lifestyle despite a relatively minor decrease in range of motion. In this case, PVNS proved to be an unlikely complication after ACL reconstruction. The patient remains at risk for the development of degenerative arthritis. [Orthopedics. 201x; xx(x):xx-xx.]. Copyright 2017, SLACK Incorporated.

  5. Immediate effects of neuromuscular joint facilitation intervention after anterior cruciate ligament reconstruction

    Science.gov (United States)

    Wang, Lei

    2016-01-01

    [Purpose] The aim of this study was to examine the immediate effects of neuromuscular joint facilitation (NJF) on the functional activity level after rehabilitation of anterior cruciate ligament (ACL) reconstruction. [Subjects and Methods] Ten young subjects (8 males and 2 females) who underwent ACL reconstruction were included in the study. The subjects were divided into two groups, namely, knee joint extension muscle strength training (MST) group and knee joint extension outside rotation pattern of NJF group. Extension strength was measured in both groups before and after the experiment. Surface electromyography (sEMG) of the vastus medialis and vastus lateralis muscles and joint position error (JPE) test of the knee joint were also conducted. [Results] JPE test results and extension strength measurements in the NJF group were improved compared with those in the MST group. Moreover, the average discharge of the vastus medialis and vastus lateralis muscles on sEMG in the NJF group was significantly increased after MST and NJF treatments. [Conclusion] The obtained results suggest that NJF training in patients with ACL reconstruction can improve knee proprioception ability and muscle strength. PMID:27512270

  6. 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.

  7. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: CLINICAL OUTCOMES OF PATELLA TENDON AND HAMSTRING TENDON GRAFTS

    Directory of Open Access Journals (Sweden)

    Dawn T. Gulick

    2002-09-01

    Full Text Available An injury to the ACL can result in significant functional impairment. It has been estimated that more than 100,000 new ACL injuries occur each year. Surgeons employ numerous techniques for reconstruction of the ACL. Of critical importance is the source of the graft to replace the damaged ACL. The graft choices include autografts (the patient's own tissue, allografts (donor tendon, and synthetic/prosthetic ligaments. Tissue harvest sites for autografting include the middle third of the patella tendon, the quadriceps tendon, semitendinosus tendon, gracilis tendon, iliotibial band, tensor fascia lata, and the Achilles tendon. Selection of the type of graft material is predicated upon the tissue's ability to tolerate high levels of stress. Likewise, the clinical presentation and functional outcome is related to the graft material selected. This manuscript specifically examined the patella tendon and hamstring tendon grafts. Numerous manuscripts that studied the outcomes of these graft materials were compiled to help the clinician appreciate the advantages and disadvantages of each of the graft materials. Outcome measures such as thigh circumference, knee range of motion, isokinetic strength, knee stability, pain, and vertical jump/1-leg hop were incorporated. The purpose of this manuscript was to compare and contrast the clinical presentation of patients who underwent an ACL reconstruction using the patella tendon versus the hamstring tendons. This information can be valuable to the clinician when considering the rehabilitation protocol after ACL reconstruction

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

    Science.gov (United States)

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

    2013-08-01

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

  9. Magnetic resonance imaging of surgically confirmed anterior cruciate ligament graft disruption

    Energy Technology Data Exchange (ETDEWEB)

    Collins, Mark S.; Bond, Jeffrey R. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Unruh, Kenneth P. [Mayo Clinic, Mayo Medical School, Rochester, MN (United States); Mandrekar, Jayawant N. [Mayo Clinic, Department of Biostatistics, Rochester, MN (United States)

    2008-03-15

    To evaluate previously described primary and secondary MRI signs of disruption to anterior cruciate ligament (ACL) grafts in surgically proven cases. We retrospectively analyzed MR images of 48 patients (mean age 29 years) with clinically suspected ACL graft disruption. All patients had surgical confirmation of the MRI findings. The reviewers analyzed the cases blinded to the surgical results and assessed each of the primary and secondary MRI signs of graft disruption individually. Subsequently, a final impression of the graft integrity based on a comprehensive assessment of all of the primary and secondary findings was made. Utilizing a comprehensive assessment of previously described primary and secondary MR findings of ACL graft disruption, the blinded reviewers were able to identify correctly full-thickness graft tears with test accuracy of 85%, sensitivity of 72%, and specificity of 100%. Individual assessment of the primary finding of graft fiber discontinuity had sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 72%, 100%, 100%, 77% and 85%, respectively, for full-thickness tears. Other individual primary and secondary findings were less reliable; however, the primary findings of marked segmental thinning of the graft and markedly abnormal graft orientation, and the secondary findings of bone contusions in the lateral compartment and large joint effusion, had high specificity and positive predictive value. Of the four missed cases, two had associated arthrofibrosis. The comprehensive assessment of previously described primary and secondary MRI findings of ACL graft disruption has high test specificity and moderately high test accuracy. The presence of graft fiber discontinuity is the most reliable primary or secondary finding when assessed individually. Marked segmental thinning of the graft and abnormal fiber orientation, and the presence of bone contusions in the lateral compartment and large joint effusion

  10. Return to Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Football League Linemen.

    Science.gov (United States)

    Cinque, Mark E; Hannon, Charles P; Bohl, Daniel D; Erickson, Brandon J; Verma, Nikhil N; Cole, Brian J; Bach, Bernard R

    2017-06-01

    Tears of the anterior cruciate ligament (ACL) are common in the National Football League (NFL). The impact of these injuries on the careers of NFL linemen is unknown. To define the percentage of NFL linemen who return to sport (RTS) after ACL reconstruction, the mean time to RTS, and the impact on performance compared with matched controls. Cohort study; Level of evidence, 3. Data on NFL offensive and defensive linemen who sustained an ACL tear and underwent ACL reconstruction between 1980 and 2015 were analyzed. Players were identified through NFL team websites, publicly available injury reports, player profiles, and press releases. Demographics and mean in-game performance data preinjury and post-ACL reconstruction were recorded. A player was deemed to have returned to sport if he played in at least 1 NFL game after his ACL reconstruction. A healthy control group was selected to compare in-game performance data and was matched with the study group on several parameters. Overall, 73 NFL linemen met the inclusion criteria; 47 (64.3%) returned to play after ACL reconstruction (62.5% of offensive linemen, 65.9% of defensive linemen). All offensive linemen successfully returned to play the season after injury. No difference existed in number of seasons, total number of games played, mean number of games played, or mean number of games started per season when offensive linemen who RTS after ACL reconstruction were compared with matched controls (all P > .05). Among defensive linemen who RTS, most returned the season after injury (88.9%). There was no difference between defensive linemen who RTS after ACL reconstruction and matched controls in any performance metrics as an average over the remainder of their career (all P > .05). However, NFL defensive linemen who tore their ACL played fewer total seasons than matched controls (P = .020). Overall, 64.3% of NFL offensive and defensive linemen who undergo ACL reconstruction returned to play. Linemen who RTS do so at a

  11. High Intensity Neuromuscular Electrical Stimulation to Enhance Quadriceps Strength after Anterior Cruciate Ligament Reconstruction

    Institute of Scientific and Technical Information of China (English)

    Joseph A.Gallo; Christopher Proulx

    2010-01-01

    @@ Despite the implementation of accelerated ACL rehabilitation and improved surgical technique,persistent quadriceps weakness continues to be reported in the literature following ACL reconstruction.[1-4]The literature suggests,that the exclusive use of multijoint CKC exercises may not be selective enough in the recruitment of the quadriceps muscle.[5,6]Ernest et al demonstrated that hip and ankle extensors may compensate for a weak quadriceps during the lateral step-up exercise in subjects status post ACL reconstruction.[3

  12. 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.

  13. Effects of surgical joint destabilization on load sharing between ligamentous structures in the thoracic spine: a finite element investigation.

    Science.gov (United States)

    Little, J P; Adam, C J

    2011-11-01

    In vitro investigations have demonstrated the importance of the ribcage in stabilizing the thoracic spine. Surgical alterations of the ribcage may change load-sharing patterns in the thoracic spine. Computer models are used in this study to explore the effect of surgical disruption of the rib-vertebrae connections on ligament load-sharing in the thoracic spine. A finite element model of a T7-8 motion segment, including the T8 rib, was developed using CT-derived spinal anatomy for the Visible Woman. Both the intact motion segment and the motion segment with four successive stages of destabilization (discectomy and removal of right costovertebral joint, right costotransverse joint and left costovertebral joint) were analyzed for a 2000 Nmm moment in flexion/extension, lateral bending and axial rotation. Joint rotational moments were compared with existing in vitro data and a detailed investigation of the load sharing between the posterior ligaments carried out. The simulated motion segment demonstrated acceptable agreement with in vitro data at all stages of destabilization. Under lateral bending and axial rotation, the costovertebral joints were of critical importance in resisting applied moments. In comparison to the intact joint, anterior destabilization increases the total moment contributed by the posterior ligaments. Surgical removal of the costovertebral joints may lead to excessive rotational motion in a spinal joint, increasing the risk of overload and damage to the remaining ligaments. The findings of this study are particularly relevant for surgical procedures involving rib head resection, such as some techniques for scoliosis deformity correction. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Magnetic resonance imaging of cyclops lesion as a cause of persistent morbidity after anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Amit Kharat

    2015-01-01

    Full Text Available Localized anterior arthrofibrosis (cyclops lesion is having around 1-9.8% frequency rate after anterior cruciate ligament (ACL reconstruction. It has been reported to be a significant cause of loss of knee extension after reconstruction of the ACL of the knee. We present a case report of a patient with prior ACL reconstruction who presented with pain and loss of extension following surgery. MR imaging revealed the typical features of cyclops lesion. Repeat arthroscopy excision of the lesion is the only treatment to reduce the morbidity of the patient.

  15. Anterior cruciate ligament reconstruction practice patterns by NFL and NCAA football team physicians.

    Science.gov (United States)

    Erickson, Brandon J; Harris, Joshua D; Fillingham, Yale A; Frank, Rachel M; Bush-Joseph, Charles A; Bach, Bernard R; Cole, Brian J; Verma, Nikhil N

    2014-06-01

    This study aimed to determine practice patterns for National Football League (NFL) and National Collegiate Athletic Association (NCAA) Division I football team orthopaedic surgeons regarding management of anterior cruciate ligament (ACL) tears in elite, young, and middle-aged recreational athletes. Two hundred sixty-seven NFL and NCAA Division I team orthopaedic surgeons were surveyed through an online survey. A 9-question survey assessed surgeon experience, graft choice, femoral tunnel drilling access, number of graft bundles, and rehabilitation after ACL reconstruction. One hundred thirty-seven team orthopaedic surgeons (51%) responded (mean experience 16.75 ± 8.7 years). Surgeons performed 82 ± 50 ACL reconstructions in 2012. One hundred eighteen surgeons (86%) would use bone-patellar tendon-bone (BPTB) autografts to treat their starting running backs. Ninety (67%) surgeons drill the femoral tunnel through an accessory anteromedial portal (26% through a transtibial portal). Only 1 surgeon prefers a double-bundle to a single-bundle reconstruction. Seventy-seven (55.8%) surgeons recommend waiting at least 6 months before return to sport, whereas 17 (12.3%) wait at least 9 months. No surgeon recommends waiting 12 months or more before return to sport. Eighty-eight (64%) surgeons do not recommend a brace for their starting running backs during sport once they return to play. BPTB is the most frequently used graft for ACL reconstruction by NFL and NCAA Division I team physicians in their elite-level running backs. Nearly all surgeons always use a single-bundle technique, and most do not recommend a brace on return to sport in running backs. Return to sport most commonly occurs at least 6 months postoperatively, with some surgeons requiring a normal examination and normal return-to-sport testing (single leg hop). Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  16. Return to Sport in the Younger Patient With Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Webster, Kate E.; Feller, Julian A.; Whitehead, Timothy S.; Myer, Gregory D.; Merory, Peter B.

    2017-01-01

    Background: Although anterior cruciate ligament (ACL) reconstruction is generally regarded as a successful procedure, only 65% of patients return to their preinjury sport. While return-to-sport rates are likely higher in younger patients, there is a paucity of data that focus on the younger patient and their return-to-sport experience after ACL reconstruction. Purpose: To investigate a range of return-to-sport outcomes in younger athletes who had undergone ACL reconstruction surgery. Study Design: Case series; Level of evidence, 4. Methods: A group of 140 young patients (sport participation at a mean follow-up of 5 years (range, 3-7 years). Results: Overall, 76% (95% CI, 69%-83%) of the young patient group returned to the same preinjury sport. Return rates were higher for males than females (81% vs 71%, respectively; P > .05). Of those who returned to their sport, 65% reported that they could perform as well as before the ACL injury and 66% were still currently participating in their respective sport. Young athletes who never returned to sport cited fear of a new injury (37%) or study/work commitments (30%) as the primary reasons for dropout. For those who had successfully returned to their preinjury sport but subsequently stopped participating, the most common reason cited for stopping was study/work commitments (53%). At a mean 5-year follow-up, 48% of female patients were still participating in level I (jumping, hard pivoting) sports, as were 54% of males. Conclusion: A high percentage of younger patients return to their preinjury sport after ACL reconstruction surgery. For patients in this cohort who had not sustained a second ACL injury, the majority continue to participate and are satisfied with their performance. PMID:28473996

  17. 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.

  18. The efficacy of combined cryotherapy and compression compared with cryotherapy alone following anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Waterman, Brian; Walker, John J; Swaims, Chad; Shortt, Michael; Todd, Michael S; Machen, Shaun M; Owens, Brett D

    2012-05-01

    While cryotherapy has been shown to decrease postoperative pain after anterior cruciate ligament (ACL) reconstruction, less is known of the effects of combined cryotherapy and compression. The goal of this study was to compare subjective and objective patient outcomes following ACL reconstruction with combined compression and cryotherapy compared with traditional ice therapy alone. Patients undergoing ACL reconstruction were randomized to cryotherapy/compression device (group 1) or a standardized ice pack (group 2). Both groups were instructed to use the ice or cryotherapy/compression device three times per day and return to the clinic at 1, 2, and 6 weeks postoperatively. Patient-derived outcome measurements used in this study consisted of the visual analog scale (VAS), the Lysholm knee score, Short Form-36 (SF-36), and single assessment numerical evaluation (SANE). Circumferential measurements of the knee at three locations (1 cm proximal to patella, mid-patella, and 1 cm distal to patella) were also obtained as a measure of postoperative edema. Narcotic medication use was recorded by questionnaire. The primary outcome measure (VAS) was significantly different among groups in the preoperative measurement, despite similarities in group demographics. Baseline VAS for group 1 was 54.9 compared with group 2 at 35.6 (p = 0.01). By 6 weeks, this had lowered to 28.1 and 40.3, respectively, resulting in a significant 27-point decrease in mean VAS for group 1 (p cryotherapy and compression in the postoperative period after ACL reconstruction results in improved, short-term pain relief and a greater likelihood of independence from narcotic use compared with cryotherapy alone.

  19. 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

  20. Anterior Cruciate Ligament Reconstruction Using a Flexible Reamer System: Technique and Pitfalls.

    Science.gov (United States)

    Fitzgerald, Judd; Saluan, Paul; Richter, Dustin L; Huff, Nathan; Schenck, Robert C

    2015-07-01

    Anatomic reconstruction of the anterior cruciate ligament (ACL) has been shown to improve stability of the knee, particularly rotational stability, potentially leading to superior clinical outcomes and a shorter return to sport. Nonanatomic ACL reconstruction has been linked to graft failure and abnormal cartilage loading thought to contribute to progression of degenerative joint disease. Use of the far anteromedial portal (FAMP) to uncouple the tibial and femoral tunnels has led to improved reproduction of the femoral footprint and facilitates drilling of the femoral tunnel in an anatomic position. The use of the FAMP and straight reamer systems introduces its own set of potential complications, including short femoral tunnels and peroneal nerve injury. These potential complications have been addressed by drilling the femoral tunnel in a hyperflexed position, which can lead to difficulty with positioning the operative extremity, visualization, and identification of anatomic landmarks. The purpose of this case report was to review the advantages and technical aspects of using a flexible reamer system and the FAMP to achieve an anatomic ACL reconstruction while avoiding potential complications and pitfalls. Flexible reamer systems allow an additional way of uncoupling the tibial and femoral tunnels to clearly visualize and establish an anatomic starting point within the femoral footprint of the native ACL while avoiding the complications associated with knee hyperflexion and straight reamers with the far anteromedial portal. In the authors' experience, an anatomic reconstruction of the ACL can be achieved safely using flexible reamers while avoiding some of the difficulties seen with straight reamers used in conjunction with an uncoupled, far anteromedial approach.

  1. Comparing Transtibial and Anteromedial Drilling Techniques for Single-bundle Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Sukur, Erhan; Akman, , Yunus Emre; Senel, , Ahmet; Unkar, Ethem Ayhan; Topcu, , Huseyin Nevzat; Ozturkmen, , and Yusuf

    2016-01-01

    Background: Among the many factors that determine the outcome following anterior cruciate ligament (ACL) reconstruction, the position of the femoral tunnel is known to be critically important and is still the subject of extensive research. Objective: We aimed to retrospectively compare the outcomes of arthroscopic ACL reconstruction using transtibial (TT) or anteromedial (AMP) drilling techniques for femoral tunnel placement. Methods: ACL reconstruction was performed using the TT technique in 49 patients and the AMP technique in 56 patients. Lachman and pivot-shift tests, the Lysholm Knee Scale, International Knee Documentation Committee (IKDC) score, Tegner activity scale and visual analog scale (VAS) were used for the clinical and functional evaluation of patients. Time to return to normal life and time to jogging were assessed in addition to the radiological evaluation of femoral tunnel placement. Results: In terms of the Lysholm, IKDC, Tegner score, and stability tests, no significant differences were found between the two groups (p > 0.05). Statistical analysis revealed reduced time to return to normal life and jogging in the AMP group (p < 0.05). The VAS score was also significantly reduced in the AMP group (p < 0.05). The position of the femoral tunnel was anatomically appropriate in 51 patients in the AMP group and 5 patients in the TT group. Conclusion: The AMP technique is superior to the TT technique in creating anatomical femoral tunnel placement during single-bundle ACL reconstruction and provides faster recovery in terms of return to normal life and jogging at short-term follow-up. PMID:27733884

  2. [Arthroscopic coracoclavicular ligament reconstruction versus open modified Weaver-Dunn procedure for acromioclavicular joint dislocations:comparison of curative effect].

    Science.gov (United States)

    Li, F L; Jiang, C Y; Lu, Y; Zhu, Y M; Li, X

    2015-04-18

    To compare the surgical outcomes between arthroscopic coracoclavicular ligament reconstruction and open modified Weaver-Dunn procedure for the treatment of acromioclavicular joint dislocations. From January 2011 to June 2012, 63 consecutive patients with acromioclavicular joint dislocations who were treated with either arthroscopic coracoclavicular ligament reconstruction or open modified Weaver-Dunn procedure were retrospectively reviewed after the final follow-up. There were 49 men and 14 women with a mean age of (40.3±10.6) years. The mean time from injury to surgery was (10.3±5.3) d. According to the Rockwood classification, there were 45 patients with type V injury and 18 patients with type III injury. All the patients with type III injury claimed high level of sport activity. The patients were divided into the arthroscopic surgery group (32 cases) or the open surgery group (31 cases) depending on the type of the surgery that each patient had taken. All the patients were routinely followed up after the surgery. The visual analogue score (VAS), American shoulder and elbow surgeons(ASES) score and University of California Los Angeles(UCLA) score were employed to evaluate the postoperative shoulder function. The postoperative radiographs of both shoulders were taken for each patient to evaluate the loss of reduction of the acromioclavicular joint. The mean follow-up time was (29.6±6.0) months (range: 24 to 43 months). No significant difference was found between the arthroscopic surgery group and the open surgery group with regard to the patient's age [(41.0±10.5) years vs. (38.0± 10.8) years], gender (male/female,24/8 vs.25/6), classification (V/III,22/10 vs.23/8), time from injury to surgery [(10.6±4.9) d vs.(10.1±5.7) d], dominant involvement (19/32 vs.17/31)and mean follow-up time [(29.8±6.4) months vs.(29.5±5.5) months], P>0.05. At the end of the last follow-up, no significant difference was noted between the two groups regarding the mean forward

  3. 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...

  4. 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.

  5. Surgical Reconstruction for Severe Tracheal Obstruction in Morquio A Syndrome.

    Science.gov (United States)

    Pizarro, Christian; Davies, Ryan R; Theroux, Mary; Spurrier, Ellen A; Averill, Lauren W; Tomatsu, Shunji

    2016-10-01

    Progressive tracheal obstruction is commonly seen in Morquio A syndrome and can lead to life-threatening complications. Although tracheostomy can address severe upper airway obstruction, lower airway obstruction, commonly associated with a narrow thoracic inlet and vascular compression, requires an alternative approach. We describe the case of a 16-year-old patient with Morquio A syndrome whose near-fatal tracheal obstruction was relieved by timely surgical tracheal vascular reconstruction with dramatic resolution of his respiratory symptoms.

  6. ACL reconstruction - discharge

    Science.gov (United States)

    Anterior cruciate ligament reconstruction - discharge; ACL reconstruction - discharge ... had surgery to reconstruct your anterior cruciate ligament (ACL). The surgeon drilled holes in the bones of ...

  7. The Restoration of Passive Rotational Tibio-Femoral Laxity after Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Moewis, Philippe; Duda, Georg N.; Jung, Tobias; Heller, Markus O.; Boeth, Heide; Kaptein, Bart; Taylor, William R.

    2016-01-01

    While the anterior cruciate ligament (ACL) is considered one of the most important ligaments for providing knee joint stability, its influence on rotational laxity is not fully understood and its role in resisting rotation at different flexion angles in vivo remains unknown. In this prospective study, we investigated the relationship between in vivo passive axial rotational laxity and knee flexion angle, as well as how they were altered with ACL injury and reconstruction. A rotometer device was developed to assess knee joint rotational laxity under controlled passive testing. An axial torque of ±2.5Nm was applied to the knee while synchronised fluoroscopic images of the tibia and femur allowed axial rotation of the bones to be accurately determined. Passive rotational laxity tests were completed in 9 patients with an untreated ACL injury and compared to measurements at 3 and 12 months after anatomical single bundle ACL reconstruction, as well as to the contralateral controls. Significant differences in rotational laxity were found between the injured and the healthy contralateral knees with internal rotation values of 8.7°±4.0° and 3.7°±1.4° (p = 0.003) at 30° of flexion and 9.3°±2.6° and 4.0°±2.0° (p = 0.001) at 90° respectively. After 3 months, the rotational laxity remained similar to the injured condition, and significantly different to the healthy knees. However, after 12 months, a considerable reduction of rotational laxity was observed towards the levels of the contralateral controls. The significantly greater laxity observed at both knee flexion angles after 3 months (but not at 12 months), suggests an initial lack of post-operative rotational stability, possibly due to reduced mechanical properties or fixation stability of the graft tissue. After 12 months, reduced levels of rotational laxity compared with the injured and 3 month conditions, both internally and externally, suggests progressive rotational stability of the reconstruction with

  8. Transtibial technique versus two incisions in anterior cruciate ligament reconstruction: tunnel positioning, isometricity and functional evaluation

    Directory of Open Access Journals (Sweden)

    Ricardo Hideki Yanasse

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To compare the transtibial and two-incision techniques for anterior cruciate ligament (ACL reconstruction using a single band. METHODS: A prospective and randomized study was conducted in blocks. Patients underwent ACL reconstruction by means of two techniques: transtibial (group 1: 20 patients or two incisions (group 2: 20 patients. The radiographic positioning of the tunnel, inclination of the graft, graft isometricity and functional results (IKDC and Lysholm were evaluated. RESULTS: The positioning of the femoral tunnel on the anteroposterior radiograph, expressed as a mean percentage relative to the medial border of the tibial plateau, was 54.6% in group 1 and 60.8% in group 2 (p 0.05. Group 2 had better results from the pivot-shift maneuver (p < 0.05. CONCLUSION: The technique of two incisions allowed positioning of the femoral tunnel that was more lateralized and anteriorized, such that the graft was more inclined and there was a clinically better result from the pivot-shift maneuver. There was no difference in isometricity and no final functional result over the short follow-up time evaluated.

  9. Outcome of anterior cruciate ligament reconstruction with emphasis on sex-related differences.

    Science.gov (United States)

    Ahldén, M; Sernert, N; Karlsson, J; Kartus, J

    2012-10-01

    The aim of this retrospective study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using the four-strand semitendinosus-gracilis (ST/G) autograft in male (n=141) vs female (n=103) patients. The patients were operated on between 1996 and 2005, using interference screw fixation and drilling the femoral tunnel through the anteromedial portal. The pre-operative assessments and demographics, apart from age (males 29 years, females 26 years; P=0.02), were comparable at the time of surgery. At 25 (23-36) months post-operatively, no significant differences were found between the study groups in terms of anterior side-to-side knee laxity, manual Lachman test, Tegner activity level, Lysholm knee score, range of motion or donor-site morbidity. Both study groups improved significantly in most clinical assessments and functional scores compared with their pre-operative values. Two years after ACL reconstruction using ST/G autografts, there were no significant differences between male and female patients in terms of clinical outcome or functional scores.

  10. Continuous-flow cold therapy for outpatient anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Barber, F A; McGuire, D A; Click, S

    1998-03-01

    This prospective, randomized study evaluated continuous-flow cold therapy for postoperative pain in outpatient arthroscopic anterior cruciate ligament (ACL) reconstructions. In group 1, cold therapy was constant for 3 days then as needed in days 4 through 7. Group 2 had no cold therapy. Evaluations and diaries were kept at 1, 2, and 8 hours after surgery, and then daily. Pain was assessed using the VAS and Likert scales. There were 51 cold and 49 noncold patients included. Continuous passive movement (CPM) use averaged 54 hours for cold and 41 hours for noncold groups (P=.003). Prone hangs were done for 192 minutes in the cold group and 151 minutes in the noncold group. Motion at 1 week averaged 5/88 for the cold group and 5/79 the noncold group. The noncold group average visual analog scale (VAS) pain and Likert pain scores were always greater than the cold group. The noncold group average Vicodin use (Knoll, Mt. Olive, NJ) was always greater than the cold group use (P=.001). Continuous-flow cold therapy lowered VAS and Likert scores, reduced Vicodin use, increased prone hangs, CPM, and knee flexion. Continuous-flow cold therapy is safe and effective for outpatient ACL reconstruction reducing pain medication requirements.

  11. Tissue engineering as a potential alternative or adjunct to surgical reconstruction in treating pelvic organ prolapse

    DEFF Research Database (Denmark)

    Boennelycke, M; Gräs, Søren; Lose, G

    2013-01-01

    Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP).......Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP)....

  12. Long-term effects of knitted silk-collagen sponge scaffold on anterior cruciate ligament reconstruction and osteoarthritis prevention.

    Science.gov (United States)

    Shen, Weiliang; Chen, Xiao; Hu, Yejun; Yin, Zi; Zhu, Ting; Hu, Jiajie; Chen, Jialin; Zheng, Zefeng; Zhang, Wei; Ran, Jisheng; Heng, Boon Chin; Ji, Junfeng; Chen, Weishan; Ouyang, Hong-Wei

    2014-09-01

    Anterior cruciate ligament (ACL) is difficult to heal after injury due to the dynamic fluid environment of joint. Previously, we have achieved satisfactory regeneration of subcutaneous tendon/ligament with knitted silk-collagen sponge scaffold due to its specific "internal-space-preservation" property. This study aims to investigate the long-term effects of knitted silk-collagen sponge scaffold on ACL regeneration and osteoarthritis prevention. The knitted silk-collagen sponge scaffold was fabricated and implanted into a rabbit ACL injury model. The knitted silk-collagen sponge scaffold was found to enhance migration and adhesion of spindle-shaped cells into the scaffold at 2 months post-surgery. After 6 months, ACL treated with the knitted silk-collagen sponge scaffold exhibited increased expression of ligament genes and better microstructural morphology. After 18 months, the knitted silk-collagen sponge scaffold-treated group had more mature ligament structure and direct ligament-to-bone healing. Implanted knitted silk-collagen sponge scaffolds degraded much more slowly compared to subcutaneous implantation. Furthermore, the knitted silk-collagen sponge scaffold effectively protected joint surface cartilage and preserved joint space for up to 18 months post-surgery. These findings thus demonstrated that the knitted silk-collagen sponge scaffold can regenerate functional ACL and prevent osteoarthritis in the long-term, suggesting its clinical use as a functional bioscaffold for ACL reconstruction.

  13. Surgical treatment of Segond fracture combined with anterior cruciate ligament injury%Segond骨折合并前交叉韧带损伤的外科治疗

    Institute of Scientific and Technical Information of China (English)

    王琪; 刘宪民; 刘松波; 杜明昌; 白夜; 刘国强; 项良碧

    2012-01-01

    Objective To investigate the injury mechanism,clinical characteristics and surgical treatments of Segond fracture combined with anterior cruciate ligament (ACL) injury. Methods Nine patients suffering from Segond fracture combined with ACL injury were treated between January 2008 and December 2010.All the patients revealed ACL and medial collateral ligament (MCL) breakage under arthroscopy.Furthermore,one patient was associated with lateral collateral ligament (LCL) breakage and medial meniscus injury,four with medial meniscus tear and two with lateral meniscus tear.All the patients underwent arthroscopic tendon allotransplantation,ACL reconstruction and MCL repair.Besides,synchronous LCL reconstruction was performed in one patient,meniscus suture in three and meniscus plasty in four.Six patients with large Segond fracture fragments were fixed with two hollow lag crews and three with relatively small fracture fragments fixed with one hollow lag crew. Results The mean followup period was 12 months,which showed average postoperative Lysholm score of 59 points and satisfactory clinical outcome. Conclusions Segond fracture is often combined with ACL injury and is predictive for ACL injury.In ACL reconstruction,large Segond fracture blocks should be reduced and fixed and the combined injuries also should be treated in the same period.%目的 探讨Segond骨折合并前交叉韧带(anterior cruciate ligament,ACL)损伤的致伤机制、临床特点和外科治疗方法. 方法 选择2008年1月-2010年12月收治的9例Segond 骨折合并ACL损伤的患者,关节镜下均可见ACL断裂及内侧副韧带(medial collateral ligament,MCL)断裂,1例还合并外侧副韧带(lateral collateral ligament,LCL)断裂、内侧半月板损伤,4例合并内侧半月板撕裂,2例合并外侧半月板撕裂.均行关节镜下异体肌腱移植、ACL重建、内侧副韧带修补术.1例同时行LCL重建术,3例行半月板缝合术,4例行半月板成形术.6

  14. Reconstructed anterior cruciate ligaments using patellar tendon ligament grafts: diagnostic value of contrast-enhanced MRI in a 2-year follow-up regimen

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J.; Schmitt, J.; Lubrich, J.; Hochmuth, K.; Diebold, T. [Dept. of Diagnostic and Interventional Radiology, Frankfurt Univ. (Germany); Del Tredici, K. [Dept. of Clinical Neuroanatomy, Frankfurt Univ. (Germany); Suedkamp, N. [Dept. of Traumatology and Orthopedics, Humboldt University, Berlin (Germany)

    2001-08-01

    We analyzed prospectively the diagnostic efficacy of contrast-enhanced MRI following anterior cruciate neoligament (ACL) reconstruction. One hundred fifty-six MR examinations were performed 2, 12, 52, 76, and 104 weeks post-operatively on 68 patients with ACL transplants. Sagittal, parasagittal, and coronal images using unenhanced T1- and T2-weighted spin-echo sequences, and post-contrast images utilizing T1-weighted spin-echo and fat-saturated sequences, were acquired. Results were correlated with those of the pivot shift, Lachman, and a mechanical test. The MR examination criteria included morphological analysis, signal intensity, transplant contrast enhancement, secondary signs (e.g., elongation of normal ligaments), and comparison with clinically standardized test results. Two weeks post-operatively all neoligaments showed homogeneous low signal intensity on T1- and T2-weighted spin-echo sequences indistinguishable from that of normal cruciate or patellar ligaments [contrast-to-noise ratio (C/N) on T1:1.6], with a 9% percentile enhancement. At 12-52 weeks, signal intensity increased (C/N:6.7), with a mean 50% percentile enhancement. The 1-year follow-up allowed no definite assessment of the neoligament's course. At 76 and 104 weeks, significant decrements in signal intensity (C/N:3.0) and ligamentous percentile enhancement (25%) occurred. All patients tested displayed stable transplants 2 years post-operatively. Contrast-enhanced MRI allows accurate evaluation of morphology and function up to 3 months post-operatively and 1-2 years following ACL reconstructive surgery. (orig.)

  15. Intermittent blood flow restriction does not reduce atrophy following anterior cruciate ligament reconstruction

    Institute of Scientific and Technical Information of China (English)

    Erik Iversen; Vibeke Røstad; Arne Larmo

    2016-01-01

    Background: A previous study has reported a 50%reduction in disuse atrophy of the quadriceps during the first 14 days after anterior cruciate ligament (ACL) reconstruction. A follow-up trial is needed to confirm these promising results. The present study aims to investigate the effect of an occlusion stimulus on quadriceps atrophy after ACL reconstruction. Methods: A total of 24 subjects participated in the study. They were randomized into two groups. Starting the 2nd day after surgery, the occlusion group received an occlusion stimulus for 5 min, followed by removal of the occlusive pressure for 3 min. This was repeated five times in one training session, twice daily. During the period of occlusive stimulus, the subjects performed 20 low load exercises for the quadriceps. The control group followed the same exercise protocol, but without the occlusion stimulus. Changes in quadriceps anatomical cross section area (ACSA) were measured using axial magnetic resonance (MR) images at 40%and 50%of the length of the femur. Results: Both groups had a significant reduction of quadriceps ACSA from 2 days before surgery to 16 days after surgery. During the intervention period, the occlusion group lost 13.8% ± 1.1% (mean ± SEM) and the control group lost 13.1% ± 1.0% of their quadriceps ACSA, respectively. There was no significant difference between the occlusion and control groups with regards to atrophy of the quadriceps muscles. Conclusion: In conflict with other studies using a similar protocol, application of blood flow restriction the first 14 days after ACL reconstruction did not reduce quadriceps ACSA muscle atrophy measured by MR in a population of athletes.

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

    Science.gov (United States)

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

    2013-07-01

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

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

    Science.gov (United States)

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

    2016-04-01

    The inferior extensor retinaculum (IER) is an aponeurotic structure, which is in continuation with the anterior part of the sural fascia. The IER has often been used to augment the reconstruction of the lateral ankle ligaments, for instance in the Broström-Gould procedure, with good outcomes reported. However, its anatomy has not been described in detail and only a few studies are available on this structure. The presence of a non-constant oblique supero-lateral band appears to be important. This structure defines whether the augmentation of the lateral ankle ligaments reconstruction is performed using true IER or only the anterior part of the sural fascia. It is concluded that the use of this structure will have an impact on the resulting ankle stability.

  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. 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

  20. 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.

  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. Effect of physiotherapy on the strength of tibial internal rotator muscles in males after anterior cruciate ligament reconstruction (ACLR)

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    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...

  3. Treatment of patellar instability in a case of hereditary onycho-osteodysplasia (nail-patella syndrome) with medial patellofemoral ligament reconstruction: A case report.

    Science.gov (United States)

    Gong, Yubao; Yang, Chen; Liu, Yang; Liu, Jianguo; Qi, Xin

    2016-06-01

    Hereditary onycho-osteodysplasia, also known as nail-patella syndrome (NPS), is a rare genetic disorder that is primarily characterized by poorly developed nails and patella. Patients with NPS frequently suffer from patellar instability that requires surgical management. The present case report describes a 25-year-old man with NPS. The patient presented with left knee pain and was found to have recurrent left patellar dislocation. The knee pain was first reported 1-year after a minor knee trauma incident. Following complete evaluation, a diagnosis of NPS was reached. The patient underwent surgical intervention using medial patellofemoral ligament (MPFL) reconstruction with a gracilis tendon autograft looped through two transverse 3.2-mm drill holes in the patella and fixed at the natural MPFL insertion site on the medial femoral condyle with an interference screw. The surgery resulted in stabilization of the patella in the femoral trochlea and the patient did not have any subsequent dislocations or subluxations. The patient had an excellent range of knee movement in the follow-up period. This case indicates that MPFL reconstruction in patients with patellar dislocation secondary to NPS can successfully restore normal patellar tracking and result in good range of movement and functional activity.

  4. EPIDEMIOLOGY OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN BRAZIL'S PUBLIC HEALTH SYSTEM

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    Thiago Jambo Alves Lopes

    Full Text Available ABSTRACT Introduction: Several studies have reported on the epidemiology of Anterior Cruciate Ligament Reconstruction (ACLR in Europe and North America; however, there is currently no data relating to Brazil. Objective: To describe the incidence of ACLR in Brazil and investigate temporal trends and differences between age and sex groups. Methods: All reported ACLR cases in the public hospital system between January 2008 and December 2014 were extracted from the Information Technology Department of the Brazilian Ministry of Health. Linear regression analysis was used to assess changes in ACLR incidence in the overall population and among sex and age groups, hospitalization time, and health care costs. Results: A total of 48,241 ACLR were reported from 2008-2014 with an overall incidence of 3.49 per 100,000 persons/year. Males accounted for 82% of the procedures. The incidence of ACLR increased by 56% among males (p=0.01 and by 112% among females (p=0.001. The mean hospitalization time decreased from 2.4 days in 2008 to 1.8 day in 2014 (R2 = 0.883, p= 0.002. The total cost across all years was US$56 million, with a mean of US$1,145 per ACLR. Conclusion: Although the total incidence of ACLR in Brazil is lower compared to other countries, it has increased over the years, especially in females. The creation of an ACLR registry is necessary in the future, for more accurate control and new investigations.

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

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    Edmar Stieven Filho

    2015-04-01

    Full Text Available OBJECTIVE: To verify whether the combination of tibial cross pin fixation and femoral screw fixation presents biomechanical advantages when compared to femoral cross pin fixation and tibial screw fixation for the reconstruction of the anterior cruciate ligament (ACL.METHODS: Thirty-eight porcine knees and bovine extensor digitorum tendons were used as the graft materials. The tests were performed in three groups: (1 standard, used fourteen knees, and the grafts were fixated with the combination of femoral cross pin and a tibial screw; (2 inverted, used fourteen knees with an inverted combination of tibial cross pin and a femoral screw; (3 control, ten control tests performed with intact ACL. After the grafts fixation, all the knees were subjected to tensile testing to determine yield strength and ultimate strength.RESULTS: There was no statistically significant difference in survival techniques in regard to strength, yield load and tension. There was a higher survival compared in the standard curves of yield stress (p < 0.05.CONCLUSION: There is no biomechanical advantage, observed in animal models testing, in the combination of tibial cross pin fixation and femoral screw when compared to femoral cross pin fixation and tibial screw.

  6. Functional result relating to the positioning of the graft in anterior cruciate ligament reconstruction

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    Otávio de Melo Silva Júnior

    2015-02-01

    Full Text Available OBJECTIVE: To ascertain the coronal angles for the femoral and tibial tunnels that provide the best postoperative result from anterior cruciate ligament (ACL reconstruction surgery, through assessing the variables of the IKDC and Lysholm-Tegner questionnaires and the hop test.METHODS: Sixteen patients with a single unilateral ACL injury who underwent this surgery between 24 and 36 months earlier were evaluated. They were divided into four groups in which the tibial and femoral tunnel angles were greater than or less than 65° in the coronal plane.RESULTS: The results demonstrated that a more vertical angle for the tibial tunnel (72° and a more horizontal angle for the femoral tunnel (60°, with valgus alignment of 12° correlated with the best values for the variables studied. This may indicate that the long-term results from this surgery are excellent.CONCLUSION: A more horizontal femoral angle and a more vertical tibial angle produced better assessments in the tests that were applied and in the functional results evaluated.

  7. Variables associated with return to sport following anterior cruciate ligament reconstruction: a systematic review.

    Science.gov (United States)

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

    2014-03-01

    As one of the purposes of anterior cruciate ligament reconstruction (ACLR) is to return athletes to their preinjury activity level, it is critical to understand variables influencing return to sport. Associations between return to sport and variables representing knee impairment, function and psychological status have not been well studied in athletes following ACLR. The purpose of this review was to summarise the literature reporting on variables proposed to be associated with return to sport following ACLR. Systematic review. Medline, EMBASE, CINAHL and Cochrane databases were searched for articles published before November 2012. Articles included in this review met these criteria: (1) included patients with primary ACLR, (2) reported at least one knee impairment, function or psychological measure, (3) reported a return to sport measure and (4) analysed the relationship between the measure and return to sport. Weak evidence existed in 16 articles suggesting variables associated with return to sport included higher quadriceps strength, less effusion, less pain, greater tibial rotation, higher Marx Activity score, higher athletic confidence, higher preoperative knee self-efficacy, lower kinesiophobia and higher preoperative self-motivation. Weak evidence supports an association between knee impairment, functional and psychological variables and return to sport. Current return to sport guidelines should be updated to reflect all variables associated with return to sport. Utilising evidence-based return to sport guidelines following ACLR may ensure that athletes are physically and psychologically capable of sports participation, which may reduce reinjury rates and the need for subsequent surgery.

  8. Muscle strength and function before and after anterior cruciate ligament reconstruction using semitendonosus and gracilis.

    Science.gov (United States)

    Keays, S L; Bullock-Saxton, J; Keays, A C; Newcombe, P

    2001-10-01

    This study assessed the quadriceps and hamstring strength before and 6 months after anterior cruciate ligament (ACL) reconstructive surgery using the hamstrings and related the findings to functional performance. Six months after surgery is a critical time for assessment as this is when players are returning to sport. Maximum isokinetic strength of 31 patients with complete unilateral ACL ruptures was measured at speeds of 60 degrees and 120 degrees per second. Functional assessment included the single hop, the triple hop, the shuttle run, side-step and carioca tests. All patients underwent a controlled quadriceps emphasized home-based physiotherapy program both before and after surgery. Results show that before surgery there was a 7.3% quadriceps strength deficit at 60 degrees per second compared to the uninjured leg but no hamstring strength deficit. After surgery there was a statistically significant but relatively small loss of muscle strength. The quadriceps strength deficit had increased to 12% and there was a 10% hamstring deficit. Post-operatively there was an 11% and 6.3% improvement in the hop tests, a 9% (P < 0.01) improvement in the shuttle run, a 15% (P < 0.001) improvement in the side step and a 24% (P < 0.001) improvement in the carioca tests (P < 0.001) despite the loss of muscle strength.

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

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    Matthew R. Patterson

    2014-01-01

    Full Text Available The use of inertial sensors to characterize pathological gait has traditionally been based on the calculation of temporal and spatial gait variables from inertial sensor data. This approach has proved successful in the identification of gait deviations in populations where substantial differences from normal gait patterns exist; such as in Parkinsonian gait. However, it is not currently clear if this approach could identify more subtle gait deviations, such as those associated with musculoskeletal injury. This study investigates whether additional analysis of inertial sensor data, based on quantification of gyroscope features of interest, would provide further discriminant capability in this regard. The tested cohort consisted of a group of anterior cruciate ligament reconstructed (ACL-R females and a group of non-injured female controls, each performed ten walking trials. Gait performance was measured simultaneously using inertial sensors and an optoelectronic marker based system. The ACL-R group displayed kinematic and kinetic deviations from the control group, but no temporal or spatial deviations. This study demonstrates that quantification of gyroscope features can successfully identify changes associated with ACL-R gait, which was not possible using spatial or temporal variables. This finding may also have a role in other clinical applications where small gait deviations exist.

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

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    Adam Czaplicki

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

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

    Science.gov (United States)

    Czaplicki, Adam; Jarocka, Marta; Walawski, Jacek

    2015-01-01

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

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

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    Albuquerque Roberto Freire da Mota e

    2003-01-01

    Full Text Available Anterior knee instability associated with a varus deformity is a complex condition with several treatment possibilities. Among these, anterior cruciate ligament (ACL associated to a simultaneous valgus tibial osteotomy is a increasing indication. This simultaneous procedure adds technical issues to those related to the isolated surgeries. Thus, the osteotomy plane and location of fixation hardware shouldn?t conflict with tibial tunnel and ACL graft fixation. Authors analyze the relations between a opening tibial valgus osteotomy stabilized with a Puddu plate and ACL reconstruction with a patellar tendon graft fixated with interference screws in 10 human cadaver knees. A straight oblique tibial osteotomy starting on the medial tibial cortex and oriented laterally and proximally was performed on all knees with a 10mm opening medially and stabilized with a Puddu plate on the most posterior aspect of the medial tibia, and a tibial tunnel drilled 50° to tibial plateau. With this technique there was no intersection between tibial tunnel or interference screw and the osteotomy or the plate fixation screws.

  13. 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.

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

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    Maria Luzete Costa Cavalcante

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

  15. Biceps Femoris Architecture and Strength in Athletes with a Previous Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Timmins, Ryan G; Bourne, Matthew N; Shield, Anthony J; Williams, Morgan D; Lorenzen, Christian; Opar, David A

    2016-03-01

    This study aimed to determine whether limbs with a history of anterior cruciate ligament (ACL) injury reconstructed from the semitendinosus display different biceps femoris long head (BFlh) architecture and eccentric strength, assessed during the Nordic hamstring exercise, compared with the contralateral uninjured limb. The architectural characteristics of the BFlh were assessed at rest and at 25% of a maximal voluntary isometric contraction (MVIC) in the control group (n = 52) and in the group who had previous ACL injury (n = 15) using two-dimensional ultrasonography. Eccentric knee flexor strength was assessed during the Nordic hamstring exercise. Fascicle length was shorter (P = 0.001; d range, 0.90-1.31) and pennation angle (P range, 0.001-0.006; d range, 0.87-0.93) was greater in the BFlh of the ACL-injured limb compared with those in the contralateral uninjured limb at rest and during a 25% MVIC. Eccentric strength was lower in the ACL-injured limb when compared with the contralateral uninjured limb. Fascicle length, MVIC, and eccentric strength were not different between the left and right limb in the control group. Limbs with a history of ACL injury reconstructed from the semitendinosus have shorter fascicles and greater pennation angles in the BFlh compared with those of the contralateral uninjured side. Eccentric strength during the Nordic hamstring exercise of the ACL-injured limb is significantly lower than that of the contralateral side. These findings have implications for ACL rehabilitation and hamstring injury prevention practices, which should consider altered architectural characteristics.

  16. Screening for arthrofibrosis after anterior cruciate ligament reconstruction: analysis of association with human leukocyte antigen.

    Science.gov (United States)

    Skutek, Michael; Elsner, Holger-A; Slateva, Kalina; Mayr, Hermann-O; Weig, Thomas-G; van Griensven, Martijn; Krettek, Christian; Bosch, Ulrich

    2004-05-01

    Arthrofibrosis represents a severe complication of trauma and reconstructive joint surgery because of generalized connective tissue proliferation resulting in painful joint stiffness. It often appears stereotypical in terms of its clinical and pathologic features, comprising excess deposition of extracellular matrix proteins such as collagen type I, III, and VI and proliferation of fibroblasts. However, trauma and surgery around joints does not always lead to fibrosis, suggesting a genetic predisposition. For a number of autoimmune diseases, strong associations have been described. The objective of the study was to investigate whether an association of HLA (human leukocyte antigen) with primary arthrofibrosis exists. Retrospective cohort study. Seventeen patients with primary arthrofibrosis after autologous anterior cruciate ligament (ACL) reconstruction were identified and clinically reviewed. Blood samples were taken, and DNA was isolated by column extraction method. DNA samples were typed for the loci HLA-A, -B, -C, -DRB1, and -DQB1. Results were compared with the frequencies of allelic groups as determined for the caucasoid population. HLA-Cw*07 was significantly less often found in the patient group than in the general population (P =.022). The opposite effect was seen for Cw*08, which was found in 17.6% of the patient group but only in 3.8% of the reference group (P =.045). A significant difference was also seen for DQB1*06, because 23.5% of the patients but 48.6% of the reference group possessed an allelic variant of this group (P =.048). However, according to the relatively small number of patients, a statistical bias cannot be excluded. A possible link may exist between arthrofibrosis and HLA-Cw*07- and DQB1*06-negative as well as Cw*08-positive individuals. Further investigation is necesessary to confirm or vitiate the possible association. Level IV.

  17. Validation of an algorithm for planar surgical resection reconstruction

    Science.gov (United States)

    Milano, Federico E.; Ritacco, Lucas E.; Farfalli, Germán L.; Aponte-Tinao, Luis A.; González Bernaldo de Quirós, Fernán; Risk, Marcelo

    2012-02-01

    Surgical planning followed by computer-assisted intraoperative navigation in orthopaedics oncology for tumor resection have given acceptable results in the last few years. However, the accuracy of preoperative planning and navigation is not clear yet. The aim of this study is to validate a method capable of reconstructing the nearly planar surface generated by the cutting saw in the surgical specimen taken off the patient during the resection procedure. This method estimates an angular and offset deviation that serves as a clinically useful resection accuracy measure. The validation process targets the degree to which the automatic estimation is true, taking as a validation criterium the accuracy of the estimation algorithm. For this purpose a manually estimated gold standard (a bronze standard) data set is built by an expert surgeon. The results show that the manual and the automatic methods consistently provide similar measures.

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

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    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.

  19. 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.

  20. Ankle ligament injuries

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    Per A.F.H. Renström

    1998-06-01

    that is refractory to conservative measures and bracing as outlined above, surgical treatment must address the subtalar joint as well. Subtalar ligament injury and instability are probably more common than appreciated. Definition and diagnosis of this entity are difficult, however. Fortunately, it appears that in the majority of the acute injuries healing occurs with the same functional rehabilitation program as that for lateral ankle ligament sprains. For chronic subtalar instability an intial attempt at functional rehabilitation with ankle proprioceptive training and bracing should be attempted. If this program fails primary repair or reconstruction can be beneficial. Reconstructive procedures must address the subtalar joint. Subtalar instability often occurs in conjunction with talocrural instability, so careful diagnosis is critical in anyone with chronic ankle instability. If either is not addressed, the patient will continue to have problems. Deltoid ligament injuries most often occur in association with ankle fractures. They are rare as isolated injuries. If no fracture is evident on radiographs, particular attention must be paid to the syndesmosis to ensure there is not an associated syndesmosis disruption. True isolated deltoid injuries seem to do well with non-operative functional treatment as for lateral ankle ligament injuries. Deltoid ruptures associated with ankle fractures appear to heal well by addressing the other injuries and allowing the deltoid to heal on its own. It is vital to correct any syndesmosis injury and to obtain correct bony alignment. Syndesmosis injuries can be debilitating if not treated properly. Careful physical exam and interpretation of radiographs is necessary to obtain a correct diagnosis. Partial injuries appear to do well with functional rehabilitation. However, complete tears, if widening is not corrected, can lead to chronic ankle pain and early degenerative changes. Widening of the syndesmosis with a tear of the inferior

  1. 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.

  2. The use of brushite calcium phosphate cement for enhancement of bone-tendon integration in an anterior cruciate ligament reconstruction rabbit model.

    Science.gov (United States)

    Wen, Chun-Yi; Qin, Ling; Lee, Kwong-Man; Chan, Kai-Ming

    2009-05-01

    This study was designed to investigate the osteoconductivity and bioresorption of brushite calcium phosphate cement (CPC) in bone-tendon interface healing after anterior cruciate ligament (ACL) reconstruction. Surgical reconstruction using grafted tendon in bone tunnel was performed bilaterally in 28 skeletal mature rabbits. Brushite CPC was implanted between grafted tendon and bone tunnel of one limb with the contralateral one as the control. A batch of 14 rabbits was sacrificed at 6 and 12 weeks, respectively, after surgery. At each time point, six rabbits were used for micro-CT and subsequent histological examinations, whereas the remaining eight rabbits were used for pull-out testing. The components of brushite CPC-dicalcium phosphate dihydrate matrix degraded rapidly with beta-tricalcium phosphate granules left for guiding new bone formation. Brushite CPC augmented the peri-tendon bone volume and promoted bone growth into the healing interface. The ultimate strength and stiffness of the graft-tunnel complexes on experimental side was higher than that of the control by 117% and 102%, respectively, at 6 weeks postoperatively (p brushite CPC caused a paradigm shift in failure mode from intra-tunnel to intra-articular portion at 12 weeks postoperatively (p = 0.013). Brushite CPC significantly enhanced the bone-tendon integration after ACL reconstruction, which provided a scientific basis for clinical application.

  3. The effectiveness of surgical correction of uterine prolapse: cervical amputation with uterosacral ligament plication (modified Manchester) versus vaginal hysterectomy with high uterosacral ligament plication.

    NARCIS (Netherlands)

    Boer, T.A. de; Milani, A.L.; Kluivers, K.B.; Withagen, M.I.J.; Vierhout, M.E.

    2009-01-01

    INTRODUCTION AND HYPOTHESIS: The objective of this study is to evaluate cervical amputation with uterosacral ligament plication (modified Manchester) and compare it to vaginal hysterectomy with high uterosacral ligament plication procedure with special regard to the middle compartment. METHODS:

  4. Gait analysis associated with ankle ligament reconstruction%踝关节重建手术前后的步态分析

    Institute of Scientific and Technical Information of China (English)

    崔大平; 赵德伟; 孙强; 于小光

    2013-01-01

    [ Objective]The aim of this study is to determine how selected gait parameters, measured by three-dimensional motion capture system, may change as a result of ankle ligament deficiency and following ankle ligament reconstruction. [ Method] The study was performed on 39 ankle ligament-deficient subjects prior to and 6 months, 12 months, 18months and 24 for months after ankle ligament reconstructive surgery by the four stranded hamstring tendon technique. The group was examined an average of 2. 6 months after injury ( ranging from 2 weeks to 16 months) , but before surgery. Gait analysis was performed using the DorealSoft DVMC-8801 three-dimensional motion capture system (Doreal Software Co. ,Ltd. , China). Kinematic data were recorded for the lower limb. The results obtained from the injured subjects were compared with those of 58 individuals without ankle ligament damage. Each subject was asked to walk on a motorized treadmill (ECON USA) with different slope and perform-after six minutes of familiarization time-at least 2 minutes of walking at a constant speed of 1.9 km/h. [ Result ] The ankle ligament-deficient patients exhibited a quadriceps avoidance pattern prior to and 6 months after surgery. In the individuals operated on, the spatial-temporal parameters and the ankle angle had already regained a normal pattern for the ankle ligament-deficient limb during gait 12 months after surgery. However, the relative ankle ligament movement parameter-which describes the tibial translation into the direction of ankle ligament-and the angular acceleration showed no significant statistical difference compared with the values of healthy control group just 18 months after surgery. [Conclusion]The data from this study suggest that ANKLE LIGAMENT surgical repair significantly alters lower-extremity gait patterns, and that the establishment of pre-injury gait patterns takes at least 18 months to occur. 3D gait analysis for assessment of patients undergoing anterior cruciate

  5. Interference screw versus Endoscrew fixation for anterior cruciate ligament reconstruction: A biomechanical comparative study in sawbones and porcine knees

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    Chu-Chih Hung

    2014-04-01

    Full Text Available Interference screw fixation is one of the most common methods for ligament reconstruction. Although the advantages and clinical outcomes of this procedure have been widely reported, post-surgical complications often arise. The purpose of this study was to evaluate a new femoral fixation device, the Endoscrew, for anterior cruciate ligament (ACL reconstruction. We performed a mechanical test in accordance with American Society for Testing and Materials (ASTM standards and an in vitro biomechanical study. An axial pullout test was conducted to evaluate the mechanical properties of the new device and the interference screw when implanted in solid rigid polyurethane foam test blocks. The biomechanical test used porcine femora to evaluate the initial fixation strength between these two implants. The maximum pullout force of the interference screw group [722.05 ± 130.49 N (N] was significantly greater (p < 0.01 than the Endoscrew group (440.79 ± 26.54 N when implanted in polyurethane foam 320 kg/m3 density. With polyurethane foam 160 kg/m3 density, the maximum pullout forces were (242.61 ± 37.36 N (p < 0.001 and (99.33 ± 30.01 N for the interference screw group and Endoscrew group, respectively. In the in vitro mechanical study, the Endoscrew (646.39 ± 72.38 N required a significantly greater ultimate load prior to failure (p < 0.05 when compared with the interference screw (489.72 ± 138.64 N. With regard to pullout stiffness, there was no statistically significant difference (p < 0.13 between the Endoscrew group (99.15 ± 12.16 N/mm and the interference screw group (87.96 ± 11.12 N/mm. The cyclic stiffness was also not significantly different (p < 0.44 between the Endoscrew group (93.09 ± 16.07 N/mm and the interference screw group (85.78 ± 14.76 N/mm. The axial pullout test showed that the strength of the Endoscrew was close to the fixation strength required for daily activities, but it is

  6. Return to Play After Revision Anterior Cruciate Ligament Reconstruction in National Football League Players.

    Science.gov (United States)

    Okoroha, Kelechi R; Kadri, Omar; Keller, Robert A; Marshall, Nathan; Cizmic, Zlatan; Moutzouros, Vasilios

    2017-04-01

    National Football League (NFL) players who undergo anterior cruciate ligament (ACL) reconstruction have been shown to have a lower return to play (RTP) than previously expected. However, RTP in the NFL after revision ACL reconstruction (RACLR) is not well defined. The purpose of this study is to determine the RTP of NFL players after RACLR and evaluate factors that predict RTP. Our hypothesis was that more experienced and established players would be more likely to RTP after RACLR. Cohort study; Level of evidence, 3. A total of 24 NFL players who underwent RACLR between 2007 and 2014 were reviewed and evaluated. Return to NFL play, time to return, seasons and games played prior to and after revision surgery, draft status, and demographic data were collected. Overall RTP was determined, and players who did RTP were compared with those unable to RTP. Data were also compared with control players matched for age, position, size, and experience. After RACLR, 79% (19/24) of NFL players returned to NFL regular-season play at an average of 12.6 months. All players who were drafted in the first 4 rounds, played in at least 55 games, or played 4 seasons of NFL play prior to injury were able to RTP. Players drafted in the first 4 rounds of the NFL draft were more likely to RTP than those who were not (odds ratio, 0.1; 95% CI, 0.01-1.00; P = .05). Those who returned to NFL play played in significantly less games and seasons after their injury than before (P = .01 and P = .01, respectively). However, these values did not differ when compared with matched controls (P = .67 and P = .33). NFL players who RTP after RACLR do so at a similar rate but prolonged time period compared with after primary ACL reconstruction. Athletes who were drafted in earlier rounds were more likely to RTP than those who were not. Additionally, player experience prior to injury is an important factor when predicting RTP after RACLR.

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

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    Rodrigo Barreiros Vieira

    2014-04-01

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

  8. In vitro study of knee stability after two-band two-tunnel posterior cruciate ligament reconstruction

    Institute of Scientific and Technical Information of China (English)

    MAO Yuan-qing; CHEN Bai-cheng; ZHU Zhen-an

    2006-01-01

    Objective: To compare the ability of three different reconstruction procedures in restoring the posterior displacement of tibia and the posterior stability of the knee joint from 0° to 120° flexion.Methods: Three posterior cruciate ligaments (PCL)reconstruction procedures were performed, namely twoband two-tunnel reconstruction, one-band anterior tunnel reconstruction and one-band posterior tunnel reconstruction. The posterior displacement of the tibia in relation to the femur was measured when a 200N posterior force was applied.Results: Within the flexion range of 0° to 30°, the displacement in the one-band posterior tunnel reconstruction showed little difference from that of an intact knee (P>0.05). But when the flexion exceeded 30°,especially when it exceeded 60°, the displacement in oneband posterior tunnel reconstruction was much greater than that of an intact knee (P < 0.01 ). In two-band two-tunnel reconstruction and one-band anterior tunnel reconstruction,the displacement was approximately the same as that of an intact knee ranging from 0° to 120° (P > 0.05), while a slight over-restriction might be found at some angles.Conclusions: Two-band reconstruction could effectively restrict the posterior displacement of the tibia and restore anterior, posterior stability of the knee joint within its full range of flexion. One-band anterior tunnel reconstruction also could maintain the posterior stability of the knee, while the result of one-band posterior tunnel reconstruction is the most unsatisfactory.

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

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    A. V. Rybin

    2015-01-01

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

  10. Influence of different levels of sports activities on the quality of life after the reconstruction of anterior cruciate ligament

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    Ninković Srđan

    2015-01-01

    Full Text Available Introduction. The goal of this study was to examine the nature and presence of influence of different levels of sports activity on the life quality of the patients a year after the reconstruction of anterior cruciate ligament. Material and Methods. The study included 185 patients operated at the Department of Orthopedic Surgery and Traumatology of the Clinical Centre of Vojvodina, who were followed for twelve months. Data were collected using the modified Knee Injury and Osteoarthritis Outcome Score questionnaire which included the Lysholm scale. Results. This study included 146 male and 39 female subjects. The reconstruction of anterior cruciate ligament was equally successful in both gender groups. In relation to different types of sports activity, there were no differences in the overall life quality measured by the questionnaire and its subscales, regardless of the level (professional or recreational. However, regarding the level of sports activities, there were differences among the subjects engaged in sports activities at the national level as compared with those going in for sports activities at the recreational level, and particularly in comparison with physically inactive population. A significant correlation was not found by examining the aforementioned relationship between sports activities. Conclusions. This study has shown that the overall life quality a year after the reconstruction of the anterior cruciate ligament does not differ in relation to either the gender of the subjects or the type of sports activity, while the level of sports activity does have some influence on the quality of life. Professional athletes have proved to train significantly more intensively after this reconstruction than those going in for sports recreationally.

  11. Criteria for Return to Sport after Anterior Cruciate Ligament reconstruction with lower reinjury risk (CR'STAL study): protocol for a prospective observational study in France.

    Science.gov (United States)

    Rambaud, Alexandre J M; Semay, Bertrand; Samozino, Pierre; Morin, Jean-Benoît; Testa, Rodolphe; Philippot, Rémi; Rossi, Jérémy; Edouard, Pascal

    2017-06-30

    The decision regarding when to return to sport after an anterior cruciate ligament reconstruction (ACLR) is an important one. Using a variety of subjective and objective parameters, various attempts have been made to determine an optimal timeline for a return to sport after ACLR, but none have been validated.The aim of the present study is therefore to determine which criteria or combination of criteria could allow to return to sport with the lowest possible risk of reinjury. This study is a prospective cohort, single-centre study, with repeated assessments at 6, 9 and 12 months post-ACL surgical reconstruction and including a 3-year follow-up of patients' sporting activity and reinjuries. 275 patients will be included to test explanatory variables. Postural control analysis, knee laxity, questionnaires (International Knee Documentation Committee (IKDC), Tampa Scale of Kinesiophobia-11 (TSK-11), Anterior Cruciate Ligament-Return to Sport After Reinjury (ACL-RSI) and Single Assessment Numeric Evaluation (SANE)), modified Star Excursion Balance Test, running and sprinting biomechanics, Hop Tests and Isokinetic Tests will all be used. The primary outcome will be any reinjury during the follow-up period, defined as a graft rupture, a contralateral ACL rupture or any injury necessitating an interruption of training and requiring a medical consultation. Two groups will be constituted during the follow-up, separating reinjured from non-reinjured patients. In addition, classic analysis and data mining approaches will be used to build predictive models. The results of this study will be disseminated through peer-reviewed publications and scientific presentations. Ethical approval was obtained through the ethics committee of the University Hospital of Saint-Etienne (reference number IRBN522015/CHUSTE). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise

  12. 关节镜下人工韧带加强系统重建前交叉韧带%Arthroscopic reconstruction of the anterior cruciate ligament using ligament advanced reinforcement system artificial ligament

    Institute of Scientific and Technical Information of China (English)

    陈明; 董启榕

    2008-01-01

    状态:平均伸屈活动度0°到128.0°±11.6°.Lysholm膝关节功能评分法平均积分由术前的(45.3±1.31)分提高到术后的(85.6±2.24)分,差异有显著性意义(P<0.05).膝不稳症状消失,前抽屉试验阴性.③Tegner评分也有明显提高.结论:LARS人工韧带用于重建前交叉韧带与宿丰组织相容性良好,重建后患者膝关节功能及主观满意度均得到明显提高.%BACKGROUND: The improvement in production technology of new materials including artificial ligament reduces material rupture caused by fatigue and histocompatibility-related synovitis and other complications, leading to a wide application of artificial ligament. OBJECTIVE: To evaluate the histocompatibility and clinical curative effects of reconstruction of the anterior cruciate ligament (ACL) of the knee with ligament advanced reinforcement system (LARS) artificial ligament using arthroscopy. DESIGN: A completely randomized clinical design. SETTING: Department of Orthopedics, Second Affiliated Hospital of Soochow University. PARTICIPANTS: Thirty-two cases of ACL injury received LARS artificial ligament in the Department of Orthopedics, Second Affiliated Hospital of Soochow University From June 2005 to June 2006 and were recruited for this study. The 32 patients averaged 21 years old and were injured in sports. Prior to surgery, MRI showed injury to ACL and semilunar valve in all patients. Written informed consent for therapeutic contents was obtained from each patient. METHODS: Thirty-two patients with injury to ACL of the knee underwent arthroscopic ACL reconstruction. LARS was used to reconstruct the ACL. The LARS was produced by Laboratoire d'Application et de Recherche Scientifique, France (Certification No. CE0459, 1SO9002-EN46002). Artificial ligament was made of polyethylene terephthalate, which had the material type L021201 (left knee) and L021202 (right knee). Artificial ligament was designed to imitate the anatomic structure and biomechanical principle of artificial

  13. "Functional outcome of lower limb following anterior cruciate ligament reconstruction; a prospective clinical study"

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    Olyaei G.R

    2007-06-01

    Full Text Available Background: Both isokinetic testing and functional tests are commonly used to evaluate anterior cruciate ligament reconstructed (ACLR patients. The object of this study was to evaluate motor performance of the knee and determine the relationship of isokinetic test scores to scores on a variety of lower extremity functional tests. Methods: Ten healthy subjects and eleven ACLR patients at least six months after surgery performed the following: knee isokinetic tests at 60 and 180 deg/sec; three functional tests including leg vertical jump, single hop, and triple cross-over hop for distance. The International Knee Document Committee Subjective Knee Evaluation Form (IKDCSKEF was used to score the self-assessment of each study participant. Paired T-test was used to compare the involved and uninvolved knee. Pearson correlation coefficients were used to determine the relationship between the scores on the isokinetic test and functional tests. Significance was determined by P<0.05. Results: IKDCSKEF score was significantly lower in patients than control subjects. Quadriceps peak torque and functional test scores were significantly lower in the involved knee of the ACLR subjects compared to the uninvolved knee. Correlation coefficients of isokinetic peak torque to body weight and functional testing were not significant in patients or control subjects, whi1e the limb symmetry index (LSI of the quadriceps isokinetics peak torque to body weight and the LSI of the functional tests were significant (r = 0.54 to 0.97. Conclusion: These results indicate a significant relationship between the LSI of various functional tests and the LSI of isokinetic testing among ACLR patients. Thus, in situations where an isokinetic dynamometer is not available, the LSI of functional tests can be used to estimate quadriceps deficiency for ACLR patients.

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

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    Clare Ardern

    2009-07-01

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

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

    Science.gov (United States)

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

    2013-11-01

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

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

    Science.gov (United States)

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

    2017-08-01

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

  17. A phenomenological contact model: Understanding the graft-tunnel interaction in anterior cruciate ligament reconstructive surgery.

    Science.gov (United States)

    Salehghaffari, Shahab; Dhaher, Yasin Y

    2015-07-16

    In this paper, we sought to expand the fidelity of a validated model of the anterior cruciate ligament reconstruction (ACL-R) procedure by incorporating a stick-slip contact model with linear pressure-overclosure relationship at the interface. The suggested model is characterized by three unknown parameters, friction coefficient, shear stress softening and contact stiffness. In the absence of any isolated experiments exploring the graft-tunnel interactions during an aggregate joint load, the calibration data used in this study are derived from a reported biomechanical study. A Bayesian calibration procedure was employed to find the unknown probability distribution function (PDF) of these contact parameters. Initially, the response surface approximations of the predicted graft forces from laxity test simulations was adopted to estimate the likelihood of noisy experimental data reported in the literature. Then, the wide domain of contact parameters was sampled sequentially based on the Marcov Chain Monte Carlo (MCMC) method with acceptance-rejection criteria to search for population of samples in significantly narrower domain of unknown parameters that are associated with the highest occurrence likelihood of noisy experimental data. Our simulations with calibrated contact parameters indicate that pre-tensioning applied at 30° of flexion leads to larger graft force after the joint is fully extended compared to the graft force when the same pre-tensioning force is applied at full extension. Moreover, regardless of the pre-tensioning force, the graft-tunnel contact pressure is larger when the fixation of the graft is performed at full extension, increasing with the pre-tensioning force.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-06-15

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

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

    Science.gov (United States)

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

    2017-01-01

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

  20. Effect of anterior cruciate ligament reconstruction on biomechanical features of knee in level walking: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    SHI Dong-liang; WANG Yu-bin; AI Zi-sheng

    2010-01-01

    Background The anterior cruciate ligament (ACL) is one of the most commonly injured knee ligaments. Even following ACL reconstruction, significant articular cartilage degeneration can be observed and most patients suffer from premature osteoarthritis. Articular cartilage degeneration and osteoarthritis development after ACL injury are regarded as progressive process that are affected by cyclic loading during frequently performed low-intensity daily activities. The purpose of this study was to perform a meta analysis on studies assessing the effects of ACL reconstruction on kinematics, kinetics and proprioception of knee during level walking.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 July 2010 comparing gait and proprioception of a reconstructed-ACL group with an intact-ACL group were pooled for this review. Thirteen studies were included in the final meta analysis.Results There was no significant difference in step length, walking speed, maximum knee flexion angle during loading response, joint position sense and threshold to detect passive motion between the reconstructed-ACL group and the intact-ACL group (P >0.05). However, there was a significant difference in peak knee flexion angle, maximum angular knee flexion excursion during stance, peak knee flexion moment during walking and maximum external tibial rotation angle throughout the gait cycle between the reconstructed-ACL group and the intact-ACL group (P <0.05).Conclusions Step length, walking speed, maximum knee flexion angle during loading response, joint position sense and threshold to detect passive motion usually observed with ACL deficiency were restored after the ACL reconstruction and rehabilitation, but no significant improvements were observed for peak knee flexion angle, maximum angular knee flexion excursion

  1. Stable relocation of the radial head without annular ligament reconstruction using the Ilizarov technique to treat neglected Monteggia fracture: two case reports

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    Wani Shareef A

    2010-10-01

    Full Text Available Abstract Introduction A Monteggia facture dislocation is not an uncommon injury, and the diagnosis can often be missed. Long-term follow-up of untreated Monteggia fracture dislocations reveals development of premature arthritis, pain, instability, and loss of pronation and supination. Methods involving annular ligament reconstruction require post-operative immobilization and use of transcapitellar pinning for maintenance of reduction, and thus a delay in rehabilitation. The literature reports satisfactory results with methods that involve ulnar osteotomy and open reduction of the radial head without annular ligament reconstruction. We used the Ilizarov method in two cases with neglected Monteggia fracture dislocations to stably reduce the radial head without open reduction and annular ligament reconstruction. Case presentation We report two cases of neglected Monteggia fracture dislocation, in two Kashmiri boys aged four and six years. Using ulnar osteotomy with distraction osteogenesis, we were able to relocate the radial head gradually and maintain the reduction without a requirement for open reduction and annular ligament reconstruction. Conclusion Distraction lengthening and hyperangulation in different planes by use of the Ilizarov technique effectively reduces the radial head without open reduction and annular ligament reconstruction.

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

    Science.gov (United States)

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

    2016-03-01

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

  3. 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.

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    Hiranyakumar

    2016-03-01

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

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

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    Ali Ashraf-Jamshidi

    2014-06-01

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

  7. The effect of cold therapy on pain, swelling, and range of motion after anterior cruciate ligament reconstructive surgery.

    Science.gov (United States)

    Daniel, D M; Stone, M L; Arendt, D L

    1994-10-01

    This prospective study assessed the effect of cold therapy on pain, pain medication use, limb swelling, and knee range of motion in 131 patients who had an arthroscopically assisted anterior cruciate ligament reconstruction. Patients were randomized into five treatment groups. Cooling pads were incorporated into the dressing in 89 patients, and no cooling pads were used in 42 patients. There were four cooling-pad temperature groups: 40 degrees F, 45 degrees F, 55 degrees F, and 70 degrees F. The cooling pads lowered the skin temperature. There was no difference between groups with respect to hospital stay, pain medication use, pain scale, knee girth, or range of motion.

  8. Lumbar disk. Surgical tricks for safeguarding the "root's ecology".

    Science.gov (United States)

    de Divitiis, E; Spaziante, R; Cappabianca, P; Donzelli, R

    1984-07-01

    Restoration of a physiologic periradicular environment is a fundamental step toward improving the results of surgical procedures on the herniated lumbar disk. Combined with the preservation of periradicular fat (or free transplant of subcutaneous fat), reconstruction of the yellow ligament, recreating the interlaminar plane, may act as a barrier against postoperative adhesions. An operative technique is described that is aimed toward preserving the yellow ligament with the purpose of reconstructing it at the end of the surgical procedure on the root.

  9. Postinfectious ankylosis of the knee after bacterial arthritis following routine anterior cruciate ligament (ACL) reconstruction

    Science.gov (United States)

    Mester, Bastian; Schoepp, Christian; Glombitza, Martin; Rixen, Dieter

    2016-01-01

    Aims and Objectives: Knee arthroscopy is a very common surgical procedure. It belongs to the most frequently performed procedures in orthopedics and traumatology and is considered to have a low complication rate. The risk of postoperative knee infection following ACL reconstrucion is estimated 1-2 %. Thereby the ACL reconstruction cannot always be preserved. Persistent defects after healing and postinfectios osteoarthritis are observed. We present the case of an adolescent patient suffering from postoperative knee infection following routine ACL reconstruction, who is developing - while infection is decreasing - a complete bony ankylosis of the knee, clinically meaning a severe constraint to joint function with complete stiffness of the knee. Materials and Methods: The 13-year-old male patient sustained a distorsion of the right knee during sports at school, after clinical examination magnetic resonance tomography showed a complete tear of the ACL. Single bundle ACL reconstruction was done using autologous hamstrings in Transfix technique. After 5 days at hospital the patient was discharged without any complications. Shortly afterwards the patient was admitted to hospital again presenting a postoperative knee infection. After primary operative revision the patient was shifted to our intensive care unit in a septic condition for stabilization. During 4 month of stay at our hospital multiple operative revisions were performed as arthrotomy, debridement, insertion of antibiotic carriers, complete removal of the autograft and total synovectomy. We found a severe bacterial infection (staphylococcus aureus) of the knee joint, classified Gaechter IV, histopathologically mostly avital cartilage tissue and chronic synovialitis. After decrease of the infection we could discharge the patient from hospital. Results: During the following 8 month under ongoing physiotherapy the patient was developing an increasing stiffness of the knee, finally fixed at 30 degrees of flexion and

  10. The application of digital surgical diagnosis and treatment technology: a promising strategy for surgical reconstruction of craniomaxillofacial defect and deformity.

    Science.gov (United States)

    Wang, Li-ya; Du, Hong-ming; Zhang, Gang; Tang, Wei; Liu, Lei; Jing, Wei; Long, Jie

    2011-12-01

    The craniomaxillofacial defect and deformity always leads to serious dysfunction in mastication and facial contour damage, significantly reducing patients' quality of life. However, surgical reconstruction of a craniomaxillofacial hard tissue defect or deformity is extremely complex and often does not result in desired facial morphology. Improving the result for patients with craniomaxillofacial defect and deformity remains a challenge for surgeons. Using digital technology for surgical diagnosis and treatment may help solve this problem. Computer-assisted surgical technology and surgical navigation technology are included in the accurate digital diagnosis and treatment system we propose. These technologies will increase the accuracy of the design of the operation plan. In addition, the intraoperative real-time navigating location system controlling the robotic arm or advanced intelligent robot will provide accurate, individualized surgical treatment for patients. Here we propose the hypothesis that a digital surgical diagnosis and treatment technology may provide a new approach for precise surgical reconstruction of complicated craniomaxillofacial defect and deformity. Our hypothesis involves modern digital surgery, a three-dimensional navigation surgery system and modern digital imaging technology, and our key aim is to establish a technological platform for customized digital surgical design and surgical navigation for craniomaxillofacial defect and deformity. If the hypothesis is proven practical, this novel therapeutic approach could improve the result of surgical reconstruction for craniomaxillofacial defect and deformity for many patients.

  11. 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

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

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    Sabrine Souissi

    2011-12-01

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

  13. Long-term Results of Arthroscopic Arthrolysis for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Mayr, Hermann O; Brandt, Christian M; Weig, Thomas; Koehne, Manuel; Bernstein, Anke; Suedkamp, Norbert P; Hube, Robert; Stoehr, Amelie

    2017-02-01

    The current study was conducted to evaluate the long-term clinical and radiological outcomes after arthroscopic arthrolysis for arthrofibrosis after anterior cruciate ligament reconstruction (ACLR). All patients treated with arthrolysis between 1990 and 1998 were included. Indication was arthrofibrosis in at least one knee compartment or a cyclops syndrome limiting range of motion (ROM) by > 5° of extension deficit and 15° of flexion deficit. International Knee Documentation Committee (IKDC) 2000 subjective and objective, Lysholm score, and x-ray evaluation were documented. Statistical analysis and power calculation were performed (P < .05). One hundred forty-one patients (follow-up, 71%) were examined at a mean of 18.7 ± 2.6 years after arthroscopic arthrolysis. Mean IKDC 2000 score was 79.49 ± 14.32. IKDC objective was normal in 0%, nearly normal in 6%, abnormal in 56%, and severely abnormal in 38%. One hundred percent of patients showed more than grade II osteoarthritis. ROM improvement after arthrolysis did not change significantly compared with midterm results (t = 4.5 years). Patients with persisting motion deficits (P = .02) and after medial meniscus resection (P < .001) at time of ACLR showed significantly greater progression of osteoarthritis in comparison with patients without these additional disorders. In case of arthrolysis later than 1 year after ACLR, a more severe osteoarthritis grade (4% vs 20% grade III; P = .038) and a lower jump distance (IKDC: 61% A, 25% B vs 39% A, 41% B; P = .028) were obvious compared with patients who underwent arthrolysis within the first year after ACLR. Long-term motion improvement can be achieved by arthrolysis. Persistent loss of motion resulted in a higher degree of osteoarthritis in the study population. Early intervention seems advisable as patients with arthrolysis later than 1 year after index surgery reached worse IKDC objective grading. Level IV, therapeutic case series. Copyright © 2016

  14. Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques.

    Science.gov (United States)

    Spencer, H T; Hsu, L; Sodl, J; Arianjam, A; Yian, E H

    2016-04-01

    To compare radiographic failure and re-operation rates of anatomical coracoclavicular (CC) ligament reconstructional techniques with non-anatomical techniques after chronic high grade acromioclavicular (AC) joint injuries. We reviewed chronic AC joint reconstructions within a region-wide healthcare system to identify surgical technique, complications, radiographic failure and re-operations. Procedures fell into four categories: (1) modified Weaver-Dunn, (2) allograft fixed through coracoid and clavicular tunnels, (3) allograft loop coracoclavicular fixation, and (4) combined allograft loop and synthetic cortical button fixation. Among 167 patients (mean age 38.1 years, (standard deviation (sd) 14.7) treated at least a four week interval after injury, 154 had post-operative radiographs available for analysis. Radiographic failure occurred in 33/154 cases (21.4%), with the lowest rate in Technique 4 (2/42 4.8%, p = 0.001). Half the failures occurred by six weeks, and the Kaplan-Meier survivorship at 24 months was 94.4% (95% confidence interval (CI) 79.6 to 98.6) for Technique 4 and 69.9% (95% CI 59.4 to 78.3) for the other techniques when combined. In multivariable survival analysis, Technique 4 had better survival than other techniques (Hazard Ratio 0.162, 95% CI 0.039 to 0.068, p = 0.013). Among 155 patients with a minimum of six months post-operative insurance coverage, re-operation occurred in 9.7% (15 patients). However, in multivariable logistic regression, Technique 4 did not reach a statistically significant lower risk for re-operation (odds ratio 0.254, 95% CI 0.05 to 1.3, p = 0.11). In this retrospective series, anatomical CC ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. Anatomical coracoclavicular ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. ©2016 The British Editorial

  15. 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 ...

  16. A Case-Control Study Comparing Bone Bruising and Intra-articular Injuries in Patients Undergoing Anterior Cruciate Ligament Reconstruction With and Without Medial Collateral Ligament Tears

    Science.gov (United States)

    Kluczynski, Melissa A.; Marzo, John M.; Rauh, Michael A.; Bernas, Geoffrey A.; Bisson, Leslie J.

    2016-01-01

    Background: Concomitant injuries can occur in patients with combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears; however, no studies have compared these injuries in patients undergoing ACL reconstruction with an MCL tear to those with an intact MCL. Purpose: To compare bone bruising, meniscus tears, and chondral lesions in patients undergoing ACL reconstruction with an MCL tear (cases) to those with an intact MCL (controls). Study Design: Case-control study; Level of evidence, 3. Methods: Thirty-two cases and 352 controls were identified from a prospective registry. Bone bruising was confirmed on magnetic resonance imaging, and meniscus tears and chondral lesions were confirmed arthroscopically. Demographics and concomitant injuries were compared between cases and controls using exact chi-square tests. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% CIs adjusted for age, sex, body mass index, and mechanism and type of injury. Results: Cases had significantly more contact injuries than controls (58.1% vs 21.3%, P < .0001). The prevalence and odds of bone bruising of the lateral tibial plateau (89.7% vs 84.6%; P = .59; OR, 3.53; 95% CI, 0.45-27.71), lateral femoral condyle (82.8% vs 72.8%; P = .28; OR, 1.94; 95% CI, 0.64-5.88), medial tibial plateau (20.7% vs 31.7%; P = 0.29; OR, 0.53; 95% CI, 0.19-1.53), and medial femoral condyle (6.9% vs 8.3%; P ≥ .999; OR, 1.07; 95% CI, 0.21-5.40) did not differ significantly between cases and controls. The prevalence and odds of lateral meniscus tears (53.3% vs 43%; P = .34; OR, 1.85; 95% CI, 0.76-4.52), medial meniscus tears (31.3% vs 33.5%; P = .85; OR, 0.90; 95% CI, 0.37-2.21), and chondral lesions (16% vs 10.8%; P = .50; OR, 0.70; 95% CI, 0.15-3.21) also did not significantly differ between cases and controls. Conclusion: ACL-MCL injuries were most often due to a contact mechanism, whereas ACL tears without associated MCL injury were more frequently due to a

  17. Two-dimensional HRCT for monitoring postoperative results of the anterior cruciate ligament reconstruction. Zweidimensionale (2-D) CT-Arthrotomographie zur postoperativen Kontrolle einer neuen vorderen Kreuzbandplastik

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    Tosch, U.; Witt, H. (Freie Univ. Berlin (Germany, F.R.). Roentgendiagnostisches Zentralinstitut); Hertel, P.; Lais, E. (Freie Univ. Berlin (Germany, F.R.). Unfallchirurgische Klinik)

    1989-11-01

    Fifty-eight patients underwent intraarticular reconstruction of the anterior cruciate ligament. This was performed by using an autogenous transplant from the mid portion of the patellar ligament with a proximal and distal bone block, as described by Hertel. For comparison with the conventional X-ray examination, HRCT was performed to study the early postoperative results. In four patients (7%) dislocation of the bone block in the femoral condyle was seen. Two-dimensional reconstruction proved to be a satisfactory method for demonstration of the exact position of the autogenous transplant in both coronary and sagittal planes. (orig.).

  18. Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations.

    Science.gov (United States)

    Choi, Nam Hong; Lim, Seok Min; Lee, Sang Young; Lim, Tae Kang

    2017-04-01

    This study was conducted to report loss of reduction and complications after single-tunnel coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus tendon graft for acute acromioclavicular (AC) joint dislocations. This retrospective study included patients with acute, unstable AC dislocations (surgery within 6 weeks after trauma). We excluded patients with chronic injury and distal clavicle fractures with CC ligaments disruption. We measured the CC distance on anteroposterior radiographs of both clavicles, preoperatively, immediately postoperatively, and at the final follow-up visit. We evaluated clinical outcomes using the American Shoulder and Elbow Surgeons Shoulder Assessment and the University of California, Los Angeles Shoulder Rating Scale scores and perioperative complications. There were 30 patients (27 men and 3 women) with mean age of 41 years (range, 19-70 years). The mean follow-up period was 31 months (range, 12-186 months). Mean CC distance was 15.5 ± 3.7 mm (84% ± 14% of the contralateral shoulder) preoperatively, 8.9 ± 2.6 mm (9% ± 40%) immediately postoperatively (P 25% increase of CC distance) developed in 14 patients (47%), and complications occurred in 6 patients (20%), including 3 distal clavicle fractures through the tunnel. Final clinical scores were significantly lower in patients with complications (27 vs. 33 of the University of California, Los Angeles assessment [P < .001] and 81 vs. 95 of the American Shoulder and Elbow Surgeons Shoulder assessment [P < .001]). In acute AC joint dislocation, single-tunnel CC ligament reconstruction using autogenous tendon graft resulted in loss of reduction rate of 47% and a complication rate of 20%. The development of complications adversely affected clinical outcomes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Analysis of the outcome of Anterior Cruciate Ligament reconstruction surgery on knee in athletes from Sari, 2007-2008

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    Seyed Esmaeel Shafiei

    2009-01-01

    Full Text Available (Received 3 November, 2009 ; Accepted 11 May, 2010AbstractBackground and purpose: The anterior cruciate ligament (ACL is one of the four major ligaments of the knee and also the most important knee stabilizer. Since the incidence of ACL tearing is especially high in young athletes, and reconstruction surgery and a prolonged rehabilitation may be rtequired, understanding the outcome of the ACL reconstruction surgery and preventive measures such as physiotherapy and muscle supporting exercises, could improve the outcome of the ACL reconstruction surgery. The aim of this study was to evaluate and recognize the outcome of ACL reconstruction surgery in athletes from Sari in 2007-2008.Materials and methods: In this descriptive study, 57 male athletes (mean age: 26.56 ± 6.17 years referred to several hospitals in sari during 2007-2008 were assessed after ACL reconstruction surgery. The assessment for the outcome of the ACL reconstruction surgery was done by physical examination, such as range of motion (ROM and performing stability tests (lachman test, anterior drawer test. Data were analyzed using statistical tests; ANOVA, χ2 and t -test.Results: Mean age of the patients was 26.56 ± 6.17 years (17-51. Mean duration after surgery was 18.4 ± 10.57(5-35. The most common cause of tearing was playing soccer (63.2%. The right knee was affected in 35 players (61.4% compared with the left knee in 22 (38.6%. Thirty three (57.9% right knees were dominant in comparison with 24(42.1% left knees. Type of trauma in 17 subjects (29.8% was contact and 40 (70.2% was non-contact. There were three (5.3% patients with movement limitation (10-30˚ and five (8.8% with knee instability. There was no significant relationship between mean duration after surgery and limitations in movements (P=0.412, knee stability (P=0.999, and patients satisfaction (P=0.412. There was a significant relation between dominant knee and stability (P=0.046.Conclusion: According to the results

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

    Science.gov (United States)

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

    2015-04-01

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

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

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    Fanggang Bi

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

  2. Chronic multiple knee ligament injuries: epidemiological analysis of more than one hundred cases

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    Rosalvo Zosimo Bispo Júnior

    2008-01-01

    Full Text Available INTRODUCTION: Diagnosis and treatment of multiple ligament injuries of the knee remain a real challenge for most surgeons. OBJECTIVE: To find out the epidemiological profile of patients surgically treated at a Reference Service with more than one chronic ligament injury in the knee joint. MATERIALS AND METHODS: Of a total of 978 operated patients, 109 presented at least two associated ligament injuries in the same knee. Demographic and clinical variables were evaluated. RESULTS: The anterior cruciate ligament group presented a larger number of cases of ligament injuries related with sports practice and falls, while the posterior cruciate ligament and anterior cruciate ligament + posterior cruciate ligament groups presented more cases related to traffic accidents and trauma with object (weight on the knee (p<0.001. The varus group presented significantly higher values of time since injury (p<0.01. In the group with new anterior cruciate ligament injury (neoligament associated with other ligament injuries the disruption times were higher, showing statistical significance (p<0.001. CONCLUSIONS: Anterior cruciate ligament injury associated with other ligament injuries other than posterior cruciate ligament injury are related to sports practice and falls. Posterior cruciate ligament injury associated to other ligament injuries, including or not anterior cruciate ligament injury, are related to traffic accidents and direct trauma caused by an object on the knee. Significant delay between primary ligament injuries and their reconstructions generates varus deformity of the affected knee. In spite of the large delay in seeking medical treatment, few patients with neoligament anterior cruciate ligament injury and other combined disruptions will develop varus deformity.

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

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    Helen Dawes

    2003-03-01

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

  4. Effect of graft fixation sequence on knee joint biomechanics in double-bundle anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Shi, Dongliang; Zhou, Jingbin; Yapici, Can; Linde-Rosen, Monica; Smolinski, Patrick; Fu, Freddie H

    2015-03-01

    To investigate the effect of graft fixation sequence in double-bundle anterior cruciate ligament (ACL) reconstruction on knee biomechanics. Twelve mature porcine knees underwent double-bundle ACL reconstruction with a randomized fixation order of the two graft bundles. The knees were subjected to external loadings of (1) an 89 N anterior tibial load at 30°, 60° and 90° of knee flexion and (2) 4 N-m internal and external tibial torques at 30° and 60° of knee flexion for ACL intact, deficient and reconstructed states. Knee kinematics and in situ graft forces were measured under the applied loads. The anterior tibial translation of the two reconstructions was not different from each other but was significantly different from the intact ACL. There was no difference in internal and external rotations between the intact knees and the reconstructions. At lower flexion angles, the graft that was fixed last (whether anteromedial or posterolateral) tended to carry significantly higher in situ load under anterior tibial loading and tibial torques. While a difference in knee kinematics may not be observable with different graft fixation sequences, fixation sequence can alter the in situ forces that the grafts bear under knee loading.

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

    Directory of Open Access Journals (Sweden)

    Marc Tompkins

    2014-01-01

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

  6. 关节镜下应用LARS人工韧带同时重建前、后交叉韧带%Reconstruction of combined anterior cruciate ligament and posterior cruciate ligament injuries by using LARS artificial ligament under arthroscope

    Institute of Scientific and Technical Information of China (English)

    康一凡; 王谦

    2008-01-01

    Objective To explore the treatment method and clinical effect of LARS artificial ligament in treatment of combined anterior cruciate ligament(ACL) and posterior crueiate ligament (PCL) injuries of the knee under arthroscope. Methods Thirteen cases of ACL and PCL injuries were reconstructed with LARS ligament. The patients were followed up for 12-36 months. The International Knee Documentation Committee (IKDC) and Lysholm knee score scale were used for functional evaluation. In the meantime, KT-1000 was employed to check anterior and posterior laxation of the knee. Results No knee infection or limitation of knee extension occurred. Knee flexion was 105° -125° (average 117°). At termination of follow up, 10 cases (77%) was graded as A and 3 (23%) as B according to IKDC. KT-1000 examination at 25° flexion showed that the difference of anterior laxation was less than 2 mm in 12 cases and 3-5mm in 1. KT-1000 examination at 70°flexion showed that the difference of anterior laxation was less than 2mm in 12 cases and 2-4 mm in 1. The Lysholm score was (63.8±2.9) points (49459 points) before operation and (91.1 ±2.7) points (88-95 points) at follow up, with statistical difference (P <0.01). Conclusion Reconstruction of ACL and PCL by using LARS ligament under arthroscope is a kind of minimally invasive, safe and effective method to treat ACL and PCL injuries of the knee, with good short term outcome.%目的 探讨关节镜下应用LARS人工韧带重建前交叉韧带(ACL)、后交叉韧带(PCL)同时损伤的方法及疗效. 方法 关节镜下同时重建13例ACL、PCL损伤的患者,重建材料采用LARS人工韧带.术后随访12~36个月,采用国际膝关节文件编制委员会(IKDC)韧带标准评价表和Lysholm膝关节功能评分表评估患膝功能,通过KT-1000检查膝关节前后松弛度.结果 术后无膝关节感染发生;均无伸膝受限,屈膝活动度105°~125°,平均117°.术后随访时IKDC评分:A类10例(77%),B类3例(23%).

  7. LARS人工韧带移植重建膝关节前交叉韧带28例%Anterior cruciate ligament reconstruction using ligament advanced reinforcement system artificial ligament in 28 cases

    Institute of Scientific and Technical Information of China (English)

    符培亮; 吴宇黎; 吴海山; 陈宣; 李晓华; 钱齐荣; 祝云利

    2008-01-01

    Scientifique,France) is the high-tenacity polyester fiber polyethylene terephthalate.METHODS: Twenty-eight patients with anterior cruciate ligament injury were performed arthroscopic reconstruction of theligament with LARS artificial ligament and were averagely followed up for 20 months.MAIN OUTCOME MEASURES: Patients' anterior drawer test, Lysholm score, range of motion prior to transplantationand in follow-up.RESULTS: The knee unstable symptom of 28 patients disappeared, anterior drawer test was negative, joint function wasgood with the flexion of 5.71 to 129.64 degrees. Average Lysholm score raised from (45.7±9.82) points prior totransplantation to (86.5±6.44) points after transplantation (P < 0.001). All patients resumed normal activities at 2 monthsafter transplantation, without acute or chronic synovitis and host response to materials.CONCLUSION: LARS artificial ligament is a relatively safe transplantation material and especially suitable to reconstructanterior cruciate ligament with sport injury. Mid-/short-term follow-up shows good result.

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

    Directory of Open Access Journals (Sweden)

    Chang-Ik Hur

    2017-01-01

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

  9. Why does minimally invasive coracoclavicular ligament reconstruction using a flip button repair technique fail? An analysis of risk factors and complications.

    Science.gov (United States)

    Schliemann, Benedikt; Roßlenbroich, Steffen B; Schneider, Kristian N; Theisen, Christina; Petersen, Wolf; Raschke, Michael J; Weimann, André

    2015-05-01

    Aim of the present study was to evaluate the risk factors for the failure of coracoclavicular ligament reconstruction using a flip button repair technique and to analyse complications related to this procedure. Seventy-one patients (3 female, 68 male) underwent surgical treatment using a flip button repair technique for an acute acromioclavicular joint dislocation. The following factors and its impact on clinical and radiographic outcome were assessed: age at trauma, interval between trauma and surgery, degree of displacement (according to Rockwood's classification), coracoid button position, button migration and post-operative appearance of ossifications. Sixty-three patients were available for follow-up. The overall Constant score was 95.2 points (range 61-100 points) compared to 97 points (range 73-100 points) for the contralateral side (p = 0.05). Nine patients (14.3 %) needed surgical revision. Inappropriate positioning of the coracoid bone tunnel with subsequent button dislocation was the most frequently observed mode of failure (6 cases, 9.5 %). Button migration into the clavicle was associated with loss of reduction (p = 0.02). The patient's age at the time of trauma had a significant impact on the clinical outcome, whereas younger patients achieved better results (p = 0.02). The interval between trauma and surgery did not significantly affect the outcome (n.s.). Good to excellent clinical results can be achieved with the presented surgical technique. The age of the patient at trauma had a significant influence on the functional outcome. Furthermore, placement of the coracoid button centrally under the coracoid base is crucial to prevent failure. IV.

  10. Functional tissue engineering of ligament healing

    Directory of Open Access Journals (Sweden)

    Hsu Shan-Ling

    2010-05-01

    Full Text Available Abstract Ligaments and tendons are dense connective tissues that are important in transmitting forces and facilitate joint articulation in the musculoskeletal system. Their injury frequency is high especially for those that are functional important, like the anterior cruciate ligament (ACL and medial collateral ligament (MCL of the knee as well as the glenohumeral ligaments and the rotator cuff tendons of the shoulder. Because the healing responses are different in these ligaments and tendons after injury, the consequences and treatments are tissue- and site-specific. In this review, we will elaborate on the injuries of the knee ligaments as well as using functional tissue engineering (FTE approaches to improve their healing. Specifically, the ACL of knee has limited capability to heal, and results of non-surgical management of its midsubstance rupture have been poor. Consequently, surgical reconstruction of the ACL is regularly performed to gain knee stability. However, the long-term results are not satisfactory besides the numerous complications accompanied with the surgeries. With the rapid development of FTE, there is a renewed interest in revisiting ACL healing. Approaches such as using growth factors, stem cells and scaffolds have been widely investigated. In this article, the biology of normal and healing ligaments is first reviewed, followed by a discussion on the issues related to the treatment of ACL injuries. Afterwards, current promising FTE methods are presented for the treatment of ligament injuries, including the use of growth factors, gene delivery, and cell therapy with a particular emphasis on the use of ECM bioscaffolds. The challenging areas are listed in the future direction that suggests where collection of energy could be placed in order to restore the injured ligaments and tendons structurally and functionally.

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

    Science.gov (United States)

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

    2017-04-01

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

  12. Relationship between quadriceps femoris muscle volume and muscle torque at least 18 months after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Konishi, Y; Oda, T; Tsukazaki, S; Kinugasa, R; Fukubayashi, T

    2012-12-01

    The purpose of this study was to evaluate motor unit recruitment in the quadriceps femoris (QF) after anterior cruciate ligament (ACL) rupture and repair. Subjects included 24 patients at ≥ 18 months after ACL reconstruction and 22 control subjects with no history of knee injury. A series of cross-sectional magnetic resonance images were obtained to compare the QF of patients' injured side with that of their uninjured sides and that of uninjured control subjects. Muscle torque per muscle volume was calculated as isokinetic peak torque divided by QF muscle volume (cm(3)). The mean muscle torque per unit volume of the injured side of patients was not significantly different from that of the uninjured side or control subjects (one-way ANOVA) Results of the present study were contrary to the results of a previous study that evaluated patients at ≤ 12 months after ACL reconstruction. The present study found that high-threshold motor unit recruitment was restored at ≥ 18 months after ACL reconstruction. Thus, clinicians must develop techniques that increase the recruitment of high-threshold motor units in the QF from the period immediately after the injury until approximately 18 months after ACL reconstruction.

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

    Science.gov (United States)

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

    2016-05-01

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

  14. Arthroscopic reconstruction of multiple ligaments injury of knees%膝关节多发韧带损伤的修复与重建

    Institute of Scientific and Technical Information of China (English)

    皇甫小桥; 赵金忠; 何耀华; 杨星光; 王锋; 朱越; 刘闻欣

    2011-01-01

    目的 探讨关节镜下重建膝关节前十字韧带(anterior cruciate ligament,ACL)、后十字韧带(posterior cruciate ligament,PCL)、后内侧韧带结构(posteromedial complex,PMC)或后外侧韧带结构(posterolateral complex,PLC)损伤的疗效.方法 2005年3月至2007年5月,43例膝关节多发韧带损伤患者采用异体肌腱于关节镜下重建ACL和PCL,同期重建增强PMC或PLC损伤.其中24例行ACL和PCL重建+PMC重建,19例行ACL和PCL重建+PLC重建.根据国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分和Lysholm膝关节功能评分表对患膝功能进行评估.结果 全部患者随访24~48个月,平均(33.10±9.65)个月.患者在0°和20°应力测试时稳定性均完全恢复.IKDC评分入院时均为显著异常(D级),术后随访时正常(A级)29例(67%,29/43)、接近正常(B级)11例(26%,11/43)、异常(C级)3例(7%,3/43).患者术前Lysholm膝关节功能评分为(46.7±4.2)分,末次随访时为(89.6±2.8)分,差异有统计学意义(t=8.563,P<0.01).结论 膝关节多发韧带损伤可于关节镜下行ACL和PCL联合重建,同期行关节外韧带结构修复增强,能有效恢复关节功能,治疗效果满意.%Objective To describe the surgical technique and outcomes of arthroscopic reconstruction anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) and repair of the injured posteromedial complex (PMC) or posterolateral complex (PLC) structures of the knee joint in treatment of multiple ligaments injuries of knee. Methods From March 2005 to May 2007, 43 patients with multiple ligaments injuries of knee underwent arthroscopic reconstruction. Twenty-four patients were treated with arthroscopic reconstruction of combined ACL and PCL with allograft tendons and augmentation of PMC. The other 19 patients were treated with repair the PLC in addition to reconstruction of ACL and PCL. The International Knee Documentation Committee (IKDC) and Lysholm knee score were

  15. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-12-15

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

  17. 关节镜下膝关节多发韧带损伤重建术后的康复护理%Rehabilitation nursing after arthroscopic reconstruction for multiple ligament injuries of knee

    Institute of Scientific and Technical Information of China (English)

    钱雪梅; 董伟强; 刘素霞; 杨春英

    2013-01-01

    Objective To investigate the rehabilitation nursing procedure and its effects after arthroscopic reconstruction for multiple ligament injuries of the knee. Methods From March 2010 to September 2012, 11 cases of multiple ligament injuries of knee received anterior/posterior cruciate ligaments reconstruction by arthroscopy. According to the reconstruction materials, different surgical techniques and individual differences of patients, various rehabilitation training plans for perioperation period were specificly guided and managed. Patients were followed up to evaluate the clinical effects of training. Results All the patients were regularly followed up for one week to 29 months, with an average time of ( 14. 29 ±9. 13) months. All the patients felt no more unstability of the knee. Their gaits were normal. The anterior drawing test and lateral stress test were both negative in all cases. Posterior drawing test was positive in nine cases and negative in two cases. The difference between preoperative and postoperative knee functions was statistically significant (P 95°,无关节不稳定症状.11例膝关节前抽屉试验及外侧侧方应力试验均为(-);后抽屉试验:(+)9例,(-)2例,手术前后比较差异均有统计学意义(Z=3.035,Z=3.066,P均小于0.01).结论 根据患者多发韧带损伤特点,制定个体化、系统的围手术期康复训练计划,加强出院后持续康复训练管理,对促进关节镜下重建多发韧带损伤术后关节功能的全面康复至关重要.

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

    NARCIS (Netherlands)

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

    2011-01-01

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

  19. Comparing low volume saphenous-obturator block with placebo and femoral-obturator block for anterior cruciate ligament reconstruction: a randomized controlled trial

    DEFF Research Database (Denmark)

    Lenz, Katja; Jensen, Kenneth; Tanggaard, Katrine

    2017-01-01

    BACKGROUND: Anterior cruciate ligament reconstruction (ACL-RC) is often associated with moderate to severe postoperative pain even with a multimodal analgesic regimen. We aimed to compare the analgesic efficacy of low volume saphenous-obturator block with placebo and femoral- obturator block in p...

  20. Evaluation of gait kinematics and symmetry during the first two stages of physiotherapy after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Winiarski, Sławomir; Czamara, Andrzej

    2012-01-01

    One of the primary goals of physiotherapy after anterior cruciate ligament (ACL) reconstruction is to restore of the patient's normal gait patterns. However, to date, only a limited number of studies have examined gait during physiotherapeutic procedures following ACL reconstruction. Thus, the objective of the present study was to evaluate gait kinematics and symmetry in male patients after ACL reconstruction during the first two stages of their physiotherapy programme. Ninety-seven males, including 53 patients after primary ACL reconstruction in one limb and 44 healthy controls, participated in the study. The patients were examined using a movement analysis system during their physiotherapeutic programme (from the 2nd to the 12th week following reconstruction). Some selected parameters of gait kinematics, a dynamic range of movement in the knee joint and gait asymmetry coefficients were evaluated. During the 12th week of physiotherapy, a mean gait velocity increased by more than 0.97 m/s compared to that obtained during the 2nd week of physiotherapy. A statistically significant increase in the relative length of stance phase was observed in the involved extremity, from 36.1% to 62.7% (P = 0.01); the range of movement significantly improved from 25.8 degrees during the 2nd week to 63.7 degrees during the 12th week of physiotherapy. At the same time, the stance time asymmetry coefficient decreased from 68.5% to -0.4%. We observed a significant improvement in most of the gait parameters from the 2nd to the 12th week of physiotherapy after reconstruction and also in comparison to the results obtained for the control group.

  1. "Anatomic" single-bundle anterior cruciate ligament reconstruction reduces both anterior translation and internal rotation during the pivot shift.

    Science.gov (United States)

    Porter, Mark D; Shadbolt, Bruce

    2014-12-01

    The ability of single-bundle anterior cruciate ligament (ACL) reconstruction to restore rotational control has been questioned by proponents of the double-bundle technique. The term anatomic positioning has become popularized in recognition of the incorrect positioning sometimes used in the past, which may have contributed to the lack of rotation control. The pivot-shift test remains the most clinically useful measure of ACL deficiency, and it is now possible to measure it both accurately and objectively using computer navigation. Single-bundle ACL reconstruction will reduce anterior translation and internal rotation of the tibia during the pivot-shift test when compared with the contralateral uninjured knee. Descriptive laboratory study. A total of 20 patients with an acute isolated ACL rupture underwent reconstruction with a single-bundle autologous hamstring graft. Computer navigation was used intraoperatively to plot the pivot shift before and after reconstruction. The opposite uninjured knee was used as a control. Statistical analysis was used to compare the pivot shifts before and after surgery. Single-bundle ACL reconstruction produced a significant reduction in anterior translation, from a mean ± SD of 17.4 ± 3.80 mm to 6.4 ± 1.95 mm (P operated knee both before and after surgery. It is possible to reduce both anterior translation and internal rotation, which occur during the pivot-shift test in the ACL-deficient knee, using single-bundle ACL reconstruction, when measured at the time of surgery. However, normal motion is not fully restored. © 2014 The Author(s).

  2. Arthroscopic-Assisted Combined Dorsal and Volar Scapholunate Ligament Reconstruction with Tendon Graft for Chronic SL Instability.

    Science.gov (United States)

    Ho, Pak-Cheong; Wong, Clara Wing-Yee; Tse, Wing-Lim

    2015-11-01

    Background Both the dorsal and the volar portion of the scapholunate interosseous ligament (SLIL) are major stabilizers of the scapholunate (SL) joint. Most reconstruction methods to restore SL stability do not address the volar constraints and frequently fail to reduce the SL gapping. Wrist arthroscopy allows a complete evaluation of the SL interval, accompanying ligament status, and associated SL advanced collapse (SLAC) wrist changes. It enables simultaneous reconstruction of the dorsal and palmar SL ligaments anatomically with the use tendon graft in a boxlike structure. Materials and Methods From October 2002 to June 2012, the treatment method was applied in 17 patients of chronic SL instability of average duration of 9.5 months (range 1.5-18 months). There were three Geissler grade 3 and 14 grade 4 instability cases. The average preoperative SL interval was 4.9 mm (range 3-9 mm). Dorsal intercalated segment instability (DISI) deformity was present in 13 patients. Six patients had stage 1 SLAC wrist change radiologically. Concomitant procedures were performed in four patients. Description of Technique With the assistance of arthroscopy and intraoperative imaging as a guide, a combined limited dorsal and volar incision exposed the dorsal and palmar SL interval without violating the wrist joint capsule. Bone tunnels of 2.4 mm were made on the proximal scaphoid and lunate. A palmaris longus tendon graft was delivered through the wrist capsule and the bone tunnels to reduce and connect the two bones in a boxlike fashion. Once the joint diastasis is reduced and any DISI malrotation corrected, the tendon graft was knotted and sutured on the dorsal surface of the SL joint extra-capsularly in a shoe-lacing manner. The scaphocapitate joint was transfixed with Kirschner wires (K-wires) to protect the reconstruction for 6-8 weeks. Results The average follow-up was 48.3 months (range 11-132 months). Thirteen returned to their preinjury job level. Eleven

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

    Science.gov (United States)

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

    2012-11-01

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

  4. Reconstruction of the medial patellofemoral ligament in cases of acute traumatic dislocation of the patella: current perspectives and trends in Brazil1,

    Directory of Open Access Journals (Sweden)

    Gustavo Gonçalves Arliani

    2014-10-01

    Full Text Available Objective:To evaluate the approaches and procedures used by knee surgeons in Brazil for treating medial patellofemoral lesions (MPFL of the knee in cases of acute traumatic dislocation of the patella.Materials and methods:A questionnaire comprising 15 closed questions on topics relating to treating MPFL of the knee following acute dislocation of the patella was used. It was applied to Brazilian knee surgeons during the three days of the 44th Brazilian Congress of Orthopedics and Traumatology, in 2012.Results:106 knee surgeons completely filled out the questionnaire and formed part of the sample analyzed. Most of them were from the southeastern region of Brazil. The majority (57% reported that they perform fewer than five MPFL reconstruction procedures per year. Indication of non-surgical treatment after a first episode of acute dislocation of the patella was preferred and done by 93.4% of the sample. Only 9.1% of the participants reported that they had never observed postoperative complications. Intraoperative radioscopy was used routinely by 48%. The professionals who did not use this tool to determine the point of ligament fixation in the femur did not have a statistically greater number of postoperative complications than those who used it (p > 0.05.Conclusions:There are clear evolutionary trends in treatments and rehabilitation for acute dislocation of the patella due to MPFL, in Brazil. However, further prospective controlled studies are needed in order to evaluate the clinical and scientific benefit of these trends.

  5. Single- vs. double-bundle anterior cruciate ligament reconstruction: a new aspect of knee assessment during activities involving dynamic knee rotation.

    Science.gov (United States)

    Czamara, Andrzej; Królikowska, Aleksandra; Szuba, Łukasz; Widuchowski, Wojciech; Kentel, Maciej

    2015-02-01

    Few studies have compared single-bundle (SB) and double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) in the knee joint during activities involving change-of-direction maneuvers and knee rotation. This study examined whether the type of ACLR contributes to postphysiotherapy outcomes, with an emphasis on knee function assessment during activities involving dynamic knee rotation. Fifteen male patients after SB ACLR and 15 male patients after DB ACLR took part in the same physiotherapy program. Twenty-four weeks after ACLR, both groups underwent anterior laxity measurement, pivot shift tests, range of movement and joint circumference measurements, subjective assessment of pain and stability levels in the knee joint, peak torque measurement of the muscles rotating the tibia toward the femur, and a run test with maximal speed and change-of-direction maneuvers. Comparative analysis did not show any differences between the results of anterior tibial translation, pivot shift test, range of movement and joint circumference, and subjective assessment of pain and knee joint stability levels. No differences were noted between the groups in peak torque values obtained from the muscles responsible for internal and external tibial rotation or results of the run test. The data obtained from this study can be used by research teams to monitor and compare the effectiveness of various study protocols involving surgical and physiotherapy treatment. The data are especially useful when combined with the clinical assessment of patients who would like to return to sport.

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

    Directory of Open Access Journals (Sweden)

    Yee Han Dave Lee

    2015-10-01

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

  7. 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.

  8. Avoiding graft-tunnel length mismatch in anterior cruciate ligament reconstruction: the single-bone plug technique.

    Science.gov (United States)

    Grawe, Brian; Smerina, Amber; Allen, Answorth

    2014-06-01

    Anterior cruciate ligament reconstruction, using autogenous bone-patellar tendon-bone (BTB) as a graft material, is commonly performed in the setting of anterior cruciate ligament insufficiency. Although bone-patellar tendon-bone autograft has an extensive track record, showing excellent clinical results, donor-site morbidity and graft-tunnel mismatch can still be problematic for a subset of patients. In the setting of a tendon graft that is too long, adequate interference screw fixation cannot be obtained, typically resulting in a tibial-sided bone plug that achieves less than 15 to 20 mm of bone in the distal tibial tunnel. We present an easy and effective technique for avoiding the graft-tunnel mismatch problems that commonly occur in patients who have an excessively long patellar tendons. This technique involves a simple preoperative planning algorithm that ultimately results in a single tibial-sided plug harvest. Bony interference fixation is then obtained on the femoral side and soft-tissue fixation on the tibial side. This technique allows for satisfactory graft fixation while avoiding the donor-site morbidity associated with patellar bone plug harvest.

  9. Cost of Outpatient Arthroscopic Anterior Cruciate Ligament Reconstruction Among Commercially Insured Patients in the United States, 2005-2013

    Science.gov (United States)

    Herzog, Mackenzie M.; Marshall, Stephen W.; Lund, Jennifer L.; Pate, Virginia; Spang, Jeffrey T.

    2017-01-01

    Background: Despite the significance of anterior cruciate ligament (ACL) injuries, these conditions have been under-researched from a population-level perspective. It is important to determine the economic effect of these injuries in order to document the public health burden in the United States. Purpose: To describe the cost of outpatient arthroscopic ACL reconstruction and health care utilization among commercially insured beneficiaries in the United States. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: The study used the Truven Health Analytics MarketScan Commercial Claims and Encounters database, an administrative claims database that contains a large sample (approximately 148 million) of privately insured individuals aged <65 years and enrolled in employer-sponsored plans. All claims with Current Procedural Terminology (CPT) code 29888 (arthroscopically aided ACL reconstruction or augmentation) from 2005 to 2013 were included. “Immediate procedure” cost was computed assuming a 3-day window of care centered on date of surgery. “Total health care utilization” cost was computed using a 9-month window of care (3 months preoperative and 6 months postoperative). Results: There were 229,446 outpatient arthroscopic ACL reconstructions performed over the 9-year study period. Median immediate procedure cost was $9399.49. Median total health care utilization cost was $13,403.38. Patients who underwent concomitant collateral ligament (medial [MCL], lateral [LCL]) repair or reconstruction had the highest costs for both immediate procedure ($12,473.24) and health care utilization ($17,006.34). For patients who had more than 1 reconstruction captured in the database, total health care utilization costs were higher for the second procedure than the first procedure ($16,238.43 vs $15,000.36), despite the fact that immediate procedure costs were lower for second procedures ($8685.73 vs $9445.26). Conclusion: These results provide a

  10. Attitudes of Lebanese university students towards surgical hymen reconstruction.

    Science.gov (United States)

    Awwad, Johnny; Nassar, Anwar; Usta, Ihab; Shaya, Monique; Younes, Zeina; Ghazeeri, Ghina

    2013-11-01

    Many cultural and religious beliefs place virginity at a high level of social significance, in that women who lose their virginity before marriage may face humiliation, ostracism, divorce, and extreme violence. This led to an increase in the demand for virginity restoration through surgical hymen reconstruction among these cultures. However, data regarding the acceptance of hymenoplasty in societies that consider sexuality a taboo are scarce. In this cross-sectional study, we investigated the effects of gender and religion on sexual attitudes towards hymenoplasty, premarital sex, and virginity in a sample of 600 Lebanese university students. Our findings showed that approval of hymenoplasty was low among participants regardless of gender (25.7 % men vs. 19.1 % women) and religious affiliations (22.5 % Muslims vs. 22.3 % Christians). Arguments for rejection were rooted in moral ethics and personal convictions: "form of deceiving and cheating" (80.7 %) and "betrayal of honesty in the relationship" (80.4 %). Reasons for acceptance included: personal belief in "women's rights, autonomy, and freedom" (72.2 %) and "physical harm and death" (63.5 %).Male participants were more likely to approve premarital coital sex than females (61.0 vs. 27.3 %). Muslims were also more likely to reject marrying a non-virgin than Christians (39.9 vs. 18.0 %). Female participants expressed more tolerance towards marrying a non-virgin male partner (78.3 vs. 57.3 %). Low acceptance of hymenoplasty among Lebanese university students was found to be related to moral ethics and personal convictions independently from gender and religious affiliation. Differences in sexual attitudes towards premarital coital sex and virginity, however, were more significantly influenced by culture and religion.

  11. Relationship between different skin incisions and the injury of the infrapatellar branch of the saphenous nerve during anterior cruciate ligament reconstruction

    Institute of Scientific and Technical Information of China (English)

    LUO Hao; YU Jia-Kuo; AO Ying-fang; YU Chang-long; PENG Li-bin; LIN Chun-yang; ZHANG Ji-ying; FU Xin

    2007-01-01

    Background After anterior cruciate ligament (ACL) reconstruction, some patients suffered from sensory disturbance around the surgical incision of the leg, This research was aimed to investigate the relationship between the different skin incisions and the injury of the infrapatellar branch of the saphenous nerve (IPBSN) post ACL reconstruction,Methods ACL reconstructions were performed with quadruple hamstring tendon for 60 patients, Sensory disturbance around the skin incision was followed up at an average of 14.5±4.7 months post operation. Among the 60 patients,vertical incision for 35 patients and oblique incision for 25 patients were used for graft taking during ACL reconstruction.The lengths of the incisions were measured. The patients were asked to mark the sensory disturbance zone at follow up time, and then the marked area was measured. The IPBSN of 15 cadaver knees were anatomized. The distance between the IPBSN and the upper edge of the pes anserinus tendon at the middle point of the incision was measured.Independent-samples t-test, chi-square and Mann-Whitney tests were used for statistical analyses.Results The patients'age (P=0.329), the follow-up time (P=0.681), and the incision length (P=0.732) between the two groups had no significant difference. Twenty-three patients (65.7%) in the vertical incision group had IPBSN injury compared with 6 patients (24.0%) in oblique incision group (P=0.002). The average sensory disturbance area in vertical incision group ((48.0±75.3) cm2) was significantly larger (P=0.004) than that in the oblique group ((8.4±19.4) cm2). The anatomy measurement showed the average distance between IPBSN and the upper edge of the pes anserinus tendon was 0.6 cm at the incision.Conclusions Oblique incision with less risk of damage for IPBSN may be better for graft harvesting in ACL reconstruction. As the IPBSN is so near and parallel to the hamstring tendons, damage to the IPBSN is one of the potential complications for graft

  12. Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery.

    Science.gov (United States)

    Ageberg, Eva; Roos, Harald P; Silbernagel, Karin Grävare; Thomeé, Roland; Roos, Ewa M

    2009-02-01

    Hamstring muscles play a major role in knee-joint stabilization after anterior cruciate ligament (ACL) injury. Weakness of the knee extensors after ACL reconstruction with patellar tendon (PT) graft, and in the knee flexors after reconstruction with hamstring tendons (HT) graft has been observed up to 2 years post surgery, but not later. In these studies, isokinetic muscle torque was used. However, muscle power has been suggested to be a more sensitive and sport-specific measures of strength. The aim was to study quadriceps and hamstring muscle power in patients with ACL injury treated with surgical reconstruction with PT or HT grafts at a mean of 3 years after surgery. Twenty subjects with PT and 16 subjects with HT grafts (mean age at follow up 30 years, range 20-39, 25% women), who were all included in a prospective study and followed the same goal-based rehabilitation protocol for at least 4 months, were assessed with reliable, valid, and responsive tests of quadriceps and hamstring muscle power at 3 years (SD 0.9, range 2-5) after surgery. The mean difference between legs (injured minus uninjured), the hamstring to quadriceps (H:Q, hamstring divided by quadriceps) ratio, and the limb symmetry index (LSI, injured leg divided by uninjured and multiplied by 100) value, were used for comparisons between the groups (analysis of variance). The mean difference between the injured and uninjured legs was greater in the HT than in the PT group for knee flexion power (-21.3 vs. 7.7 W, p = 0.001). Patients with HT graft had lower H:Q ratio in the injured leg than the patients with PT graft (0.63 vs. 0.77, p = 0.012). They also had lower LSI for knee flexion power than those in the PT group (88 vs. 106%, p knee extension power. The lower hamstring muscle power, and the lower hamstring to quadriceps ratio in the HT graft group than in the PT graft group 3 years (range 2-5) after ACL reconstruction, reflect imbalance of knee muscles after reconstruction with HT graft that

  13. Relationship between tunnel widening and different rehabilitation procedures after anterior cruciate ligament reconstruction with quadrupled hamstring tendons

    Institute of Scientific and Technical Information of China (English)

    YU Jia-kuo; Hans H.Paessler

    2005-01-01

    Background It has been demonstrated that bone tunnel widening could appear after knee anterior cruciate ligament (ACL) reconstruction, especially for those patients whose ruptured ACL were reconstructed with semitendinosus and gracilis tendons. Many factors can influence the extent of tunnel widening. Few studies have investigated the relationship between bone tunnel widening and rehabilitation procedures. This research was carried out to find the rehabilitation procedures' influence on the tibial bone tunnel widening after ACL reconstruction. Methods Sixty-five cases, whose ACL reconstructions were done using quadrupled semitendinosus and gracilis tendons, were divided into two groups. Group A had 33 cases, 19 men, 14 women, averaged (31.2±12.4) years old, only ACL reconstruction was done using Paessler's technique, and aggressive rehabilitation procedure was used for function recovery post operation. Group B had 32 cases, 20 men, 12 women, averaged (30.3±10.3) years old. Except for ACL reconstruction, every patient in group B accepted meniscus repair using re-fixation methods or cartilage repair using microfracture technique, conservative rehabilitation procedure was used post operation. Six months post operation, standard posterior-anterior radiographic plates were taken for each case, CorelDRAW 8.0 software was used to digitize all X-ray plates and measure the upper, middle and lower parts of the tibial tunnel. Magnification effect of X-ray plates was taken out after measurement. Results Six months after ACL reconstruction the tibial tunnel widening of the upper, middle and lower parts on both the posterior-anterior and lateral X-ray plates in Group A with aggressive rehabilitation procedure was much more serious than in Group B with conservative rehabilitation. KT-1000 knee stability measurement and clinical manifestation showed no difference between the two groups. Conclusions Rehabilitation procedure after ACL reconstruction is one of the reasons for

  14. 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.

  15. The use of cold therapy in the postoperative management of patients undergoing arthroscopic anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Edwards, D J; Rimmer, M; Keene, G C

    1996-01-01

    In this prospective, randomized study we assessed the use of cold therapy after arthroscopic anterior cruciate ligament reconstruction. Seventy-one patients were randomly allocated, without the knowledge of the single surgeon, to one of three groups: Group I had an ice water-filled CryoCuff fitted in the operating theater after surgery, Group II had room temperature water in the CryoCuff, and Group III patients had no CryoCuff. Patients were well matched for age, sex, and associated surgery. An independent observer measured blood loss, analgesic use, range of motion, and visual analog pain scores postoperatively. There were no differences between any of the three groups regarding the variables measured. The use of cold therapy devices as an adjunct to the postoperative management of these patients must be questioned.

  16. The use of cold therapy after anterior cruciate ligament reconstruction. A prospective, randomized study and literature review.

    Science.gov (United States)

    Konrath, G A; Lock, T; Goitz, H T; Scheidler, J

    1996-01-01

    We performed a randomized, prospective study to assess the effectiveness of postoperative cold therapy in patients who had anterior cruciate ligament reconstructions. Drain output, length of hospital stay, range of motion, and use of pain medication were all assessed. Patients were randomized into one of four groups after surgery. Group 1 patients had a cooling pad applied to the knee postoperatively and set at a temperature of 40 degrees to 50 degrees F, Group 2 had the cooling pad set at 70 degrees to 80 degrees F, Group 3 received ice packs, and Group 4 received no cold therapy of any kind. The skin temperatures in Groups 1 and 3 were significantly lower than the skin temperatures in Groups 2 and 4 (P cold therapy were seen in any group. Thus, both ice packs and cooling pads significantly decreased knee temperature, but we found no objective benefits in the early postoperative course due to this decrease in temperature.

  17. Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls.

    Science.gov (United States)

    Fältström, Anne; Hägglund, Martin; Kvist, Joanna

    2017-02-01

    Good functional performance with limb symmetry is believed to be important to minimize the risk of injury after a return to pivoting and contact sports after anterior cruciate ligament reconstruction (ACLR). This study aimed to investigate any side-to-side limb differences in functional performance and movement asymmetries in female soccer players with a primary unilateral anterior cruciate ligament (ACL)-reconstructed knee and to compare these players with knee-healthy controls from the same soccer teams. Cross-sectional study; Level of evidence, 3. This study included 77 active female soccer players at a median of 18 months after ACLR (interquartile range [IQR], 14.5 months; range, 7-39 months) and 77 knee-healthy female soccer players. The mean age was 20.1 ± 2.3 years for players with an ACL-reconstructed knee and 19.5 ± 2.2 years for controls. We used a battery of tests to assess postural control (Star Excursion Balance Test) and hop performance (1-legged hop for distance, 5-jump test, and side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using 2-dimensional analyses. The reconstructed and uninvolved limbs did not differ in any of the tests. In the 5-jump test, players with an ACL-reconstructed knee performed worse than controls (mean 8.75 ± 1.05 m vs 9.09 ± 0.89 m; P = .034). On the drop vertical jump test, the ACL-reconstructed limb had significantly less knee valgus motion in the frontal plane (median 0.028 m [IQR, 0.049 m] vs 0.045 m [IQR, 0.043 m]; P = .004) and a lower probability of a high knee abduction moment (pKAM) (median 69.2% [IQR, 44.4%] vs 79.8% [IQR, 44.8%]; P = .043) compared with the control players' matched limb (for leg dominance). Results showed that 9% to 49% of players in both groups performed outside recommended guidelines on the different tests. Only 14 players with an ACL-reconstructed knee (18%) and 15 controls (19%) had results that met the recommended

  18. The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotatory stability: A biomechanical study on human cadavers.

    Science.gov (United States)

    Tavlo, M; Eljaja, S; Jensen, J T; Siersma, V D; Krogsgaard, M R

    2016-08-01

    Studies suggest that the anterolateral ligament (ALL) is important for knee stability. The purpose was to clarify ALL's effect on rotatory and anterior-posterior stability in the anterior cruciate ligament (ACL)-insufficient and reconstructed knees and the effect of reconstruction of an insufficient ALL. Eighteen cadaveric knees were included. Stability was tested for intact (+ALL), detached (-ALL) and reconstructed (+ reALL) ALL, with ACL removed (-ACL) and reconstructed (+ACL) in six combinations. All were tested in 0, 30, 60, and 90 °C flexion. Anterior-posterior stability was measured with a rolimeter. Rotation with a torque of 8.85 Nm was measured photographically. The ALL was well defined in 78% of knees. ACL reconstruction had a significant effect on anterior-posterior stability. Detaching the ALL had a significant effect on internal rotatory stability and on anterior-posterior stability in ACL-insufficient knees. Reconstruction of ACL and ALL reestablished knee stability. The appearance of the ALL was not uniform. The ALL was an internal rotational stabilizer. Anatomical ALL reconstruction in combination with ACL reconstruction could reestablish stability. ALL reconstruction might be considered in patients with combined ACL and ALL tears, but the clinical effect should be established in a controlled clinical study.

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

    Science.gov (United States)

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

    2009-05-01

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

  20. Immediate physical therapy in dogs with rupture of the cranial cruciate ligament submitted to extracapsular surgical stabilization

    Directory of Open Access Journals (Sweden)

    L. Berté

    2012-02-01

    Full Text Available The study evaluated the influence of immediate physical therapy on the functional recovery of hind limbs of dogs with experimental cranial cruciate ligament rupture which underwent surgical extracapsular stabilization as well as to verify its interference in joint stability. Eight dogs were randomly divided into two groups: GI (control (n=4 and GII (physical therapy (n=4. The dogs in GII underwent the following therapeutic treatments in the postoperative period: cryotherapy, passive joint movement, massage, passive straightening, neuromuscular electrical stimulation, hydrotherapy (bath and aquatic mat and therapeutic exercises. We performed evaluations of the thigh circumference, goniometry, X-ray, and knee stability (drawer test. Results did not demonstrate a significant difference between the groups nor between different post-operative times. Regarding gait analysis, we found that the 4 dogs in GI remained in degree 3 of lameness 45 and 90 days postoperatively. However, in GII, one dog remained in degree 3 45 and 90 days after surgery; one dog changed from degree 3 to 4 90 days after surgery and the other 2 dogs changed from degree 3 to 5 90 days after surgery. It is possible to conclude that dogs with CCL rupture that undergo immediate physical therapy demonstrate better results in regards to functional gait recovery. The therapeutic modalities used in the immediate post-operative period did not cause instability of the operated knee. Further studies are needed with a larger number of dogs to indicate the immediate physical therapy in dogs with CCL ligament rupture which underwent extracapsular stabilization.

  1. Arthroscopically Assisted Reconstruction of Acute Acromioclavicular Joint Dislocations: Anatomic AC Ligament Reconstruction With Protective Internal Bracing—The “AC-RecoBridge” Technique

    Science.gov (United States)

    Izadpanah, Kaywan; Jaeger, Martin; Ogon, Peter; Südkamp, Norbert P.; Maier, Dirk

    2015-01-01

    An arthroscopically assisted technique for the treatment of acute acromioclavicular joint dislocations is presented. This pathology-based procedure aims to achieve anatomic healing of both the acromioclavicular ligament complex (ACLC) and the coracoclavicular ligaments. First, the acromioclavicular joint is reduced anatomically under macroscopic and radiologic control and temporarily transfixed with a K-wire. A single-channel technique using 2 suture tapes provides secure coracoclavicular stabilization. The key step of the procedure consists of the anatomic repair of the ACLC (“AC-Reco”). Basically, we have observed 4 patterns of injury: clavicular-sided, acromial-sided, oblique, and midportion tears. Direct and/or transosseous ACLC repair is performed accordingly. Then, an X-configured acromioclavicular suture tape cerclage (“AC-Bridge”) is applied under arthroscopic assistance to limit horizontal clavicular translation to a physiological extent. The AC-Bridge follows the principle of internal bracing and protects healing of the ACLC repair. The AC-Bridge is tightened on top of the repair, creating an additional suture-bridge effect and promoting anatomic ACLC healing. We refer to this combined technique of anatomic ACLC repair and protective internal bracing as the “AC-RecoBridge.” A detailed stepwise description of the surgical technique, including indications, technical pearls and pitfalls, and potential complications, is given. PMID:26052493

  2. Alendronate reduced peri-tunnel bone loss and enhanced tendon graft to bone tunnel healing in anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    PPY Lui

    2013-01-01

    Full Text Available Peri-tunnel bone loss after anterior cruciate ligament (ACL reconstruction is commonly observed, both clinically and experimentally. We aimed to study the effect and mechanisms of different doses of alendronate in the reduction of peri-tunnel bone loss and promotion of graft-bone tunnel healing in ACL reconstruction. Eighty-four ACL-reconstructed rats were divided into 4 groups. Alendronate at different dosages, or saline, were injected subcutaneously weekly, for 2 or 6 weeks post-reconstruction, for vivaCT (computed tomography imaging, biomechanical tests, histology and immunohistochemistry. Alendronate significantly increased bone mass and density of tissue inside bone tunnels except at the epiphyseal region of tibial tunnel. The femoral tunnel diameter decreased significantly in the mid-dose and high-dose alendronate groups compared to that in the saline group at week 6. Alendronate significantly increased the peri-tunnel bone mass and density along all tunnel regions at week 6. Better graft-bone tunnel integration and intra-tunnel graft integrity were observed in the alendronate groups. The ultimate load was significantly higher in the mid-dose and high-dose alendronate groups at week 2, but not at week 6. There was a reduction in matrix metalloprotein (MMP1, MMP13 and CD68-positive cells at the peri-tunnel region and graft-bone interface in the alendronate-treated group compared to the saline group. Alendronate reduced peri-tunnel bone resorption, increased mineralised tissue inside bone tunnel as well as histologically and biomechanically promoted graft-bone tunnel healing, probably by reducing the expression of MMP1, MMP13 and CD68-positive cells. Alendronate might be used for reducing peri-tunnel bone loss and promoting graft-bone tunnel healing at early stage post-ACL reconstruction.

  3. A Comparative Animal Study of Tendon Grafts Healing After Remnant-Preserving Versus Conventional Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Zhang, Lei; Jiang, Kan; Chai, Hao; Zhou, Mei; Bai, Jingping

    2016-01-01

    Background The aim of this study was to determine if anterior cruciate ligament (ACL) reconstruction by remnant preservation promotes cell proliferation, vascularization, proprioception recovery, and improved biomechanical properties of the tendon grafts. Material/Methods 75 New Zealand rabbits were randomly assigned into the control group (group A), conventional ACL reconstruction group (group B), ACL reconstruction using remnant preservation and graft through remnant sleeve technique group (group C), and ACL reconstruction using remnant preservation and remnant tensioning technique group (group D). The remnant and healing of tendon grafts in groups C and D were observed at 3, 6, and 12 weeks after surgery, and the mRNA expression levels of VEGF, NT-3 and GAP-43 in ACL (group A) or tendon graft samples (groups B, C, and D) were determined by real-time PCR. Tendon graft cell count, microvessel density (MVD), and proprioceptors were determined by H&E staining, CD34, and S-100 immunohistochemical staining. The biomechanical properties of the tendon graft at week 12 in groups B, C, and D were examined by using a tensile strength test. Results Remnant and tendon grafts were not healed at 3, 6, and 12 weeks after the operation in groups C and D. VEGF, NT-3, and GAP-43 mRNA expressions in groups B, C, and D were higher than those in group A (P0.05). Furthermore, tendon graft cell count, MVD, proprioception, and biomechanical properties showed no significant differences (P>0.05) among groups B, C, and D at various time points. Conclusions There was no significant difference in cell proliferation, vascularization, proprioception recovery, or biomechanical properties of the tendon grafts between remnant-preserving and conventional ACL reconstruction methods. PMID:27669454

  4. Effect of cross exercise on quadriceps acceleration reaction time and subjective scores (Lysholm questionnaire following anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Antonogiannakis Emmanouel M

    2009-01-01

    Full Text Available Abstract Background Anterior cruciate ligament (ACL injury or reconstruction can cause knee impairments and disability. Knee impairments are related to quadriceps performance – accelerated reaction time (ART – and disability to performance of daily living activities which is assessed by questionnaires such as the Lysholm knee score. The purposes of this study were to investigate the effect of cross exercise, as supplementary rehabilitation to the early phase of ACL reconstruction: a on quadriceps ART at the angles 45°, 60° and 90° of knee flexion and, b on the subjective scores of disability in ACL reconstructed patients. Methods 42 patients who underwent ACL reconstruction were randomly divided into 3 groups, two experimental and one control. All groups followed the same rehabilitation program. The experimental groups followed 8 weeks of cross eccentric exercise (CEE on the uninjured knee; 3 d/w, and 5 d/w respectively. Quadriceps ART was measured at 45°, 60° and 90° of knee flexion pre and nine weeks post-operatively using an isokinetic dynamometer. Patients also completed pre and post operatively the Lysholm questionnaire whereby subjective scores were recorded. Results Two factor ANOVA showed significant differences in ART at 90° among the groups (F = 4.29, p = 0.02, p Significant differences were also found in the Lysholm score among the groups (F = 4.75, p = 0.01, p Conclusion CEE showed improvements on quadriceps ART at 90° at a sequence of 3 d/w and in the Lysholm score at a sequence of 3 d/w and 5 d/w respectively on ACL reconstructed patients.

  5. [Surgical treatment of tumors of the carotid body with reconstruction of the internal carotid artery].

    Science.gov (United States)

    Reparaz, L; Magallón, P; Riera, L; Capilla, M T; Merino, M J; Martínez, I; Hernández, A; Sáez, L; Alamo, O; Jiménez Cossío, J A

    1990-01-01

    The experience about treatment in infiltrating tumors of Carotid Corpus, III Degree (Shamblin), is presented. Different methods of carotid reconstruction, and biologic and evolutive characteristics are emphasized, discussing preoperatory study and surgical technics.

  6. Proportion of Patients Reporting Acceptable Symptoms or Treatment Failure and Their Associated KOOS Values at 6 to 24 Months After Anterior Cruciate Ligament Reconstruction

    DEFF Research Database (Denmark)

    Ingelsrud, Lina Holm; Granan, Lars-Petter; Terwee, Caroline B

    2015-01-01

    BACKGROUND: The proportion of patients perceiving their symptoms as either acceptable or as a failure of treatment after anterior cruciate ligament reconstruction (ACLR) is unknown. Commonly used outcome scores such as the Knee injury and Osteoarthritis Outcome Score (KOOS) suffer from poor...... of treatment outcome. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: In 2012, a total of 1197 patients were randomly extracted from the Norwegian Knee Ligament Registry at 3 postoperative time points: 397 at 6 months, 400 at 12 months, and 400 at 24 months. The inclusion criterion...

  7. Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction.

    Science.gov (United States)

    Sinha, Indranil; Pusic, Andrea L; Wilkins, Edwin G; Hamill, Jennifer B; Chen, Xiaoxue; Kim, Hyungjin M; Guldbrandsen, Gretchen; Chun, Yoon S

    2017-01-01

    Surgical-site infection causes devastating reconstructive failure in implant-based breast reconstructions. Large national database studies offer insights into complication rates, but only capture outcomes within 30 days postoperatively. This study evaluates both early and late surgical-site infection in immediate implant-based reconstruction and identifies predictors. As part of the Mastectomy Reconstruction Outcomes Consortium Study, 1662 implant-based breast reconstructions in 1024 patients were evaluated for early versus late surgical-site infection. Early surgical-site infection was defined as infection occurring within 30 days postoperatively; late surgical-site infection was defined as infection occurring 31 days to 1 year postoperatively. Minor infection required oral antibiotics only, and major infection required hospitalization and/or surgical treatment. Direct-to-implant patients had 1-year follow-up, and tissue expander patients had 1-year post-exchange follow-up. Among 1491 tissue expander and 171 direct-to-implant reconstructions, overall surgical-site infection rate for tissue expander was 5.7 percent (85 of 1491) after first-stage, 2.5 percent (31 of 1266) after second-stage, and 9.9 percent (17 of 171) for direct-to-implant reconstruction. Over 47 to 71 percent of surgical-site infection complications were late surgical-site infection. Multivariate analysis identified radiotherapy and increasing body mass index as significant predictors of late surgical-site infection. No significant difference between the direct-to-implant and tissue expander groups in the occurrence of early, late, or overall surgical-site infection was found. The majority of surgical-site infection complications in immediate implant-based breast reconstructions occur more than 30 days after both first-stage and second-stage procedures. Radiotherapy and obesity are significantly associated with late-onset surgical-site infection. Current studies limited to early complications do

  8. 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.

  9. [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.

  10. Surgical Excision of Multiple Penile Syringomas With Scrotal Flap Reconstruction

    OpenAIRE

    2014-01-01

    Objective: Penile syringomas are rare lesions usually occurring in isolation. We report the excision and reconstruction of multiple synchronous penile shaft syringomas with local scrotal flaps. Methods: We report a rare case of excision of multiple penile syringomas and reconstruction with scrotal flaps in a 29-year-old man. Results: Penile syringomas were excised and reconstructed with scrotal flaps in a single-stage procedure. Conclusions: In addition to providing wound coverage, this recon...

  11. Comprehensive approach in surgical reconstruction of facial nerve paralysis: a 10-year perspective.

    Science.gov (United States)

    Gur, Eyal; Stahl, Shy; Barnea, Yoav; Leshem, David; Zaretski, Arik; Amir, Aharon; Meilik, Beni; Miller, Ehud; Shapira, Eyal; Abu Jabel, Amin; Weiss, Jerry; Arad, Ehud

    2010-04-01

    Facial paralysis presents diverse functional and aesthetic abnormalities. Reconstruction may be achieved by several methods. We reviewed the management and outcome of facial paralysis patients to establish principles on which a comprehensive reconstructive approach may be based. Records were reviewed of all patients operated for facial paralysis at our institution between 1998 and 2007. Ninety-five patients were included, of which 15 patients had static reconstruction alone, and 80 patients had dynamic reconstruction. Presented is our experience in reconstruction of facial paralysis over the past decade, delineating a comprehensive approach to this condition. Various surgical techniques are described.

  12. Advances in Surgical Reconstructive Techniques in the Management of Penile, Urethral, and Scrotal Cancer.

    Science.gov (United States)

    Bickell, Michael; Beilan, Jonathan; Wallen, Jared; Wiegand, Lucas; Carrion, Rafael

    2016-11-01

    This article reviews the most up-to-date surgical treatment options for the reconstructive management of patients with penile, urethral, and scrotal cancer. Each