WorldWideScience

Sample records for nonosseous acl injuries

  1. ACL Injuries

    Science.gov (United States)

    ... while doing things like skiing, playing soccer or football, and jumping on a trampoline. When you injure ... severity of the injury, age, physical condition, medical history, and other injuries or illnesses. People who are ...

  2. Anterior cruciate ligament (ACL) injury

    Science.gov (United States)

    ... joint Quickly stop moving and change direction while running, landing from a jump, or turning Basketball, football, soccer, and skiing are common sports linked to ACL tears. ACL injuries often occur with other injuries. For example, an ...

  3. Reducing the Risk of ACL Injury in Female Athletes

    Science.gov (United States)

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

    2010-01-01

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

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

    NARCIS (Netherlands)

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

    2012-01-01

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

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

    Science.gov (United States)

    Weiss, Kaitlyn; Whatman, Chris

    2015-09-01

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

  6. Evaluation of Partial Transection versus Synovial Debridement of the ACL as Novel Canine Models for Management of ACL Injuries.

    Science.gov (United States)

    Bozynski, Chantelle C; Kuroki, Keiichi; Stannard, James P; Smith, Patrick A; Stoker, Aaron M; Cook, Cristi R; Cook, James L

    2015-10-01

    A major hurdle in investigating important clinical questions in knee ligament treatment is a lack of valid translational animal models. This study characterizes the effects of partial transection versus synovial debridement of the anterior (cranial) cruciate ligament (ACL) in dogs. A total of 27 adult purpose-bred research hounds underwent surgery and were assessed over the following 8 weeks. Dogs were randomized into the following three ACL status groups: sham control (n = 9), intact ACL with synovial debridement (exposed ACL) (n = 9), and partial transection of the ACL (partial tear ACL) (n = 9). Dogs in the exposed ACL group and partial tear ACL group had significantly (p < 0.05) more severe lameness, pain, effusion, reduced function, and reduced comfortable range of motion compared with controls, with the partial tear ACL group being most severely affected. More severe ACL and whole-joint pathology, and radiographic scores for osteoarthritis were present in the partial tear ACL group compared with exposed and/or sham control group. On the basis of these findings, biologic components of ACL injury (exposed ACL) played a role in whole-joint inflammation, but the clinical and pathological effects were more severe when both biologic and biomechanical components were present (i.e., partial tear ACL). These novel canine models were successfully developed to evaluate partial transection versus synovial debridement of the ACL and these models will be used to evaluate treatment options for acute management of ACL injuries. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

    Science.gov (United States)

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

    2017-12-01

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

  8. Mechanisms of ACL injury in professional rugby union: a systematic video analysis of 36 cases.

    Science.gov (United States)

    Montgomery, Connor; Blackburn, Jeff; Withers, Daniel; Tierney, Gregory; Moran, Cathal; Simms, Ciaran

    2016-12-30

    The mechanisms of ACL injury in rugby are not well defined. To describe the mechanisms of ACL injury in male professional rugby players using systematic video analysis. 36 cases from games played in top professional leagues and international matches were analysed. 5 analysts independently assessed all videos to record the estimated frame/time of initial ground contact, frame/time of ACL tear and a range of play specific variables. This included contact versus non-contact ACL injuries, injury timing, joint flexion angles and foot contact with the ground. 37 side-stepping manoeuvres from a control game were analysed to allow comparison of non-injury versus injury situations. 57% of ACL injuries occurred in a contact manner. 2 main scenarios were identified: (1) offensive running and (2) being tackled, indicating that the ball carrier might be at higher risk of ACL injury. The majority of non-contact ACL injuries resulted from a side-stepping manoeuvre. In most non-contact cases, initial ground contact was through heel strike. Statistical assessment of heel strike at initial ground contact versus non-heel strike cases showed a significant difference in injury versus non-injury outcomes, with heel strike associated with higher injury risk. Non-contact ACL injuries had lower median knee flexion angles and a more dorsiflexed ankle when compared with a control group (10° vs 20°, p≤0.001 and 10° vs 0°, p=0.033 respectively). Over half of ACL injuries in rugby in our analysis resulted from a contact mechanism. For non-contact injuries, lower knee flexion angles and heel-first ground contact in a side-stepping manoeuvre were associated with ACL injury. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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

    Science.gov (United States)

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

    2009-12-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  14. Comparision of treatment outcomes in isolated injuries of anterior cruciate ligament (ACL and injuries of ACL connected with damages of menisci, conducted with use of KOOS scale

    Directory of Open Access Journals (Sweden)

    Piotr Piech

    2017-03-01

    Full Text Available Introduction: Anterior cruciate ligament (ACL rupture is one of the most common knee injuries. Such trauma is caused by sudden hyperextension and internal rotation above physiological range of movement. It is most commonly diagnosed in young and physically active people. ACL injury is often accompanied by damages of menisci. Aim: The aim of this study was to compare treatment outcomes in patients with isolated rupture of ACL and with both ACL and menisci damages Materials and Methods: In this retrospective study subjective opinions of 46 patients of Orthopedics and Traumatology Clinic of SPSK4 in Lublin were evaluated. Subjects were 19-59 years old, 28 of them had isolated ACL injury, while 18 suffered also with menisci damages. The study was conducted using KOOS questionnaires. Complications, hospitalization time and reconstruction technique were also taken into account. Results: Maximum rating in KOOS scale is 100 points for each of the parameters. This rating characterizes the most favorable state. For pain average rating in isolated ACL injury was 82,31 while in ACL injury with meniscus damage it was 84,37. For other parameters results were respectively: quality of life – 63,59 and 61,81; remaining symptoms 74,57 and 74,09; daily activities 86.61 and 83.84;  sport 70.71 and 65.56. The data have been developed with the help of non-compliance test chi2. Conclusions: The results of the work show that there is a correlation between the type of injury and the assessment of the patient in three parameters: remaining symptoms, daily functioning and sport. The other two parameters (quality of life, pain were irrelevant.

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

    Science.gov (United States)

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

    2018-02-01

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

  16. Muscle Activation During ACL Injury Risk Movements in Young Female Athletes: A Narrative Review

    Directory of Open Access Journals (Sweden)

    Jesper Bencke

    2018-05-01

    Full Text Available Young, adolescent female athletes are at particular high risk of sustaining a non-contact anterior cruciate ligament (ACL injury during sport. Through the last decades much attention has been directed toward various anatomical and biomechanical risk factors for non-contact ACL injury, and important information have been retrieved about the influence of external loading factors on ACL injury risk during given sports-specific movements. However, much less attention has been given to the aspect of neuromuscular control during such movements and only sparse knowledge exists on the specific muscle activation patterns involved during specific risk conditions. Therefore, the aim of this narrative review was (1 to describe anatomical aspects, strength aspects and biomechanical aspects relevant for the understanding of ACL non-contact injury mechanisms in young female athletes, and (2 to review the existing literature on lower limb muscle activation in relation to risk of non-contact ACL-injury and prevention of ACL injury in young female athletes. Studies investigating muscle activity patterns associated with sports-specific risk situations were identified, comprising cohort studies, intervention studies and prospective studies. Based on the retrieved studies, clear gender-specific differences in muscle activation and coordination were identified demonstrating elevated quadriceps activity and reduced hamstring activity in young female athletes compared to their male counterparts, and suggesting young female athletes to be at elevated risk of non-contact ACL injury. Only few studies (n = 6 examined the effect of preventive exercise-based intervention protocols on lower limb muscle activation during sports-specific movements. A general trend toward enhanced hamstring activation was observed during selected injury risk situations (e.g., sidecutting and drop landings. Only a single study examined the association between muscle activation deficits and ACL

  17. Muscle Activation During ACL Injury Risk Movements in Young Female Athletes: A Narrative Review.

    Science.gov (United States)

    Bencke, Jesper; Aagaard, Per; Zebis, Mette K

    2018-01-01

    Young, adolescent female athletes are at particular high risk of sustaining a non-contact anterior cruciate ligament (ACL) injury during sport. Through the last decades much attention has been directed toward various anatomical and biomechanical risk factors for non-contact ACL injury, and important information have been retrieved about the influence of external loading factors on ACL injury risk during given sports-specific movements. However, much less attention has been given to the aspect of neuromuscular control during such movements and only sparse knowledge exists on the specific muscle activation patterns involved during specific risk conditions. Therefore, the aim of this narrative review was (1) to describe anatomical aspects, strength aspects and biomechanical aspects relevant for the understanding of ACL non-contact injury mechanisms in young female athletes, and (2) to review the existing literature on lower limb muscle activation in relation to risk of non-contact ACL-injury and prevention of ACL injury in young female athletes. Studies investigating muscle activity patterns associated with sports-specific risk situations were identified, comprising cohort studies, intervention studies and prospective studies. Based on the retrieved studies, clear gender-specific differences in muscle activation and coordination were identified demonstrating elevated quadriceps activity and reduced hamstring activity in young female athletes compared to their male counterparts, and suggesting young female athletes to be at elevated risk of non-contact ACL injury. Only few studies ( n = 6) examined the effect of preventive exercise-based intervention protocols on lower limb muscle activation during sports-specific movements. A general trend toward enhanced hamstring activation was observed during selected injury risk situations (e.g., sidecutting and drop landings). Only a single study examined the association between muscle activation deficits and ACL injury risk

  18. Muscle Activation During ACL Injury Risk Movements in Young Female Athletes

    DEFF Research Database (Denmark)

    Bencke, Jesper; Aagaard, Per; Zebis, Mette K

    2018-01-01

    , and important information have been retrieved about the influence of external loading factors on ACL injury risk during given sports-specific movements. However, much less attention has been given to the aspect of neuromuscular control during such movements and only sparse knowledge exists on the specific......, intervention studies and prospective studies. Based on the retrieved studies, clear gender-specific differences in muscle activation and coordination were identified demonstrating elevated quadriceps activity and reduced hamstring activity in young female athletes compared to their male counterparts......Young, adolescent female athletes are at particular high risk of sustaining a non-contact anterior cruciate ligament (ACL) injury during sport. Through the last decades much attention has been directed toward various anatomical and biomechanical risk factors for non-contact ACL injury...

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

    DEFF Research Database (Denmark)

    Renstrom, P; Ljungqvist, A; Arendt, E

    2008-01-01

    clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery...... and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3...

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

    Science.gov (United States)

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

    2017-02-01

    The ACL-Return to Sport after Injury scale (ACL-RSI) measures athletes' emotions, confidence in performance, and risk appraisal in relation to return to sport after ACL reconstruction. Aim of this study was to study the validity and reliability of the Dutch version of the ACL-RSI (ACL-RSI (NL)). Total 150 patients, who were 3-16 months postoperative, completed the ACL-RSI(NL) and 5 other questionnaires regarding psychological readiness to return to sports, knee-specific physical functioning, kinesiophobia, and health-specific locus of control. Construct validity of the ACL-RSI(NL) was determined with factor analysis and by exploring 10 hypotheses regarding correlations between ACL-RSI(NL) and the other questionnaires. For test-retest reliability, 107 patients (5-16 months postoperative) completed the ACL-RSI(NL) again 2 weeks after the first administration. Cronbach's alpha, Intraclass Correlation Coefficient (ICC), SEM, and SDC, were calculated. Bland-Altman analysis was conducted to assess bias between test and retest. Nine hypotheses (90%) were confirmed, indicating good construct validity. The ACL-RSI(NL) showed good internal consistency (Cronbach's alpha 0.94) and test-retest reliability (ICC 0.93). SEM was 5.5 and SDC was 15. A significant bias of 3.2 points between test and retest was found. Therefore, the ACL-RSI(NL) can be used to investigate psychological factors relevant to returning to sport after ACL reconstruction.

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

    DEFF Research Database (Denmark)

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

    2018-01-01

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

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

    Science.gov (United States)

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

    2017-02-01

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

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

    NARCIS (Netherlands)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2017-09-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

  6. Self-Reported Fear Predicts Functional Performance and Second ACL Injury After ACL Reconstruction and Return to Sport: A Pilot Study.

    Science.gov (United States)

    Paterno, Mark V; Flynn, Kaitlyn; Thomas, Staci; Schmitt, Laura C

    Outcomes after anterior cruciate ligament reconstruction (ACLR) are highly variable. Previous studies have failed to report the relationship between fear, objective measures of function, and reinjury rates. The purpose of this study was to determine whether fear was related to functional performance measures and risk of second ACL injury after ACLR and return to sport (RTS). Fear will be associated with performance on functional testing and second ACL injury rate. Prospective cohort study. Level 2. A total of 40 patients cleared to RTS after ACLR completed the Tampa Scale of Kinesiophobia (TSK-11), hop testing, and quadriceps strength testing, bilaterally. Patients were tracked for 12 months after RTS to identify the incidence of second ACL injury. Chi-square analyses determined whether patients with high fear (TSK-11, ≥17) were more likely to have lower levels of activity, greater asymmetry on functional testing, and higher reinjury rates. Patients with greater fear on the TSK-11 (≥17) at RTS were 4 times (odds ratio [OR], 3.73; 95% CI, 0.98-14.23) more likely to report lower levels of activity, 7 times (OR, 7.1; 95% CI, 1.5-33.0) more likely to have a hop limb symmetry lower than 95%, and 6 times (OR, 6.0; 95% CI, 1.3-27.8) more likely to have quadriceps strength symmetry lower than 90%. Patients who went on to suffer an ipsilateral second ACL injury had a greater TSK-11 score at the time of RTS (mean, 19.8 ± 4.0) than those who did not suffer a second ACL injury (mean, 16.4 ± 3.6) ( P = 0.03). Patients with a TSK-11 score of 19 or greater at the time of RTS were 13 times (relative risk, 13.0; 95% CI, 2.1-81.0) more likely to suffer a second ACL tear within 24 months after RTS. Patients with greater self-reported fear were less active, presented with lower single-leg hop performance and isometric quadriceps strength, and had an increased risk of suffering a second ACL injury in the 24 months after RTS. Self-reported fear of movement/reinjury after ACLR at

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

    Science.gov (United States)

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

    2014-01-01

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

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

    DEFF Research Database (Denmark)

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

    2018-01-01

    of the study were to 1) investigate knee-related self-efficacy 6 years after acute ACL injury in patients treated with exercise therapy alone or in combination with either early or the option of delayed ACL reconstruction (ACLR), and 2) to investigate associations between single-leg physical performance...... at various time points after ACL injury and knee self-efficacy at 6 years after injury. METHODS: Participants (n = 121) originated from the KANON-study (ISRCTN84752559), a treatment RCT including active adults with acute ACL injury treated with structured exercise therapy combined with early or the option...... of delayed ACLR. In this ancillary study, participants with knee self-efficacy data at 6 years (n = 89) were analyzed as treated; exercise therapy alone (n = 20), exercise therapy plus early ACLR (n = 46), and exercise therapy plus delayed ACLR (n = 23). The participants performed physical performance tests...

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  11. Does the FIFA 11+ Injury Prevention Program Reduce the Incidence of ACL Injury in Male Soccer Players?

    Science.gov (United States)

    Silvers-Granelli, Holly J; Bizzini, Mario; Arundale, Amelia; Mandelbaum, Bert R; Snyder-Mackler, Lynn

    2017-10-01

    The FIFA 11+ injury prevention program has been shown to decrease the risk of soccer injuries in men and women. The program has also been shown to decrease time loss resulting from injury. However, previous studies have not specifically investigated how the program might impact the rate of anterior cruciate ligament (ACL) injury in male soccer players. The purpose of this study was to examine if the FIFA 11+ injury prevention program can (1) reduce the overall number of ACL injuries in men who play competitive college soccer and whether any potential reduction in rate of ACL injuries differed based on (2) game versus practice setting; (3) player position; (4) level of play (Division I or II); or (5) field type. This study was a prospective cluster randomized controlled trial, which was conducted in 61 Division I and Division II National Collegiate Athletic Association men's soccer teams over the course of one competitive soccer season. The FIFA 11+ is a 15- to 20-minute on-the-field dynamic warm-up program used before training and games and was utilized as the intervention throughout the entire competitive season. Sixty-five teams were randomized: 34 to the control group (850 players) and 31 to the intervention group (675 players). Four intervention teams did not complete the study and did not submit their data, noting insufficient time to complete the program, reducing the number for per-protocol analysis to 61. Compliance to the FIFA 11+ program, athletic exposures, specific injuries, ACL injuries, and time loss resulting from injury were collected and recorded using a secure Internet-based system. At the end of the season, the data in the injury surveillance system were crosshatched with each individual institution's internal database. At that time, the certified athletic trainer signed off on the injury collection data to confirm their accuracy and completeness. A lower proportion of athletes in the intervention group experienced knee injuries (25% [34 of

  12. ACL injury: How do the physical examination tests compare?

    Science.gov (United States)

    Koster, Christiaan H; Harmsen, Annelieke Mk; Lichtenberg, Miranda C; Bloemers, Frank W

    2018-03-01

    Three physical examination tests are most commonly used to evaluate cruciate ligament injury. The best known and most frequently used technique is the anterior drawer test. The other 2 tests, the Lachman test and the pivot shift test, are more difficult to perform and are used less often, especially by physicians untrained in their use. In addition, there is a relatively new diagnostic test: the lever sign test. The aim of our article is to provide a short, clinically relevant overview of the literature and to assess the diagnostic value of physical examination for the primary care physician.

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

    Science.gov (United States)

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

    2016-06-01

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

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    performance and worse postural orientation were associated with worse KOOS scores 2 years later (rsp≥0.280, p≤0.045). Worse muscle power was associated with lower future ARS scores (rsp=0.281, p=0.044). CONCLUSIONS: The moderate associations suggest that improving muscle function during rehabilitation could...... and postural orientation 3 years (SD 0.85) after ACL injury. PROs at 3 and 5 years after injury included Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales Function in sport and recreation (KOOS Sport/rec) and Knee-related Quality of life (KOOS QoL), KOOS item Q3 (KOOS Q3), Tegner Activity Scale...... improve present and future PROs....

  15. Relationship Between the Risk of Suffering a First-Time Noncontact ACL Injury and Geometry of the Femoral Notch and ACL: A Prospective Cohort Study With a Nested Case-Control Analysis.

    Science.gov (United States)

    Whitney, Darryl C; Sturnick, Daniel R; Vacek, Pamela M; DeSarno, Mike J; Gardner-Morse, Mack; Tourville, Timothy W; Smith, Helen C; Slauterbeck, James R; Johnson, Robert J; Shultz, Sandra J; Hashemi, Javad; Beynnon, Bruce D

    2014-08-01

    The morphometric characteristics of the anterior cruciate ligament (ACL) and the femoral intercondylar notch within which it resides have been implicated as risk factors for injuries to this important stabilizer of the knee. Prior research has produced equivocal results with differing methodologies, and consequently, it is unclear how these characteristics affect the injury risk in male and female patients. The morphometric characteristics of the ACL and femoral intercondylar notch are individually and independently associated with the risk of suffering a noncontact ACL injury, and these relationships are different in male and female patients. Case-control study; Level of evidence, 3. Magnetic resonance imaging scans of the bilateral knees were obtained on 88 case-control pairs (27 male, 61 female) matched for age, sex, and participation on the same sports team. Patients had suffered a grade III, first-time, noncontact ACL tear. The femoral notch width at 4 locations, the thickness of the bony ridge at the anteromedial outlet of the femoral notch, the femoral notch volume, ACL volume, and ACL cross-sectional area were measured. Multivariate analysis of combined data from male and female patients revealed that decreased ACL volume (odds ratio [OR], 0.829), decreased femoral notch width (OR, 0.700), and increased bony ridge thickness at the anteromedial outlet of the femoral notch (OR, 1.614) were significant independent predictors of an ACL injury. Separate analyses of male and female patients indicated that the femoral notch ridge may be more strongly associated with a risk in female patients, while ACL volume is more strongly associated with a risk in male patients. However, statistical analysis performed with an adjustment for body weight strengthened the association between ACL volume and the risk of injuries in female patients. Morphometric features of both the ACL and femoral notch combine to influence the risk of suffering a noncontact ACL injury. When

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

    Science.gov (United States)

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

    2017-03-01

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

  17. Time from ACL injury to reconstruction and the prevalence of additional intra-articular pathology: is patient age an important factor?

    Science.gov (United States)

    Magnussen, Robert A; Pedroza, Angela D; Donaldson, Christopher T; Flanigan, David C; Kaeding, Christopher C

    2013-09-01

    Meniscus and cartilage lesions have been reported to be prevalent during delayed reconstruction of anterior cruciate ligament (ACL) injuries. Relatively, little work has been done exploring the influence of patient age on this relationship. The purpose of this study is to determine whether the effect of time from ACL injury to reconstruction on the prevalence of associated meniscal and chondral injury is influenced by patient age. It was hypothesized that patients in whom the time from ACL injury to reconstruction exceeds 12 weeks will exhibit an increased prevalence of medial compartment pathology relative to those reconstructed within 12 weeks of injury in patients of all ages. Data detailing time from ACL injury to reconstruction and the prevalence of intra-articular findings were obtained in 311 of 489 consecutive patients undergoing primary isolated ACL reconstruction. Patients were divided into two groups based on whether the time from ACL injury to reconstruction was time from ACL injury to reconstruction exceeded 12 weeks. The prevalence of lateral meniscal injury did not increase with increasing time ACL injury to surgery. Among patients aged 22 years and under, there was no increase in the prevalence of intra-articular pathology in any compartment in the late reconstruction group. In contrast, among patients over the age of 22, there was a significant increase in the prevalence of medial chondral injury (p = 0.042) in the late reconstruction group. The prevalence of injuries to the meniscus and articular cartilage in the medial compartment of the knee is increased with increasing time from ACL injury to reconstruction. This relationship may vary depending on patient age. Patients over the age of 22 exhibit a higher prevalence of intra-articular injury with delayed reconstruction, while no such differences are noted among younger patients. Retrospective comparative study, level III.

  18. No association between static and dynamic postural control and ACL injury risk among female elite handball and football players: a prospective study of 838 players.

    Science.gov (United States)

    Steffen, Kathrin; Nilstad, Agnethe; Krosshaug, Tron; Pasanen, Kati; Killingmo, Aleksander; Bahr, Roald

    2017-02-01

    Research on balance measures as potential risk factors for ACL injury is limited. To assess whether postural control was associated with an increased risk for ACL injuries in female elite handball and football players. Premier league players were tested in the preseason and followed prospectively for ACL injury risk from 2007 through 2015. At baseline, we recorded player demographics, playing experience, ACL and ankle injury history. We measured centre of pressure velocity in single-leg stabilisation tests and reach distances in the Star Excursion Balance Test. To examine the stability of postural control measures over time, we examined their short-term and long-term reproducibility. We generated logistic regression models, 1 for each of the proposed risk factors. A total of 55 (6.6%) out of 838 players (age 21±4 years; height 170±6 cm; body mass 66±8 kg) sustained a non-contact ACL injury after baseline testing (1.8±1.8 years). When comparing normalised balance measures between injured and uninjured players in univariate analyses, none of the variables were statistically associated with ACL injury risk. Short-term and long-term reproducibility of the selected variables was poor. Players with a previous ACL injury had a 3-fold higher risk of sustaining a new ACL injury compared with previously uninjured players (OR 2.9, CI 1.4 to 5.7). None of postural control measures examined were associated with increased ACL injury risk among female elite handball and football players. Hence, as measured in the current investigation, the variables included cannot be used to predict ACL injury risk. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  19. Incidence and MRI characterization of the spectrum of posterolateral corner injuries occurring in association with ACL rupture

    Energy Technology Data Exchange (ETDEWEB)

    Frois Temponi, Eduardo [Hospital Madre Teresa, Belo Horizonte, Minas Gerais (Brazil); Honorio de Carvalho, Lucio Jr. [Hospital Madre Teresa, Belo Horizonte, Minas Gerais (Brazil); Universidade Federal de Minas Gerais, Departamento do Aparelho Locomotor, Faculdade de Medicina, Belo Horizonte, Minas Gerais (Brazil); Saithna, Adnan [Southport and Ormskirk Hospitals, Southport (United Kingdom); University of Liverpool, Department of Clinical Engineering, Liverpool (United Kingdom); Thaunat, Mathieu; Sonnery-Cottet, Bertrand [Centre Orthopedic Santy, FIFA Medical Center of Excellence, Ramsay-Generale de Sante, Hopital Prive Jean Mermoz, Lyon (France)

    2017-08-15

    To determine the incidence and MRI characteristics of the spectrum of posterolateral corner (PLC) injuries occurring in association with anterior cruciate ligament (ACL) rupture. We carried out a level IV, retrospective case series study. All patients clinically diagnosed with an ACL rupture between July 2015 and June 2016 who underwent MRI of the knee were included in the study. In addition to standard MRI knee reporting, emphasis was placed on identifying injury to the PLC and a description of involvement of these structures by two musculoskeletal radiologists. Association with PLC involvement was sought with concomitant injuries using correlation analysis and logistic regression. One hundred sixty-two patients with MRI following ACL rupture were evaluated. Thirty-two patients (19.7%) had an injury to at least one structure of the PLC, including the inferior popliteomeniscal fascicle (n = 28), arcuate ligament (n = 20), popliteus tendon (n = 20), superior popliteomeniscal fascicle (n = 18), lateral collateral ligament (n = 8), popliteofibular ligament (n = 7), biceps tendon (n = 4), iliotibial band (n = 3), and fabellofibular ligament (n = 1). Seventy-five percent of all patients with combined ACL and PLC injuries had bone contusions involving the lateral compartment of the knee. The presence of these contusions strongly correlated with superior popliteomeniscal fascicle lesions (p < 0.05). There was no correlation between injuries to other structures of the PLC and other intra-articular lesions. Missed injuries of the PLC lead to considerable morbidity. The relevance of this study is to highlight that these injuries occur more frequently than previously described and that an appropriate index of suspicion, clinical examination, and MRI are all required to reduce the risk of missed diagnoses. The results of this study support previous suggestions that the rate of concomitant PLC injury in the ACL-deficient knee is under-reported. The rate of combined injuries in

  20. Motor learning strategies in basketball players and its implications for ACL injury prevention : a randomized controlled trial

    NARCIS (Netherlands)

    Benjaminse, Anne; Otten, Bert; Gokeler, Alli; Diercks, Ron L.; Lemmink, Koen A. P. M.

    Adding external focus of attention (EF, focus on the movement effect) may optimize current anterior cruciate ligament (ACL) injury prevention programmes. The purpose of the current study was to investigate the effects of an EF, by a visual stimulus and an internal focus, by a verbal stimulus during

  1. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

    Science.gov (United States)

    Ekås, Guri Ranum; Grindem, Hege; Moksnes, Håvard; Anderson, Allen F; Chotel, Franck; Cohen, Moises; Forssblad, Magnus; Ganley, Theodore J; Feller, Julian A; Karlsson, Jón; Kocher, Minider S; LaPrade, Robert F; McNamee, Michael; Mandelbaum, Bert; Micheli, Lyle; Mohtadi, Nicholas; Reider, Bruce; Roe, Justin; Seil, Romain; Siebold, Rainer; Witvrouw, Erik; Engebretsen, Lars

    2018-01-01

    In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions. PMID:29478021

  2. Joint loads resulting in ACL rupture: Effects of age, sex, and body mass on injury load and mode of failure in a mouse model.

    Science.gov (United States)

    Blaker, Carina L; Little, Christopher B; Clarke, Elizabeth C

    2017-08-01

    Anterior cruciate ligament (ACL) tears are a common knee injury with a known but poorly understood association with secondary joint injuries and post-traumatic osteoarthritis (OA). Female sex and age are known risk factors for ACL injury but these variables are rarely explored in mouse models of injury. This study aimed to further characterize a non-surgical ACL injury model to determine its clinical relevance across a wider range of mouse specifications. Cadaveric and anesthetized C57BL/6 mice (9-52 weeks of age) underwent joint loading to investigate the effects of age, sex, and body mass on ACL injury mechanisms. The ACL injury load (whole joint load required to rupture the ACL) was measured from force-displacement data, and mode of failure was assessed using micro-dissection and histology. ACL injury load was found to increase with body mass and age (p < 0.001) but age was not significant when controlling for mass. Sex had no effect. In contrast, the mode of ACL failure varied with both age and sex groups. Avulsion fractures (complete or mixed with mid-substance tears) were common in all age groups but the proportion of mixed and mid-substance failures increased with age. Females were more likely than males to have a major avulsion relative to a mid-substance tear (p < 0.01). This data compliments studies in human cadaveric knees, and provides a basis for determining the severity of joint injury relative to a major ACL tear in mice, and for selecting joint loading conditions in future experiments using this model. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1754-1763, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  3. Utilization of ACL Injury Biomechanical and Neuromuscular Risk Profile Analysis to Determine the Effectiveness of Neuromuscular Training.

    Science.gov (United States)

    Hewett, Timothy E; Ford, Kevin R; Xu, Yingying Y; Khoury, Jane; Myer, Gregory D

    2016-12-01

    The widespread use of anterior cruciate ligament (ACL) injury prevention interventions has not been effective in reducing the injury incidence among female athletes who participate in high-risk sports. The purpose of this study was to determine if biomechanical and neuromuscular factors that contribute to the knee abduction moment (KAM), a predictor of future ACL injuries, could be used to characterize athletes by a distinct factor. Specifically, we hypothesized that a priori selected biomechanical and neuromuscular factors would characterize participants into distinct at-risk profiles. Controlled laboratory study. A total of 624 female athletes who participated in jumping, cutting, and pivoting sports underwent testing before their competitive season. During testing, athletes performed drop-jump tasks from which biomechanical measures were captured. Using data from these tasks, latent profile analysis (LPA) was conducted to identify distinct profiles based on preintervention biomechanical and neuromuscular measures. As a validation, we examined whether the profile membership was a significant predictor of the KAM. LPA using 6 preintervention biomechanical measures selected a priori resulted in 3 distinct profiles, including a low (profile 1), moderate (profile 2), and high (profile 3) risk for ACL injuries. Athletes with profiles 2 and 3 had a significantly higher KAM compared with those with profile 1 (P risk profiles. Three distinct risk groups were identified based on differences in the peak KAM. These findings demonstrate the existence of discernable groups of athletes that may benefit from injury prevention interventions. ClinicalTrials.gov NCT identifier: NCT01034527. © 2016 The Author(s).

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

    DEFF Research Database (Denmark)

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

    2018-01-01

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

  5. Association between maximal hamstring strength and hamstring muscle pre-activity during a movement associated with non-contact ACL injury

    DEFF Research Database (Denmark)

    Skov Husted, Rasmus; Bencke, Jesper; Thorborg, Kristian

    2014-01-01

    Introduction Reduced hamstring pre-activity during side-cutting may predispose for non-contact ACL injury. During the last decade resistance training of the lower limb muscles has become an integral part of ACL injury prevention in e.g. soccer and handball. However, it is not known whether a strong...... hamstring (ACL-agonist) musculature is associated with a high level of hamstring muscle pre-activity during high risk movements such as side-cutting. The purpose of this study was to examine the relationship between hamstring muscle pre-activity recorded during a standardized sidecutting maneuver...... translate into high levels of muscle pre-activity during movements like the sidecutting maneuver. Thus, other exercise modalities (i.e. neuromuscular training) are needed to optimize hamstring muscle pre-activity during movements associated with non-contact ACL injury....

  6. Abnormal Mechanical Loading Induces Cartilage Degeneration by Accelerating Meniscus Hypertrophy and Mineralization After ACL Injuries In Vivo.

    Science.gov (United States)

    Du, Guoqing; Zhan, Hongsheng; Ding, Daofang; Wang, Shaowei; Wei, Xiaochun; Wei, Fangyuan; Zhang, Jianzhong; Bilgen, Bahar; Reginato, Anthony M; Fleming, Braden C; Deng, Jin; Wei, Lei

    2016-03-01

    Although patients with an anterior cruciate ligament (ACL) injury have a high risk of developing posttraumatic osteoarthritis (PTOA), the role of meniscus hypertrophy and mineralization in PTOA after an ACL injury remains unknown. The purpose of this study was to determine if menisci respond to abnormal loading and if an ACL injury results in meniscus hypertrophy and calcification. The hypotheses were that (1) abnormal mechanical loading after an ACL injury induces meniscus hypertrophy and mineralization, which correlates to articular cartilage damage in vivo, and (2) abnormal mechanical loading on bovine meniscus explants induces the overexpression of hypertrophic and mineralization markers in vitro. Controlled laboratory study. In vivo guinea pig study (hypothesis 1): Three-month-old male Hartley guinea pigs (n = 9) underwent ACL transection (ACLT) on the right knee; the left knee served as the control. Calcification in the menisci was evaluated by calcein labeling 1 and 5 days before knee harvesting at 5.5 months. Cartilage and meniscus damage and mineralization were quantified by the Osteoarthritis Research Society International score and meniscus grade, respectively. Indian hedgehog (Ihh), matrix metalloproteinase-13 (MMP-13), collagen type X (Col X), progressive ankylosis homolog (ANKH), ectonucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1), alkaline phosphatase (ALP), inorganic pyrophosphate (PPi), and inorganic phosphate (Pi) concentrations were evaluated by immunohistochemistry and enzyme-linked immunosorbent assay. In vitro bovine meniscus explant study (hypothesis 2): Bovine meniscus explants were subjected to 25% strain at 0.3 Hz for 1, 2, and 3 hours. Cell viability was determined using live/dead staining. The levels of mRNA expression and protein levels were measured using real-time quantitative reverse transcription polymerase chain reaction and Western blot after 24, 48, and 72 hours in culture. The conditioned medium was collected for sulfated

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

    Science.gov (United States)

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

    2016-04-01

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

  8. ACL deficient potential copers and non-copers reveal different isokinetic quadriceps strength profiles in the early stage after injury

    Science.gov (United States)

    Eitzen, I; Eitzen, TJ; Holm, I; Snyder-Mackler, L; Risberg, MA

    2011-01-01

    strength deficits after ACL injury compared to the commonly used peak torque values. PMID:20110458

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

    Science.gov (United States)

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

    2015-08-01

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

  10. EXERCISES THAT FACILITATE OPTIMAL HAMSTRING AND QUADRICEPS CO-ACTIVATION TO HELP DECREASE ACL INJURY RISK IN HEALTHY FEMALES: A SYSTEMATIC REVIEW OF THE LITERATURE.

    Science.gov (United States)

    Dedinsky, Rachel; Baker, Lindsey; Imbus, Samuel; Bowman, Melissa

    2017-01-01

    Background Anterior cruciate ligament (ACL) injury is common among females due to many anatomic, hormonal, and neuromuscular risk factors. One modifiable risk factor that places females at increased risk of ACL injury is a poor hamstrings: quadriceps (H:Q) co-activation ratio, which should be 0.6 or greater in order to decrease the stress placed on the ACL. Exercises that produce more quadriceps dominant muscle activation can add to the tension placed upon the ACL, potentially increasing the risk of ACL injury. Hypothesis/Purpose The purpose of this systematic review was to compare quadriceps and hamstring muscle activation during common closed kinetic chain therapeutic exercises in healthy female knees to determine what exercises are able to produce adequate H:Q co-activation ratios. Study Design Systematic Review Methods Multiple online databases were systematically searched and screened for inclusion. Eight articles were identified for inclusion. Data on mean electromyography (EMG) activation of both quadriceps and hamstring muscles, % maximal voluntary isometric contraction (MVIC), and H:Q co-activation ratios were extracted from the studies. Quality assessment was performed on all included studies. Results Exercises analyzed in the studies included variations of the double leg squat, variations of the single leg squat, lateral step-up, Fitter, Stairmaster® (Core Health and Fitness, Vancouver, WA), and slide board. All exercises, except the squat machine with posterior support at the level of the scapula and feet placed 50 cm in front of the hips, produced higher quadriceps muscle activation compared to hamstring muscle activation. Conclusion Overall, two leg squats demonstrate poor H:Q co-activation ratios. Single leg exercises, when performed between 30 and 90 degrees of knee flexion, produce adequate H:Q ratios, thereby potentially reducing the risk of tensile stress on the ACL and ACL injury. Level of Evidence 2a- Systematic Review of Cohort Studies PMID

  11. Radiological evaluation of the posterior pelvic ring in paediatric patients: Results of a retrospective study developing age- and gender-related non-osseous baseline characteristics in paediatric pelvic computed tomography - References for suspected sacroiliac joint injury.

    Science.gov (United States)

    Bayer, Jörg; Neubauer, Jakob; Saueressig, Ulrich; Südkamp, Norbert Paul; Reising, Kilian

    2016-04-01

    The prevalence of paediatric pelvic injury is low, yet they are often indicative of accompanying injuries, and an instable pelvis at presentation is related to long-term poor outcome. Judging diastasis of the sacroiliac joint in paediatric pelvic computed tomography is challenging, as information on their normal appearance is scarce. We therefore sought to generate age- and gender-related standard width measurements of the sacroiliac joint in children for comparison. A total of 427 pelvic computed tomography scans in paediatric patients (sacroiliac joint width bilaterally in axial and coronal planes. We illustrate age- and gender-related measurements of the sacroiliac joint width as a designated continuous 3rd, 15th, 50th, 85th and 97th centile graph, respectively. Means and standard deviations in the joint width are reported for four age groups. There are distinct changes in the sacroiliac joint's appearance during growth. In general, male children exhibit broader sacroiliac joints than females at the same age, although this difference is significant only in the 11 to 15-year-old age group. The sacroiliac joint width in children as measured in coronal and axial CT scans differs in association with age and gender. When the sacroiliac joint width is broader than the 97th centile published in our study, we strongly encourage considering a sacroiliac joint injury. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Association between maximal hamstring muscle strength and hamstring muscle pre-activity during a movement associated with non-contact ACL injury

    DEFF Research Database (Denmark)

    Zebis, M. K.; Sorensen, R. S.; Thorborg, K.

    2015-01-01

    Background: Reduced hamstring pre-activity during sidecutting increases the risk for non-contact ACL injury. During the last decade resistance training of the lower limb muscles has become an integral part ofACLinjury prevention in e.g. soccer and handball. However, it is not known whether a stro...

  13. Motor learning strategies in basketball players and its implications for ACL injury prevention: a randomized controlled trial.

    Science.gov (United States)

    Benjaminse, Anne; Otten, Bert; Gokeler, Alli; Diercks, Ron L; Lemmink, Koen A P M

    2017-08-01

    Adding external focus of attention (EF, focus on the movement effect) may optimize current anterior cruciate ligament (ACL) injury prevention programmes. The purpose of the current study was to investigate the effects of an EF, by a visual stimulus and an internal focus, by a verbal stimulus during unexpected sidestep cutting in female and male athletes and how these effects remained over time. Ninety experienced basketball athletes performed sidestep cutting manoeuvres in three sessions (S1, S2 and S3). In this randomized controlled trial, athletes were allocated to three groups: visual (VIS), verbal (VER) and control (CTRL). Kinematics and kinetics were collected at the time of peak knee frontal plane moment. Males in the VIS group showed a larger vertical ground reaction force (S1: 25.4 ± 3.1 N/kg, S2: 25.8 ± 2.9 N/kg, S3: 25.2 ± 3.2 N/kg) and knee flexion moments (S1: -3.8 ± 0.9 Nm/kg, S2: -4.0 ± 1.2 Nm/kg, S3: -3.9 ± 1.3 Nm/kg) compared to the males in the VER and CTRL groups and to the females in the VIS group (p knee valgus moment and the females in the VER group reduced knee varus moment over time (n.s.). Male subjects clearly benefit from visual feedback. Females may need different feedback modes to learn a correct movement pattern. Sex-specific learning preferences may have to be acknowledged in day by day practice. Adding video instruction or feedback to regular training regimens when teaching athletes safe movement patterns and providing individual feedback might target suboptimal long-term results and optimize ACL injury prevention programmes. I.

  14. Translation, cultural adaptation and validation of simplified Chinese version of the anterior cruciate ligament return to sport after injury (ACL-RSI scale.

    Directory of Open Access Journals (Sweden)

    Tianwu Chen

    Full Text Available To translate and cross-culturally adapt the anterior cruciate ligament-return to sport after injury (ACL-RSI into simplified Chinese [ACL-RSI (Cn].In this diagnostic study, the translation, cross-culturally adaptation, and validation of the ACL-RSI was performed according to international guidelines. A total of 112 patients with ACL reconstruction participated in this study. All were capable of competitive sports before the injury and completed the Knee Injury and Osteoarthritis Outcome (KOOS, the International Knee Documentation Committee (IKDC, the Tampa Scale of Kinesiophobia (TSK, and the Tegner activity score. Forty-eight patients completed the ACL-RSI (Cn twice within two weeks. The validity was tested using seven premade hypotheses. Internal consistency, reliability, and measurement error was assessed.At meanly 15.6 months postoperative, 81 (72.3% patients returned to sport, with 57 (50.9% to competitive sport and 24 (21.4% to recreational sport. Thirty-one (27.7% patients didn't return to any sport, with 19 (17.0% still had planned to return, and 12 (10.7% gave up sport. The ACL-RSI (Cn demonstrated excellent validity with all hypotheses confirmed. The outcome of ACL-RSI (Cn was strongly correlated the KOOS subscale quality of life (r = 0.66, p<0.001, the TSK (r = -0.678, p<0.001, the Tegner score (r = 0.695, p<0.001. There was statistic difference between cases returned (68.6 ± 10.1 and didn't return to sport (41.3 ± 17.7, p<0.001; between cases returned to competitive (71.1 ± 8.9 and recreational sport (62.9 ± 10.5, (P = 0.002; between cases who planned to return (50.7 ± 14.1 and gave up sport (26.5 ± 11.7, (P<0.001. The internal consistency (Cronbach's α = 0.96 and test-retest reliability [intra-class correlation coefficient (ICC = 0.90] was excellent. The measurement error, floor and ceiling effect was satisfactory. Administration time was 3.2 minutes, and no item was missed.The ACL-RSI (Cn scale was confirmed as a valid

  15. CURRENT CONCEPTS IN ACL RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Freddie H. Fu

    2008-09-01

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

  16. Reliability of 3-Dimensional Measures of Single-Leg Cross Drop Landing Across 3 Different Institutions: Implications for Multicenter Biomechanical and Epidemiological Research on ACL Injury Prevention.

    Science.gov (United States)

    DiCesare, Christopher A; Bates, Nathaniel A; Barber Foss, Kim D; Thomas, Staci M; Wordeman, Samuel C; Sugimoto, Dai; Roewer, Benjamin D; Medina McKeon, Jennifer M; Di Stasi, Stephanie; Noehren, Brian W; Ford, Kevin R; Kiefer, Adam W; Hewett, Timothy E; Myer, Gregory D

    2015-12-01

    Anterior cruciate ligament (ACL) injuries are physically and financially devastating but affect a relatively small percentage of the population. Prospective identification of risk factors for ACL injury necessitates a large sample size; therefore, study of this injury would benefit from a multicenter approach. To determine the reliability of kinematic and kinetic measures of a single-leg cross drop task across 3 institutions. Controlled laboratory study. Twenty-five female high school volleyball players participated in this study. Three-dimensional motion data of each participant performing the single-leg cross drop were collected at 3 institutions over a period of 4 weeks. Coefficients of multiple correlation were calculated to assess the reliability of kinematic and kinetic measures during the landing phase of the movement. Between-centers reliability for kinematic waveforms in the frontal and sagittal planes was good, but moderate in the transverse plane. Between-centers reliability for kinetic waveforms was good in the sagittal, frontal, and transverse planes. Based on these findings, the single-leg cross drop task has moderate to good reliability of kinematic and kinetic measures across institutions after implementation of a standardized testing protocol. Multicenter collaborations can increase study numbers and generalize results, which is beneficial for studies of relatively rare phenomena, such as ACL injury. An important step is to determine the reliability of risk assessments across institutions before a multicenter collaboration can be initiated.

  17. THE INFLUENCE OF SEX AND MATURATION ON LANDING BIOMECHANICS: IMPLICATIONS FOR ACL INJURY

    Science.gov (United States)

    Sigward, S. M.; Pollard, C. D.; Powers, C. M.

    2010-01-01

    During landing and cutting, females exhibit greater frontal plane moments at the knee (internal knee adductor moments or external knee abduction moments) and favor use of the knee extensors over the hip extensors to attenuate impact forces when compared to males. However, it is not known when this biomechanical profile emerges. The purpose of this study was to compare landing biomechanics between sexes across maturation levels. One hundred and nineteen male and female soccer players (9–22 years) participated. Subjects were grouped based on maturational development. Lower extremity kinematics and kinetics were obtained during a drop-land task. Dependent variables included the average internal knee adductor moment and sagittal plane knee/hip moment and energy absorption ratios during the deceleration phase of landing. When averaged across maturation levels, females demonstrated greater internal knee adductor moments (0.06±0.03 vs. 0.01±0.02 Nm/kg*m; Pbiomechanical pattern that increases ACL loading. This biomechanical strategy already was established in pre-pubertal female athletes. PMID:21210853

  18. Longitudinal Changes in Hip Strength and Range of Motion in Female Youth Soccer Players: Implications for ACL Injury, A Pilot Study.

    Science.gov (United States)

    Nguyen, Anh-Dung; Zuk, Emma F; Baellow, Andrea L; Pfile, Kate R; DiStefano, Lindsay J; Boling, Michelle C

    2017-09-01

    Risk of anterior cruciate ligament (ACL) injuries in young female athletes increases with age, appearing to peak during maturation. Changes in hip muscle strength and range of motion (ROM) during this time may contribute to altered dynamic movement patterns that are known to increase risk of ACL injuries. Understanding the longitudinal changes in hip strength and ROM is needed to develop appropriate interventions to reduce the risk of ACL injuries. To examine the longitudinal changes in hip strength and ROM in female youth soccer players. Longitudinal descriptive study. Field setting. 14 female youth soccer athletes (14.1 ± 1.1 y, 165.8 ± 5.3 cm, 57.5 ± 9.9 kg) volunteered as part of a multiyear risk factor screening project. Clinical measures of hip strength and ROM were collected annually over 3 consecutive years. Passive hip internal rotation (IR), external rotation (ER), abduction (ABD), and adduction (ADD) ROM were measured with a digital inclinometer. Isometric hip ABD and extension (EXT) strength were evaluated using a hand-held dynamometer. Separate repeated-measures ANOVAs compared hip strength and ROM values across 3 consecutive years (P hip ABD (P = .830) or EXT strength (P = .062) across 3 consecutive years. Longitudinal changes in hip ROM were observed with increases in hip IR (P = .001) and ABD (P hip ADD (P = .009) and ER (P hip occur as youth female soccer players increase in age. While there are no changes in hip strength, there is an increase in hip IR and ABD ROM with a concomitant decrease in hip ER and ADD ROM. The resulting asymmetries in hip ROM may decrease the activation and force producing capabilities of the hip muscles during dynamic activities, contributing to altered lower extremity mechanics known to increase the risk of ACL injuries.

  19. ACL Reconstruction

    Science.gov (United States)

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

  20. ACL Rupture in Collegiate Wrestler

    Directory of Open Access Journals (Sweden)

    Lindsay A. Palmer

    2016-05-01

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

  1. Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: a randomised controlled trial.

    Science.gov (United States)

    Zebis, Mette K; Andersen, Lars L; Brandt, Mikkel; Myklebust, Grethe; Bencke, Jesper; Lauridsen, Hanne Bloch; Bandholm, Thomas; Thorborg, Kristian; Hölmich, Per; Aagaard, Per

    2016-05-01

    Adolescent female football and handball players are among the athletes with the highest risk of sustaining anterior cruciate ligament (ACL) injuries. This study evaluated the effects of evidence-based lower extremity injury prevention training on neuromuscular and biomechanical risk factors for non-contact ACL injury. 40 adolescent female football and handball players (15-16 years) were randomly allocated to a control group (CON, n=20) or neuromuscular training group (NMT, n=20). The NMT group performed an injury prevention programme as a warm-up before their usual training 3 times weekly for 12 weeks. The CON group completed their regular warm-up exercise programme before training. Players were tested while performing a side cutting movement at baseline and 12-week follow-up, using surface electromyography (EMG) and three-dimensional movement analysis. We calculated: (1) EMG amplitude from vastus lateralis (VL), semitendinosus (ST) and biceps femoris 10 ms prior to initial contact (IC) normalised to peak EMG amplitude recorded during maximal voluntary isometric contraction and (2) VL-ST EMG preactivity difference during the 10 ms prior to foot contact (primary outcome). We measured maximal knee joint valgus moment and knee valgus angle at IC. There was a difference between groups at follow-up in VL-ST preactivity (43% between-group difference; 95% CI 32% to 55%). No between-group differences were observed for kinematic and kinetic variables. A 12-week injury prevention programme in addition to training and match play in adolescent females altered the pattern of agonist-antagonist muscle preactivity during side cutting. This may represent a more ACL-protective motor strategy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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

    Directory of Open Access Journals (Sweden)

    Holmström Eva

    2007-04-01

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

  3. ACL injuries – treatment and patients´ experiences of outpatient surgery at UNN 2008-2010

    OpenAIRE

    Pada, Marika Teresia

    2013-01-01

    Background: Since 2003 anterior cruciate ligament reconstructions have been done as outpatient surgery at the University Hospital of North Norway, UNN. Previously, the surgeries required overnight hospital stay. In 2010 a survey was done to see the experiences of the patients to whom ACL reconstruction was done 2004-2007. Thesis aims: This master thesis will focus on the patients that underwent surgery during 2008-2010, to see if the routines at UNN have improved over the past few years. Impo...

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    /chondral surgery, 60% of meniscal tears and 80% of chondral lesions had worsened since the time of primary ACLR. CONCLUSION: Concurrent injury was common in this group of elite ski racers. Primary ACL tears were typically accompanied by lateral compartment chondral lesions and complex meniscal tears that worsened...... over time. ACL/MCL tears were the most common multiligament injury pattern.......BACKGROUND: Anterior cruciate ligament (ACL) tear is the most frequent injury in alpine ski racing, and there is a high prevalence of ACL reinjury. Limited data exist on the concurrent pathology with primary ACL tears in elite alpine ski racers and the magnitude of injury progression after primary...

  5. Biomechanical evaluation of the side-cutting manoeuvre associated with ACL injury in young female handball players

    DEFF Research Database (Denmark)

    Bencke, Jesper; Curtis, Derek; Krogshede, Christina

    2013-01-01

    The purpose of the study was to investigate the biomechanics of the knee and hip joint during handball-specific side-cutting on the dominant and non-dominant leg. Understanding the sports-specific biomechanics may improve prevention measures and post-injury treatment....

  6. A Commentary on Real-Time Biofeedback to Augment Neuromuscular Training for ACL Injury Prevention in Adolescent Athletes

    Directory of Open Access Journals (Sweden)

    Adam W. Kiefer

    2015-03-01

    Full Text Available Anterior cruciate ligament injury and the associated long-term sequelae, such as immediate reductions in physical inactivity, increased adiposity and increased risk of osteoarthritis throughout adulthood, are a major health concern for adolescent athletes. Current interventions for injury prevention may have limited effectiveness, are susceptible to issues of compliance and have not achieved the widespread acceptance necessary to promote full adoption. Neuromuscular training (NMT is a well-established training intervention introduced to affect change in modifiable biomechanical risk factors to reduce the risk of injury in these athletes. Despite moderate success, neuromuscular training is still limited by its reliance on subjective feedback and after the fact (i.e., offline objective feedback techniques. The purpose of this commentary is to discuss technological tools that could be used to enhance and objectify targeted biofeedback interventions to complement NMT. Electromyography, force plates, motion sensors, and camera-based motion capture systems are innovative tools that may have realistic feasibility for integration as biofeedback into NMT programs to improve training outcomes. Improved functional deficit identification and corrective analysis may further improve and optimize athletic performance, and decrease the risk of sports-related injury during sport performance.

  7. Increasing hip and knee flexion during a drop-jump task reduces tibiofemoral shear and compressive forces: implications for ACL injury prevention training.

    Science.gov (United States)

    Tsai, Liang-Ching; Ko, Yi-An; Hammond, Kyle E; Xerogeanes, John W; Warren, Gordon L; Powers, Christopher M

    2017-12-01

    Although most ACL injury prevention programmes encourage greater hip and knee flexion during landing, it remains unknown how this technique influences tibiofemoral joint forces. We examined whether a landing strategy utilising greater hip and knee flexion decreases tibiofemoral anterior shear and compression. Twelve healthy women (25.9 ± 3.5 years) performed a drop-jump task before and after a training session (10-15 min) that emphasised greater hip and knee flexion. Peak tibiofemoral anterior shear and compressive forces were calculated using an electromyography (EMG)-driven knee model that incorporated joint kinematics, EMG and participant-specific muscle volumes and patella tendon orientation measured using magnetic resonance imaging (MRI). Participants demonstrated a decrease in peak anterior tibial shear forces (11.1 ± 3.3 vs. 9.6 ± 2.7 N · kg -1 ; P = 0.008) and peak tibiofemoral compressive forces (68.4 ± 7.6 vs. 62.0 ± 5.5 N · kg -1 ; P = 0.015) post-training. The decreased peak anterior tibial shear was accompanied by a decrease in the quadriceps anterior shear force, while the decreased peak compressive force was accompanied by decreased ground reaction force and hamstring forces. Our data provide justification for injury prevention programmes that encourage greater hip and knee flexion during landing to reduce tibiofemoral joint loading.

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

    NARCIS (Netherlands)

    van Eck, C.F.; Martins, C.A.Q.; Vyas, S.M.; Celentano, U.; van Dijk, C.N.; Fu, F.H.

    2010-01-01

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

  9. The homing of bone marrow MSCs to non-osseous sites for ectopic bone formation induced by osteoinductive calcium phosphate.

    NARCIS (Netherlands)

    Song, G.; Habibovic, Pamela; Bao, Chongyun; Hu, J.; van Blitterswijk, Clemens; Yuan, Huipin; Chen, W.; Xu, H.H.K.

    2013-01-01

    Osteoinductive biomaterials are promising for bone repair. There is no direct proof that bone marrow mesenchymal stem cells (BMSCs) home to non-osseous sites and participate in ectopic bone formation induced by osteoinductive bioceramics. The objective of this study was to use a sex-mismatched

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    Background To analyse 5-year cost-effectiveness of early versus optional delayed acute anterior cruciate ligament (ACL) reconstruction. Methods 121 young, active adults with acute ACL injury to a previously uninjured knee were randomised to early ACL reconstruction (n=62, within 10 weeks of injur...

  11. ACL injury risk in elite female youth soccer: Changes in neuromuscular control of the knee following soccer-specific fatigue.

    Science.gov (United States)

    De Ste Croix, M B A; Priestley, A M; Lloyd, R S; Oliver, J L

    2015-10-01

    Fatigue is known to influence dynamic knee joint stability from a neuromuscular perspective, and electromechanical delay (EMD) plays an important role as the feedback activation mechanism that stabilizes the joint. The aim of this study was to investigate the influence of soccer-specific fatigue on EMD in U13-, U15-, and U17-year-old female soccer players. Thirty-six youth soccer players performed eccentric actions of the hamstrings in a prone position at 60, 120, and 180°/s before and after a soccer-specific fatigue trial. Surface electromyography was used to determine EMD from the semitendinosus, biceps femoris and gastrocnemius. A time × age × muscle × velocity repeated measures analysis of variance was used to explore the influence of fatigue on EMD. A significant main effect for time (P = 0.001) indicated that EMD was significantly longer post- compared with pre-fatigue (58.4% increase). A significant time × group interaction effect (P = 0.046) indicated EMD was significantly longer in the U13 age group compared with the U15 (P = 0.011) and U17 (P = 0.021) groups and greater post-fatigue. Soccer-specific fatigue compromised neuromuscular feedback mechanisms and the age-related effects may represent a more compliant muscle-tendon system in younger compared with older girls, increasing risk of injury. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Anterior Cruciate Ligament (ACL) Injuries

    Science.gov (United States)

    ... still feel like part of the team. Keeping score, being a coach's assistant, or bringing water to your teammates may help. If you don't want to do these, start something new, like playing the guitar, painting, drawing, or another activity that won't ...

  13. Clinical significance of abnormal nonosseous soft tissue uptake of bone tracer

    International Nuclear Information System (INIS)

    Zhu Bao; Shang Yukun; Li Jiannan; Bai Jing; Cai Liang

    2006-01-01

    Objective: To evaluate the clinical significance of abnormal soft tissue uptake of bone tracer. Methods: Thirty patients with abnormal soft tissue uptake of bone tracer on 99 Tc m -methylene diphosphonic acid (MDP) skeletal imaging were analyzed. Radioactivity of soft tissue accumulated equal to or greater than the ribs were considered as abnormal. The result was compared with pathology, MRI, CT, X-ray, ultrasound, findings for evaluating its clinical significance. Results: In 7 patients with diffuse liver uptake of 99 Tc m -MDP, 6 were massive and 1 nodular liver cancer. In 2 patients with local liver uptake, one was metastatic and the other primary liver cancer. In 5 local lung uptake cases 4 were primary lung cancer and one metastatic. In 5 cases with colonic uptake 1 was schistosomiasis while the other 4 unexplainable. Subcutaneous tissue uptake was observed in 4 patients, symmetrical uptake in 2 patients with metastatic calcification microfoci in multiple myeloma, unsymmetrical uptake in 2 patients with hemangioma and abscess. Pleural uptake in 3 patients all was metastatic cancer. Abdominal uptake in 3 patients was omentum, paravertebral soft tissue metastasis and unknown cause. Breast uptake in one patient was due to breast cancer. Conclusions: There are many causes resulting in abnormal nonosseous soft tissue uptake of 99 Tc m -MDP. The final diagnosis should correlate with clinical data and other examinations. (authors)

  14. Update on rehabilitation following ACL reconstruction

    Directory of Open Access Journals (Sweden)

    John Nyland

    2010-09-01

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

  15. Update on rehabilitation following ACL reconstruction

    Science.gov (United States)

    Nyland, John; Brand, Emily; Fisher, Brent

    2010-01-01

    As anterior cruciate ligament (ACL) reconstruction has evolved to less invasive, more anatomical approaches, rehabilitation of the injured athlete has likewise become more progressive and innovative, with a sound understanding of graft and fixation strength and biologic healing-remodeling constraints. This review discusses these innovations including specific considerations before surgery, when planning rehabilitation timetables, and the importance of reestablishing nonimpaired active and passive knee range of motion and biarticular musculotendinous extensibility in positions of function. Concepts of self-efficacy or confidence and reestablishing the “athlete role” are also addressed. Since ACL injury and reinjury are largely related to the influence of structure-form-function on dynamic knee joint stability, the interrelationships between sensorimotor, neuromuscular, and conventional resistance training are also discussed. Although pivot shift “giving way” relates to function loss following ACL injury, anterior translational laxity often does not. Although there is growing evidence that progressive eccentric training may benefit the patient following ACL reconstruction, there is less evidence supporting the use of functional ACL knee braces. Of considerable importance is selecting and achieving a criteria-based progression to sports-specific training, reestablishing osseous homeostasis and improved bone density, blending open and closed kinetic chain exercises at the appropriate time period, and appreciating the influence of the trunk, upper extremities, and sports equipment use on knee loads. We believe that knee dysfunction and functional recovery should be considered from a local, regional, and global perspective. These concepts are consolidated into our approach to prepare patients for return to play including field testing and maintenance training. PMID:24198553

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

    Directory of Open Access Journals (Sweden)

    Tahmasebi MN

    2009-04-01

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

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

    OpenAIRE

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

    2014-01-01

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

  18. ACL Graft Healing and Biologics

    NARCIS (Netherlands)

    Muller, Bart; Bowman, Karl F.; Bedi, Asheesh

    2013-01-01

    Operative reconstruction of a torn anterior cruciate ligament (ACL) has become the most broadly accepted treatment. An important, but underreported, outcome of ACL reconstruction is graft failure, which poses a challenge for the orthopedic surgeon. An understanding of the tendon-bone healing and the

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    Rupture of the anterior cruciate ligament (ACL) causes changes in the walking pattern. ACL deficient subjects classified as copers and non-copers have been observed to adopt different post-injury walking patterns. How these different patterns affect the knee compression and shear forces...

  20. Femoral intercondylar notch shape and dimensions in ACL-injured patients

    NARCIS (Netherlands)

    van Eck, Carola F.; Martins, Cesar A. Q.; Vyas, Shail M.; Celentano, Umberto; van Dijk, C. Niek; Fu, Freddie H.

    2010-01-01

    The femoral intercondylar notch has been an anatomic site of interest as it houses the anterior cruciate ligament (ACL). The objective of this study was to arthroscopically evaluate the femoral notch in patients with known ACL injury. This evaluation included establishing a classification for notch

  1. ACL Return to Sport Guidelines and Criteria.

    Science.gov (United States)

    Davies, George J; McCarty, Eric; Provencher, Matthew; Manske, Robert C

    2017-09-01

    Because of the epidemiological incidence of anterior cruciate ligament (ACL) injuries, the high reinjury rates that occur when returning back to sports, the actual number of patients that return to the same premorbid level of competition, the high incidence of osteoarthritis at 5-10-year follow-ups, and the effects on the long-term health of the knee and the quality of life for the patient, individualizing the return to sports after ACL reconstruction (ACL-R) is critical. However, one of the challenging but unsolved dilemmas is what criteria and clinical decision making should be used to return an athlete back to sports following an ACL-R. This article describes an example of a functional testing algorithm (FTA) as one method for clinical decision making based on quantitative and qualitative testing and assessment utilized to make informed decisions to return an athlete to their sports safely and without compromised performance. The methods were a review of the best current evidence to support a FTA. In order to evaluate all the complicated domains of the clinical decision making for individualizing the return to sports after ACL-R, numerous assessments need to be performed including the biopsychosocial concepts, impairment testing, strength and power testing, functional testing, and patient-reported outcomes (PROs). The optimum criteria to use for individualizing the return to sports after ACL-R remain elusive. However, since this decision needs to be made on a regular basis with the safety and performance factors of the patient involved, this FTA provides one method of quantitatively and qualitatively making the decisions. Admittedly, there is no predictive validity of this system, but it does provide practical guidelines to facilitate the clinical decision making process for return to sports. The clinical decision to return an athlete back into competition has significant implications ranging from the safety of the athlete, to performance factors and actual

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

    Science.gov (United States)

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

    2013-04-01

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

  3. POST-OPERATIVE REHABILITATION PROGRAM AFTER SURGERY ACL RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Zoran Đokić

    2013-07-01

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

  4. Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort.

    Science.gov (United States)

    Wright, Rick W; Huston, Laura J; Spindler, Kurt P; Dunn, Warren R; Haas, Amanda K; Allen, Christina R; Cooper, Daniel E; DeBerardino, Thomas M; Lantz, Brett Brick A; Mann, Barton J; Stuart, Michael J

    2010-10-01

    Revision anterior cruciate ligament (ACL) reconstruction has worse outcomes than primary reconstructions. Predictors for these worse outcomes are not known. The Multicenter ACL Revision Study (MARS) Group was developed to perform a multisurgeon, multicenter prospective longitudinal study to obtain sufficient subjects to allow multivariable analysis to determine predictors of clinical outcome. To describe the formation of MARS and provide descriptive analysis of patient demographics and clinical features for the initial 460 enrolled patients to date in this prospective cohort. Cross-sectional study; Level of evidence, 2. After training and institutional review board approval, surgeons began enrolling patients undergoing revision ACL reconstruction, recording patient demographics, previous ACL reconstruction methods, intra-articular injuries, and current revision techniques. Enrolled subjects completed a questionnaire consisting of validated patient-based outcome measures. As of April 1, 2009, 87 surgeons have enrolled a total of 460 patients (57% men; median age, 26 years). For 89%, the reconstruction was the first revision. Mode of failure as deemed by the revising surgeon was traumatic (32%), technical (24%), biologic (7%), combination (37%), infection (MARS Group has been able to quickly accumulate the largest revision ACL reconstruction cohort reported to date. Traumatic reinjury is deemed by surgeons to be the most common single mode of failure, but a combination of factors represents the most common mode of failure. Allograft graft choice is more common in the revision setting than autograft. Concomitant knee injury is extremely common in this population.

  5. The acutely ACL injured knee assessed by MRI

    DEFF Research Database (Denmark)

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

    2008-01-01

    OBJECTIVES: To map by magnetic resonance imaging (MRI) and quantitative MRI (qMRI) concomitant fractures and meniscal injuries, and location and volume of traumatic bone marrow lesions (BMLs) in the acutely anterior cruciate ligament (ACL) injured knee. To relate BML location and volume to cortic...

  6. Osseous and Nonosseous Bone Scan Findings in Liver Transplant Candidates with end-stage Chronic Liver Disease

    Directory of Open Access Journals (Sweden)

    Seval Erhamamcı

    2013-08-01

    Full Text Available Objective: End-stage chronic liver disease (CLD adversely affects the function of multiple organ systems including the skeletal system. The aim of this study was to assess osseous and nonosseous bone scintigraphy (BS findings in liver transplant (LT candidates with end-stage CLD. Methods: We retrospectively evaluated BS findings in 50 consecutive patients with end-stage CLD who were undergoing preoperative assessment for LT from January 2006 to December 2011. All the patients were analyzed with respect to clinical and laboratory parameters, and BS findings. Scintigrams were visually assessed for the presence of osseous and nonosseous abnormalities. Osseous abnormalities were classified as those indicating bone metabolism changes or metastatic bone disease. Typical scintigraphic findings denoting to changes in bone metabolism were the presence of decreased osseous uptake, increased periarticular uptake, asymmetrical or unusual uptake patterns. Nonosseous findings were classified according to the degree of soft-tissue uptake as mild and severe. Results: The group consisted of 46 adult and 4 adolescent patients. All adolescent patients had normal skeletal accumulation with growth plate uptake and one had mildly increased renal cortical activity. A total of 46 adult patients had one or more of the following osseous findings: generalized decrease in osseous uptake (n=4, 8.7%; bilateral decrease in lower extremity uptake (n=26, 56.5%; symmetrically increased periarticular uptake (n=26, 56.5%; bilateral cortical/periosteal increased uptake in the lower extremity indicating hepatic hypertrophic osteoarthropathy (HOA (n=8, 17.4%; bilateral increased sacroiliac activity (n=16, 34.8%; sacral activity (n=10, 21.7%, coccygeal activity (n=2, 4.3%, focally increased uptake suggestive of metastases (n=5, 10.9%. Three rib metastases appeared to be linear. Nonosseous findings observed in adult patients were mild diffuse liver uptake (n=4, 8.7% and bilateral

  7. Diagnosis of non-osseous spinal metastatic disease: the role of PET/CT and PET/MRI.

    Science.gov (United States)

    Batouli, Ali; Braun, John; Singh, Kamal; Gholamrezanezhad, Ali; Casagranda, Bethany U; Alavi, Abass

    2018-06-01

    The spine is the third most common site for distant metastasis in cancer patients with approximately 70% of patients with metastatic cancer having spinal involvement. Positron emission tomography (PET), combined with computed tomography (CT) or magnetic resonance imaging (MRI), has been deeply integrated in modern clinical oncology as a pivotal component of the diagnostic work-up of patients with cancer. PET is able to diagnose several neoplastic processes before any detectable morphological changes can be identified by anatomic imaging modalities alone. In this review, we discuss the role of PET/CT and PET/MRI in the diagnostic management of non-osseous metastatic disease of the spinal canal. While sometimes subtle, recognizing such disease on FDG PET/CT and PET/MRI imaging done routinely in cancer patients can guide treatment strategies to potentially prevent irreversible neurological damage.

  8. The homing of bone marrow MSCs to non-osseous sites for ectopic bone formation induced by osteoinductive calcium phosphate

    Science.gov (United States)

    Song, Guodong; Habibovic, Pamela; Bao, Chongyun; Hu, Jing; van Blitterswijk, Clemens A.; Yuan, Huipin; Chen, Wenchuan; Xu, Hockin H.K.

    2013-01-01

    Osteoinductive biomaterials are promising for bone repair. There is no direct proof that bone marrow mesenchymal stem cells (BMSCs) home to non-osseous sites and participate in ectopic bone formation induced by osteoinductive bioceramics. The objective of this study was to use a sex-mismatched beagle dog model to investigate BMSC homing via blood circulation to participate in ectopic bone formation via osteoinductive biomaterial. BMSCs of male dogs were injected into female femoral marrow cavity. The survival and stable chimerism of donor BMSCs in recipients were confirmed with polymerase chain reaction (PCR) and fluorescence in situ hybridization (FISH). Biphasic calcium phosphate (BCP) granules were implanted in dorsal muscles of female dogs. Y chromosomes were detected in samples harvested from female dogs which had received male BMSCs. At 4 weeks, cells with Y-chromosomes were distributed in the new bone matrix throughout the BCP granule implant. At 6 weeks, cells with Y chromosomes were present in newly mineralized woven bone. TRAP positive osteoclast-like cells were observed in 4-week implants, and the number of such cells decreased from 4 to 6 weeks. These results show that osteoprogenitors were recruited from bone marrow and homed to ectopic site to serve as a cell source for calcium phosphate-induced bone formation. In conclusion, BMSCs were demonstrated to migrate from bone marrow through blood circulation to non-osseous bioceramic implant site to contribute to ectopic bone formation in a canine model. BCP induced new bone in muscles without growth factor delivery, showing excellent osteoinductivity that could be useful for bone tissue engineering. PMID:23298780

  9. Jumping performance differences among elite professional handball players with or without previous ACL reconstruction.

    Science.gov (United States)

    Setuain, I; Millor, N; Alfaro, J; Gorostiaga, E; Izquierdo, M

    2015-10-01

    Handball is one of the most challenging sports for the knee joint. Persistent strength and jumping capacity alterations may be observed among athletes who have suffered anterior cruciate ligament (ACL) injury. The aim of this study was to examine unilateral and bilateral jumping ability differences between previously ACL-reconstructed rehabilitated elite handball athletes and sex, age and uninjured sport activity level-pairs of control players. It was a Cross-sectional study with one factor: previous ACL injury. We recruited 22 male (6 ACL-reconstructed and 16 uninjured control players) and 21 female (6 ACL-reconstructed and 15 uninjured control players) elite handball players who were evaluated 6.2±3.4 years after surgical ACL reconstruction. A battery of jump tests, including both bilateral and unilateral maneuvers, was performed. Two-tailed unpaired (intergroup comparison) and paired (intragroup comparison) t-tests were performed for mean comparisons. The P-value cut-off for significance was set at handball athletes demonstrated both lower vertical bilateral drop jump (VBDJ) contact times and lower UTHD scores for the injured leg several years after injury. These deficits could contribute to an increase in ACL re-injury risk.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    PURPOSE: Due to the importance of hamstrings (HAM) and quadriceps (QUAD) strength for anterior cruciate ligament (ACL) injury prevention, and the high incidence of ACL injury in ski racing, HAM and QUAD maximal and explosive strength was assessed in ski racers with and without ACL reconstruction...... (ACL-R). METHODS: Uninjured (n=13 males; n=8 females) and ACL-R (n=3 males; n=5 females; 25.0±11.3 months post-op) elite ski racers performed maximal voluntary isometric HAM and QUAD contractions to obtain maximal torque (MVC) and rate of torque development (RTD) at 0-50, 0-100, 0-150 and 0-200 ms. MVC...... and RTD (per kg body mass) were calculated for the uninjured group to compare between sexes, and to compare the control group with the ACL-R limb and unaffected limb of the ACL-R skiers. H/Q MVC and RTD strength ratios were also compared RESULTS: The ACL-R limb demonstrated significant HAM and QUAD...

  11. CURBSIDE CONSULTATION OF THE ACL: 49 CLINICAL QUESTIONS

    Directory of Open Access Journals (Sweden)

    Bernard R. Bach

    2008-09-01

    Full Text Available DESCRIPTION A unique reference that offers opinions, preferences and expert advice associated with management of ACL injuries in the questions and answers format which enhanced by images, diagrams and references. PURPOSE "Curbside Consultation of the ACL" aims to provide some knowledge more than the basic information in the evaluation and the management of ACL injuries. This information is based on the opinion or the advice of an expert. Quick access of audience to these pearl and pit-falls and evidence-based expert advice for complicated cases in ACL reconstruction in the form of brief answers including current concepts is targeted by the authors. FEATURES 49 Clinical questions are outlined in 5 sections. In the first section is about preoperative questions including indications, diagnostic measures, combined ligament injuries, graft choice, preparation before surgery, avulsion of the eminence, examination in posterolateral corner injury. In the second section is preoperative questions are subjected including dropping the graft to the floor, posterior wall blowout, knees without hamstring tendon, graft amputation by interference screw, to avoid vertical tunnel in tibia, fixation methods of graft, femoral and tibial tunnel positioning. Third section is about postoperative questions including postoperative management, differences in postoperative rehabilitation protocols in different type of grafts, postoperative man-agement of meniscal repair, management in difficulties in gaining extension, infection, patellar pain, timing of reop-eration in motion problems, criteria returning to sports, outcome measures, outcome in using different grafts, role of bracing. The fourth section is about failed ACL recon-struction including causes, indications for revision, ex-panded tunnels, graft choice in revision surgery, contro-lateral patellar tendon graft for revision, rehab protocol after revision surgery, hardware removal, early degenera-tive joint disease

  12. Muscular activity during dynamic squats in patients with ACL reconstruction.

    Science.gov (United States)

    Ceaglio, Sebastian; Alberto, Federico; Catalfamo, Paola Andrea; Braidot, Ariel Andres

    2010-01-01

    One of the most frequent injuries in subjects who practice sport is the rupture of the anterior cruciate ligament (ACL). Appropriate reconstruction and rehabilitation are key issues in full recovery of patients and their return to previous activities. This paper presents a new method to estimate muscle strength during a dynamic exercise from kinematic and electromyographic (EMG) data. Recovery of patients with ACL rupture and reconstruction was evaluated 4 and 6 months after surgery by assessing the differences in knee extensor and flexor muscle activity between the unimpaired and injured limbs. The results show that squat EMGs from the extensor muscles of the knee from the injured and unimpaired limb could help assess rehabilitation outputs in patients who had undergone an ACL reconstructive surgery.

  13. Injury to the Infrapatellar Branch of the Saphenous Nerve during ACL Reconstruction with Hamstring Tendon Autograft: A Comparison between Oblique and Vertical Incisions

    Directory of Open Access Journals (Sweden)

    Hamid Mousavi

    2018-01-01

    Full Text Available Background: Injury to the infrapatellar branch of the saphenous nerve (IPBSN is common after arthroscopic ACLreconstruction with hamstring tendon autograft, as reported in up to 88% of the cases. Due to close relationshipbetween the IPBSN with pes anserine tendons insertion skin incision may sever IPBSN while harvesting gracillis andsemitendinous tendons. As the IPBSN course at the anterior of knee is oblique, we hypothesized a parallel skin incisionwith nerve passage may decrease nerve injury.Methods: Vertical and oblique incisions were compared in 79 patients in this clinical trial. The sensory loss area andpatients’ complain of numbness were measured at 2 and 8 weeks as well as 6 months after surgery.Results: Both the sensory loss area and patients’ complain of numbness decreased significantly in the oblique incisiongroup (P

  14. Knee joint kinematics and kinetics during the hop and cut after soft tissue artifact suppression: Time to reconsider ACL injury mechanisms?

    Science.gov (United States)

    Smale, Kenneth B; Potvin, Brigitte M; Shourijeh, Mohammad S; Benoit, Daniel L

    2017-09-06

    The recent development of a soft tissue artifact (STA) suppression method allows us to re-evaluate the tibiofemoral kinematics currently linked to non-contact knee injuries. The purpose of this study was therefore to evaluate knee joint kinematics and kinetics in six degrees of freedom (DoF) during the loading phases of a jump lunge and side cut using this in silico method. Thirty-five healthy adults completed these movements and their surface marker trajectories were then scaled and processed with OpenSim's inverse kinematics (IK) and inverse dynamics tools. Knee flexion angle-dependent kinematic constraints defined based on previous bone pin (BP) marker trajectories were then applied to the OpenSim model during IK and these constrained results were then processed with the standard inverse dynamics tool. Significant differences for all hip, knee, and ankle DoF were observed after STA suppression for both the jump lunge and side cut. Using clinically relevant effect size estimates, we conclude that STA contamination had led to misclassifications in hip transverse plane angles, knee frontal and transverse plane angles, medial/lateral and distractive/compressive knee translations, and knee frontal plane moments between the NoBP and the BP IK solutions. Our results have substantial clinical implications since past research has used joint kinematics and kinetics contaminated by STA to identify risk factors for musculoskeletal injuries. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Novel Insights into Anterior Cruciate Ligament Injury

    NARCIS (Netherlands)

    D.E. Meuffels (Duncan)

    2011-01-01

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

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    The aim of the present single-case study was to investigate the effect of 6 weeks' kettlebell training on the neuromuscular risk profile for ACL injury in a high-risk athlete returning to sport after ACL reconstruction. A female elite soccer player (age 21 years) with no previous history of ACL...... for semitendinosus and elevated EMG preactivity for vastus lateralis. Subsequently, the 6-week kettlebell training increased semitendinosus muscle preactivity during sidecutting by 38 percentage points to a level equivalent to a neuromuscular low-risk profile. An ACL rehabilitated female athlete with a high...

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

    NARCIS (Netherlands)

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

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

  18. Anterior cruciate ligament injuries in soccer: Loading mechanisms, risk factors, and prevention programs

    Directory of Open Access Journals (Sweden)

    Boyi Dai

    2014-12-01

    Full Text Available Anterior cruciate ligament (ACL injuries are common in soccer. Understanding ACL loading mechanisms and risk factors for ACL injury is critical for designing effective prevention programs. The purpose of this review is to summarize the relevant literature on ACL loading mechanisms, ACL injury risk factors, and current ACL injury prevention programs for soccer players. Literature has shown that tibial anterior translation due to shear force at the proximal end of tibia is the primary ACL loading mechanism. No evidence has been found showing that knee valgus moment is the primary ACL loading mechanism. ACL loading mechanisms are largely ignored in previous studies on risk factors for ACL injury. Identified risk factors have little connections to ACL loading mechanisms. The results of studies on ACL injury prevention programs for soccer players are inconsistent. Current ACL injury prevention programs for soccer players are clinically ineffective due to low compliance. Future studies are urgently needed to identify risk factors for ACL injury in soccer that are connected to ACL loading mechanisms and have cause-and-effect relationships with injury rate, and to develop new prevention programs to improve compliance.

  19. Electrospinning polymer blends for biomimetic scaffolds for ACL tissue engineering

    Science.gov (United States)

    Garcia, Vanessa Lizeth

    The anterior cruciate ligament (ACL) rupture is one of the most common knee injuries. Current ACL reconstructive strategies consist of using an autograft or an allograft to replace the ligament. However, limitations have led researchers to create tissue engineered grafts, known as scaffolds, through electrospinning. Scaffolds made of natural and synthetic polymer blends have the potential to promote cell adhesion while having strong mechanical properties. However, enzymes found in the knee are known to degrade tissues and affect the healing of intra-articular injuries. Results suggest that the natural polymers used in this study modify the thermal properties and tensile strength of the synthetic polymers when blended. Scanning electron microscopy display bead-free and enzyme biodegradability of the fibers. Raman spectroscopy confirms the presence of the natural and synthetic polymers in the scaffolds while, amino acid analysis present the types of amino acids and their concentrations found in the natural polymers.

  20. Evidence-Based ACL Reconstruction

    Directory of Open Access Journals (Sweden)

    E. Carlos RODRIGUEZ-MERCHAN

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Matthias Jacobi

    2016-01-01

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

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

    Science.gov (United States)

    ... Quickly stop moving and change direction while running, landing from a jump, or turning Skiers and people ... Health and Human Services National Institutes of Health Page last updated: 30 April 2018

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

    Directory of Open Access Journals (Sweden)

    Fabiano Kupczik

    2013-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Ashish R. Agarwal

    2017-08-01

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

  5. Anatomic Double-bundle ACL Reconstruction

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Francine Goulet

    2004-01-01

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

  8. MR imaging of the combined anterior and posterior cruciate ligament tears: focussing on the ratterns of injuries and associated findings

    International Nuclear Information System (INIS)

    Kwon, Seon Young; Choi, Chang Lak; Park, Dal Soo; Park, Eun Hee; Lee, Sang Ho; Song, Mun Kab; Lee, Kwang Won; Kwon, Soon Tae

    1997-01-01

    To evaluate the patterns of injuries and frequency of associated findings on MR imaging in patients with both anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL)tears;to compare the associated findings, as seen on MR imaging, in cases with both ACL and PCL tears with those with ACL or PCL tears. Ten patients with compbined ACL and PCL tears, 16 with ACL tears and 18 with PCL tears, all confirmed by arthroscopy or open surgery, were involved in this study. To identify the associated knee injuries, MR images were retrospectively evaluated. In ten patients with combined ACL and PCL tears, open surgery led to the identification of six complete ACL tears (60%), four partial ACL tears (40%), eitht complete PCL tears (80%) and two partial PCL tears (20%). Injuries associated with these combined tears, and revealed by MR imaging, comprised six medial collateral ligament injuries (60%), six lateral collateral ligament jnjuries (60%), five medial meniscal injuries (50%), three lateral meniscal injuries (30%), nine bony injuries (90%), two posterior capsular injuries (20%), and three popliteus muscle injuries (30%). The frequency of popliteus muscle injury was significantly different (p<0.05, Fisher's exact test) between the group with both ACL and PCL tears and that with ACL or PCL tears. Associated findings in patients with combined ACL and PCL tears are more frequent than in those with ACL or PCL tears. In cases involving combined ACL and PCL tears, associated findings-as seen on MR images-should thus be carefully examined

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

    Science.gov (United States)

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

    2018-03-01

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

  10. Longitudinal analysis of tibiofemoral cartilage contact area and position in ACL reconstructed patients.

    Science.gov (United States)

    Chen, Ellison; Amano, Keiko; Pedoia, Valentina; Souza, Richard B; Ma, C Benjamin; Li, Xiaojuan

    2018-04-18

    Patients who have suffered ACL injury are more likely to develop early onset post-traumatic osteoarthritis despite reconstruction. The purpose of our study was to evaluate the longitudinal changes in the tibiofemoral cartilage contact area size and location after ACL injury and reconstruction. Thirty-one patients with isolated unilateral ACL injury were followed with T 2 weighted Fast Spin Echo, T 1ρ and T 2 MRI at baseline prior to reconstruction, and 6 months, 1 year, and 2 years after surgery. Areas were delineated in FSE images with an in-house Matlab program using a spline-based semi-automated segmentation algorithm. Tibiofemoral contact area and centroid position along the anterior-posterior axis were calculated along with T 1ρ and T 2 relaxation times on both the injured and non-injured knees. At baseline, the injured knees had significantly smaller and more posteriorly positioned contact areas on the medial tibial surface compared to corresponding healthy knees. These differences persisted 6 months after reconstruction. Moreover, subjects with more anterior medial centroid positions at 6 months had elevated T 1ρ and T 2 measures in the posterior medial tibial plateau at 1 year. Changes in contact area and centroid position after ACL injury and reconstruction may characterize some of the mechanical factors contributing to post-traumatic osteoarthritis. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

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

    Science.gov (United States)

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

  12. Tibialis anterior volumes and areas in ACL-injured limbs compared with unimpaired.

    Science.gov (United States)

    Binder-Macleod, Benjamin I; Buchanan, Thomas S

    2006-09-01

    Past research has shown that subjects with ACL injuries show activation differences and atrophy in the muscles that cross the knee, including the gastrocnemii, which predominately act at the ankle. However, it is not known how the other ankle muscles that do not cross the knee are affected. We focused on the two muscles that control the ankle, the soleus and tibialis anterior muscles, to see how they were affected by an ACL injury. We hypothesized that the ankle muscles of subjects with ACL injuries that did not require surgery (copers) would be more like normals and that the muscles of subjects with ACL injuries who required surgery to return to normal activity (noncopers) would atrophy. Twenty-seven subjects were divided into three even categories: unimpaired subjects, copers, and noncopers. Axial spin-echo T1-weighted MRI images were used to digitally reconstruct the tibialis anterior and the soleus. We used the digitally reconstructed muscles to determine the peak cross-sectional area and volume of each muscle. The copers' tibialis anterior muscles were similar to the unimpaired subjects, but, surprisingly, the noncoper's tibialis anterior muscles of the injured leg were larger than those of their uninjured legs (P heel strike or from the inversion of the foot causing external rotation of the tibia as a stabilizing technique for the knee.

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

    Science.gov (United States)

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

    2013-06-01

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

  14. An Athlete's Nightmare: Tearing the ACL

    Science.gov (United States)

    ... on the balls of their feet. "If the calf muscles are not absorbing the force, and if the knee is not in the proper position, the knee buckles and tears the ACL," explains Dr. Boden. After her initial ...

  15. Acute injury of anterior cruciate ligament during karate training.

    Science.gov (United States)

    Huang, Kuo-Chin; Hsu, Wei-Hsiu; Wang, Ting-Chung

    2007-06-01

    A 38-year-old black-belt karate practitioner presented with acute disabling injury of his knee after swift-withdrawal of a reverse-roundhouse-kick. Examination confirmed the diagnosis of grade III ACL tear. Although there are reports documenting injury rate in modern karate, no previous cases of karate-related ACL injuries have been reported. The trauma mechanism is different than ACL injuries during other non-contact and contact sports. The current case report indicates that ACL injury can occur without any contact of the lower limb as a result of dynamic muscular forces during karate training.

  16. Tears of anterior cruciate ligament and associated injury in the knee joint: MR imaging

    International Nuclear Information System (INIS)

    Kim, Eui Jong; Ryu, Kyung Nam; Ahn, Jin Whan; Yoon, Yup

    1994-01-01

    The objective of the study was to evaluate the characteristic findings in tears of the anterior cruciate ligament(ACL) and associated injury at MR imaging. We reviewed the findings of MR images and the corresponding arthroscopic results of 32 patients with ACL tears. We evaluated the signal intensity and contour of ACL surrounding bony structures, menisci and associated injury of the knee joint. Complete ACL tears were present in 25 patients and partial ACL tears were in 7 patients. Complete ACL tears showed heterogenously increased signal intensity with contour bulging of the ACL in 14 patients (56%) and without bulging or absence in 11 patients(44%). Most patients torn ACL with contour bulging(12/14) had bone bruise, but only one patient torn ACL without bulging contour had bone bruise. ACL with thin continuous low signal band surrounding heterogenously increased signal intensity suggests partial tear which was seen in three patients of seven proved partial ACL tears. Combined bone injury in ACL tear were in 23 patients (73%) and most of these(22/23) were at midportion of lateral notch of femur and/or posterior portion of lateral tibial plateu. Deepening of lateral notch of femur were noted in 17 patients(53%). Associated injuries of the other ligaments of knee joint were buckling of the posterior cruciate ligament(16/32, 50%) and tears of the medial collateral ligament(11/32, 34%). Posterior horns of menisci were more frequent site of combined injury within menisci in patients with ACL tear. Acute tearing of ACL in MRI is seen as heterogenously increased signal intensity with contour bulging of ACL and combined bone bruises. Patients with torn ACL frequently have various combined injury. In patient with knee injury, these associated or ancillary findings suggest that ACL tear is present

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

    Directory of Open Access Journals (Sweden)

    Fu Freddie H

    2011-06-01

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

  18. Pain in donor site after BTB-ACL reconstruction with PRGF: a randomized trial.

    Science.gov (United States)

    Seijas, Roberto; Cuscó, Xavier; Sallent, Andrea; Serra, Iván; Ares, Oscar; Cugat, Ramón

    2016-06-01

    Anterior cruciate ligament (ACL) tears are highly incident injuries in young athletes within our work area. The use of the patellar graft, despite being the treatment of choice, presents post-operative problems such as anterior knee pain, which limits its use and leads to preference being taken for alternative grafts. Our aim was to evaluate if the application of PRGF reduces anterior knee pain in donor site in BTB-ACL reconstruction. 43 patients were included in the double-blinded and randomized clinical trial comparing two patient groups who underwent ACL reconstruction using patellar tendon graft, comparing anterior knee pain with and without the application of PRGF at the donor site after harvesting the graft. The PRGF group showed decreased donor site pain in comparison to the control group, with significant differences in the first two months of follow-up. The application of PRGF decreased donor site pain compared to the control group.

  19. Strength Asymmetry and Landing Mechanics at Return to Sport after ACL Reconstruction

    Science.gov (United States)

    Schmitt, Laura C.; Paterno, Mark V.; Ford, Kevin R.; Myer, Gregory D.; Hewett, Timothy E.

    2014-01-01

    Purpose Evidence-based quadriceps femoris muscle (QF) strength guidelines for return to sport following anterior cruciate ligament (ACL) reconstruction are lacking. This study investigated the impact of QF strength asymmetry on knee landing biomechanics at the time of return to sport following ACL reconstruction. Methods Seventy-seven individuals (17.4 years) at the time of return to sport following primary ACL reconstruction (ACLR group) and 47 uninjured control individuals (17.0 years) (CTRL group) participated. QF strength was assessed and Quadriceps Index calculated (QI = [involved strength/uninvolved strength]*100%). The ACLR group was sub-divided based on QI: High Quadriceps (HQ, QI≥90%) and Low-Quadriceps (LQ, QIkinetic variables were collected during a drop vertical jump maneuver. Limb symmetry during landing, and discrete variables were compared among the groups with multivariate analysis of variance and linear regression analyses. Results The LQ group demonstrated worse asymmetry in all kinetic and ground reaction force variables compared to the HQ and CTRL groups, including reduced involved limb peak knee external flexion moments (p.05). In the ACLR group, QF strength estimated limb symmetry during landing after controlling for graft type, meniscus injury, knee pain and symptoms. Conclusion At the time of return to sport, individuals post-ACL reconstruction with weaker QF demonstrate altered landing patterns. Conversely, those with nearly symmetrical QF strength demonstrate landing patterns similar to uninjured individuals. Consideration of an objective QF strength measure may aid clinical decision-making to optimize sports participation following ACL reconstruction. PMID:25373481

  20. Knee stabiligy after ACL reconstruction through graft fixation in femoral tunnel: transfemoral pinning versus endobutton techniques

    Directory of Open Access Journals (Sweden)

    Tahmasebi MN

    2011-05-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: One of the most common orthopedic complaints is direct or indirect trauma to the knee with torn anterior cruciate ligament (ACL. Reconstruction of the torn ACL is emphatically offered in active individuals as by this operation, we prevent osteoarthritis, knee instability and injury to the meniscus. There are numerous methods for graft fixation in the femoral tunnel in ACL reconstruction. If the graft proves to be stable after the operation, patients would not complain of giving way knee joints. In this clinical trial, we compared transfemoral pinning with endobutton fixation of hamstring graft in arthroscopic ACL reconstruction by examining knee stability and use of other relevant functional tests. "n"nMethods : Fourteen Patients who had undergone arthroscopic ACL reconstruction in Shariati Hospital during the years 2008-2009 and were being followed up were evaluated at least 15 months post-operatively by physical examination and the use of an arthrometer made by the Faculty of Mechanics of Sharif Technical University."n"nResults : The results showed that two out of seven patients in which their ACL had been reconstructed by hamstring graft fixation by endobutton technique, and

  1. The effectiveness of injury-prevention programs in reducing the incidence of anterior cruciate ligament sprains in adolescent athletes.

    Science.gov (United States)

    Paszkewicz, Jeffrey; Webb, Tristen; Waters, Brian; Welch McCarty, Cailee; Van Lunen, Bonnie

    2012-11-01

    There is a high incidence of anterior cruciate ligament (ACL) injury in adolescents participating in pivoting sports such as soccer, basketball, and handball. Most ACL injuries in athletes are noncontact injuries, with a mechanism of sudden deceleration, change in direction, or landing from a jump. These mechanisms coupled with an increase in contraction of the quadriceps have been shown as risk factors for ACL injuries. Injuries to the ACL may require surgery, a long rehabilitation, and the potential for reinjury. Studies have shown reductions in lower extremity injury rates using training protocols that focus on landing mechanics, balance training, strength training, and/or agility training. There has been some thought that starting preventive training programs with adolescent athletes may be the most effective approach to reducing adolescent ACL injuries. Can lower extremity injury-prevention programs effectively reduce ACL injury rates in adolescent athletes?

  2. Neuromuscular Coordination Deficit Persists 12 Months after ACL Reconstruction But Can Be Modulated by 6 Weeks of Kettlebell Training: A Case Study in Women’s Elite Soccer

    Directory of Open Access Journals (Sweden)

    Mette K. Zebis

    2017-01-01

    Full Text Available The aim of the present single-case study was to investigate the effect of 6 weeks’ kettlebell training on the neuromuscular risk profile for ACL injury in a high-risk athlete returning to sport after ACL reconstruction. A female elite soccer player (age 21 years with no previous history of ACL injury went through neuromuscular screening as measured by EMG preactivity of vastus lateralis and semitendinosus during a standardized sidecutting maneuver. Subsequently, the player experienced a noncontact ACL injury. The player was screened again following postreconstruction rehabilitation, then underwent 6-week kettlebell training, and was subsequently screened again at 6-week follow-up. Prior to and after postreconstruction rehabilitation the player demonstrated a neuromuscular profile during sidecutting known to increase the risk for noncontact ACL injury, that is, reduced EMG preactivity for semitendinosus and elevated EMG preactivity for vastus lateralis. Subsequently, the 6-week kettlebell training increased semitendinosus muscle preactivity during sidecutting by 38 percentage points to a level equivalent to a neuromuscular low-risk profile. An ACL rehabilitated female athlete with a high-risk neuromuscular profile changed to low-risk in response to 6 weeks of kettlebell training. Thus, short-term kettlebell exercise with documented high levels of medial hamstring activation was found to transfer into high medial hamstring preactivation during a sidecutting maneuver.

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  4. Effect of axial tibial torque direction on ACL relative strain and strain rate in an in vitro simulated pivot landing.

    Science.gov (United States)

    Oh, Youkeun K; Kreinbrink, Jennifer L; Wojtys, Edward M; Ashton-Miller, James A

    2012-04-01

    Anterior cruciate ligament (ACL) injuries most frequently occur under the large loads associated with a unipedal jump landing involving a cutting or pivoting maneuver. We tested the hypotheses that internal tibial torque would increase the anteromedial (AM) bundle ACL relative strain and strain rate more than would the corresponding external tibial torque under the large impulsive loads associated with such landing maneuvers. Twelve cadaveric female knees [mean (SD) age: 65.0 (10.5) years] were tested. Pretensioned quadriceps, hamstring, and gastrocnemius muscle-tendon unit forces maintained an initial knee flexion angle of 15°. A compound impulsive test load (compression, flexion moment, and internal or external tibial torque) was applied to the distal tibia while recording the 3D knee loads and tibofemoral kinematics. AM-ACL relative strain was measured using a 3 mm DVRT. In this repeated measures experiment, the Wilcoxon signed-rank test was used to test the null hypotheses with p < 0.05 considered significant. The mean (±SD) peak AM-ACL relative strains were 5.4 ± 3.7% and 3.1 ± 2.8% under internal and external tibial torque, respectively. The corresponding mean (± SD) peak AM-ACL strain rates reached 254.4 ± 160.1%/s and 179.4 ± 109.9%/s, respectively. The hypotheses were supported in that the normalized mean peak AM-ACL relative strain and strain rate were 70 and 42% greater under internal than under external tibial torque, respectively (p = 0.023, p = 0.041). We conclude that internal tibial torque is a potent stressor of the ACL because it induces a considerably (70%) larger peak strain in the AM-ACL than does a corresponding external tibial torque. Copyright © 2011 Orthopaedic Research Society.

  5. Dynamics of muscle strength improvement during isokinetic rehabilitation of athletes with ACL rupture and chondromalacia patellae.

    Science.gov (United States)

    Desnica Bakrac, N

    2003-03-01

    To assess quantitatively dynamics and extent of the increase in muscle strength during isokinetic rehabilitation. daily measurements of muscle strength; detailed testing at the beginning and at the end of rehabilitation. Cybex Rehabilitation Center, Zagreb. 44 athletes (31 m, 13 F, age 16-35), 3 injury-defined groups: athletes with ACL rupture (non-reconstructed and reconstructed) and chondromalacia patellae. all subjects underwent isokinetic rehabilitation on Cybex Orthotron KT2 device, using individually designed protocols (extension and flexion exercises, concentric muscle contractions, 15 treatments). monitoring of daily progress on rehabilitation device and detailed testing on diagnostic device. All patients showed considerable improvement. Muscle strength improved on average 141% (SD=110) in ACL-reconstructed group, 144% (SD=130) for chondromalacia patellae group and 150% (SD=74) for ACL-non-reconstructed group, comparing to initial strength. Dynamic status tested on Cybex Otrhotron diagnostic device prior and after rehabilitation strongly correlated with final progress monitored on the rehabilitation device. Isokinetic rehabilitation is a quick and effective method in treating knee injuries in athletes. Both types of objective criteria have shown significant increase in muscle strength. The improvement of muscle strength was on the average 149% (SD=101), which is about 10% daily for 15 treatments. The greatest progress, 19% per day, occurred during first five days. The athletes were able to resume their sport activities as follows: patients from chondromalacia patellae group, and most of them from the non-reconstructed ACL group were back in competition within a month, while 75% from the ACL reconstructed group came back within 3 months, and the rest of them within 5 months.

  6. Success of Meniscal Repair at ACL Reconstruction

    Science.gov (United States)

    Toman, Charles; Spindler, Kurt P.; Dunn, Warren R.; Amendola, Annunziata; Andrish, Jack T.; Bergfeld, John A.; Flanigan, David; Jones, Morgan; Kaeding, Christopher C.; Marx, Robert G.; Matava, Matthew J.; McCarty, Eric C.; Parker, Richard D.; Wolcott, Michelle; Vidal, Armando; Wolf, Brian R.; Huston, Laura J.; Harrell, Frank E.; Wright, Rick W.

    2013-01-01

    Background Meniscal repair is performed in an attempt to prevent posttraumatic arthritis resulting from meniscal dysfunction after meniscal tears. The socioeconomic implications of premature arthritis are significant in the young patient population. Investigations and techniques focusing on meniscus preservation and healing are now at the forefront of orthopaedic sports medicine. Hypothesis Concomitant meniscal repair with ACL reconstruction is a durable and successful procedure at two year follow-up. Study Design Case Series; Level of evidence, 4. Methods All unilateral primary ACL reconstructions entered in 2002 in a prospective cohort who had meniscal repair at the time of ACLR were evaluated. Validated patient oriented outcome instruments were completed preoperatively and then again at the two-year postoperative time point. Reoperation after the index procedure was also documented and confirmed by operative reports. Results 437 unilateral primary ACL reconstructions were performed with 86 concomitant meniscal repairs (57 medial, 29 lateral) in 84 patients during the study period. Patient follow-up was obtained on 94% (81/86) of the meniscal repairs, allowing confirmation of meniscal repair success (defined as no repeat arthroscopic procedure) or failure. The overall success rate for meniscal repairs was 96% (76/79 patients) at two-year follow-up. Conclusions Meniscal repair is a successful procedure in conjunction with ACL reconstruction. When confronted with a “repairable” meniscal tear at the time of ACL reconstruction, orthopaedic surgeons can expect an estimated >90% clinical success rate at two-year follow-up using a variety of methods as shown in our study. PMID:19465734

  7. Anterior cruciate ligament injury/reinjury in alpine ski racing: a narrative review

    Science.gov (United States)

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

    2017-01-01

    The purpose of the present review was to: 1) provide an overview of the current understanding on the epidemiology, etiology, risk factors, and prevention methods for anterior cruciate ligament (ACL) injury in alpine ski racing; and 2) provide an overview of what is known pertaining to ACL reinjury and return to sport after ACL injury in alpine ski racing. Given that most of the scientific studies on ACL injuries in alpine ski racing have been descriptive, and that very few studies contributed higher level scientific evidence, a nonsystematic narrative review was employed. Three scholarly databases were searched for articles on ACL injury or knee injury in alpine ski racing. Studies were classified according to their relevance in relation to epidemiology, etiology, risk factors, and return to sport/reinjury prevention. Alpine ski racers (skiers) were found to be at high risk for knee injuries, and ACL tears were the most frequent diagnosis. Three primary ACL injury mechanism were identified that involved tibial internal rotation and anteriorly directed shear forces from ski equipment and the environment. While trunk muscle strength imbalance and genetics were found to be predictive of ACL injuries in development-level skiers, there was limited scientific data on ACL injury risk factors among elite skiers. Based on expert opinion, research on injury risk factors should focus on equipment design, course settings/speed, and athlete factors (eg, fitness). While skiers seem to make a successful recovery following ACL injury, there may be persistent neuromuscular deficits. Future research efforts should be directed toward prospective studies on ACL injury/reinjury prevention in both male and female skiers and toward the effects of knee injury on long-term health outcomes, such as the early development of osteoarthritis. International collaborations may be necessary to generate sufficient statistical power for ACL injury/reinjury prevention research in alpine ski racing

  8. ACL Surgical Technique — Staying Out of Trouble

    Directory of Open Access Journals (Sweden)

    Predescu Vlad

    2016-11-01

    Full Text Available The incidence of ACL tear and reconstruction has increased over time, and failure of ACL reconstruction is not perfectly defined among surgeons. Atraumatic failure of ACL surgery represents approximately 70% of causes, and occurs in diagnostic errors, technical errors and problems of ACL graft integrations. Regarding surgical technique, we should answer certain questions about our choice of surgery, tunnel position, graft type, graft suture, tensioning the graft, and how we deal with certain incidents or intraoperative accidents. The purpose of this article is to review the current information and trends of ACL reconstruction, and presents some tips and tricks we use in our current practice.

  9. Anterior Cruciate Ligament Injuries in National Football League Athletes From 2010 to 2013: A Descriptive Epidemiology Study.

    Science.gov (United States)

    Dodson, Christopher C; Secrist, Eric S; Bhat, Suneel B; Woods, Daniel P; Deluca, Peter F

    2016-03-01

    There is a high incidence of anterior cruciate ligament (ACL) injuries among National Football League (NFL) athletes; however, the incidence of reinjury in this population is unknown. This retrospective epidemiological study analyzed all publicly disclosed ACL tears occurring in NFL players between 2010 and 2013 to characterize injury trends and determine the incidence of reinjury. Descriptive epidemiological study. A comprehensive online search identified any NFL player who had suffered an ACL injury from 2010 to 2013. Position, playing surface, activity, and date were recorded. Each player was researched for any history of previous ACL injury. The NFL games database from USA Today was used to determine the incidence of ACL injuries on artificial turf and grass fields. Databases from Pro Football Focus and Pro Football Reference were used to determine the injury rate for each position. NFL players suffered 219 ACL injuries between 2010 and 2013. Forty players (18.3%) had a history of previous ACL injury, with 27 (12.3%) retears and 16 (7.3%) tears contralateral to a previous ACL injury. Five players (2.28%) suffered their third ACL tear. Receivers (wide receivers and tight ends) and backs (linebackers, fullbacks, and halfbacks) had significantly greater injury risk than the rest of the NFL players, while perimeter linemen (defensive ends and offensive tackles) had significantly lower injury risk than the rest of the players. Interior linemen (offensive guards, centers, and defensive tackles) had significantly greater injury risk compared with perimeter linemen. ACL injury rates per team games played were 0.050 for grass and 0.053 for turf fields (P > .05). In this retrospective epidemiological study of ACL tears in NFL players, retears and ACL tears contralateral to a previously torn ACL constituted a substantial portion (18.3%) of total ACL injuries. The significant majority of ACL injuries in players with a history of previous ACL injury were retears. Skilled

  10. 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.

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

    Science.gov (United States)

    Nawasreh, Zakariya Hussein

    Anterior cruciate ligament (ACL) rupture is a common sport injury of young athletes who participate in jumping, cutting, and pivoting activities. Although ACL reconstruction (ACLR) surgery has the goal of enabling athletes to return to preinjury activity levels, treatment results often fall short of this goal. The outcomes after ACLR are variable and less than optimal with low rate of return to preinjury activity level and high risk for second ACL injury. Factors related to the knee functional limitations, strength deficits, and limb-to-limb movement asymmetry may be associated with poor outcomes after ACLR. Additionally, the criteria that are used to determine a patient's readiness to return to the preinjury activity level are undefined which may also be associated with poor outcomes after ACLR. The clinical decision-making to clear patients' for safe and successful return to high physical activities should be based on a universal comprehensive set of objective criteria that ensure normal knee function and limb-to-limb symmetry. A battery of return to activity criteria (RTAC) that emphases normal knee function and limb-to-limb movement symmetry has been constituted to better ensure safe and successful return to preinjury activity level. Yet, only variables related to patients' demographics, concomitant injuries, and treatment measures have been used to predict return to preinjury activity levels after ACLR. However, the ability of RTAC variables that ensure normal knee function and limb movement symmetry to predict the return to participate in the same preinjury activity level after ACLR has not been investigated. In light of this background, the first aim of the present study was to compare functional knee performance-based and patient-reported measures of those who PASS and who FAIL on RTAC at 6 months (6-M) following ACLR with those at 12 months (12-M) and 24 months (24-M) following ACLR and to determine how performance-based and patient-reported measures

  12. TIBIAL LANDMARKS IN ACL ANATOMIC REPAIR

    Directory of Open Access Journals (Sweden)

    M. V. Demesсhenko

    2016-01-01

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

  13. Fourier Series Formalization in ACL2(r

    Directory of Open Access Journals (Sweden)

    Cuong K. Chau

    2015-09-01

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

  14. Delaying ACL reconstruction and treating with exercise therapy alone may alter prognostic factors for 5-year outcome

    DEFF Research Database (Denmark)

    Filbay, Stephanie R; Roos, Ewa M; Frobell, Richard B

    2017-01-01

    , body mass index, preinjury activity level, education and smoking. RESULTS: For all participants (n=118), graft/contralateral ACL rupture, non-ACL surgery and worse baseline 36-item Short-Form Mental Component Scores were associated with worse outcomes. Treatment with exercise therapy alone......AIM: Identify injury-related, patient-reported and treatment-related prognostic factors for 5-year outcomes in acutely ACL-ruptured individuals managed with early reconstruction plus exercise therapy, exercise therapy plus delayed reconstruction or exercise therapy alone. METHODS: Exploratory...... was a prognostic factor for less knee symptoms compared with early reconstruction plus exercise therapy (regression coefficient 10.1, 95% CI 2.3 to 17.9). Baseline meniscus lesion was associated with worse sport/recreation function (-14.4, 95% CI -27.6 to -1.3) and osteochondral lesions were associated with worse...

  15. Relationship between knee kinetic outcome measures in vertical counter movement jumps and self-reported function in ACL reconstructed subjects

    DEFF Research Database (Denmark)

    Brekke, Anders Falk

    2014-01-01

    Relationship between knee kinetic outcome measures in counter movement jumps and self-reported function in ACL reconstructed subjects Brekke AF1,2, Nielsen DB2, Holsgaard-Larsen A2 1School of physiotherapy, University College Zealand, Denmark 2Orthopaedic Research Unit, Department of Orthopaedics...... and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark Introduction: Altered loading pattern of the medial aspect of the knee has been associated with the development of knee osteoarthritis (OA). Anterior cruciate ligament (ACL) injuries are associated...... with early-onset OA with associated pain, functional limitations, and decreased quality of life. However, specific knee loading pattern of the medial aspect has not been investigated during different jump-tasks in ACL-reconstructed patients. The purpose was to investigate potential kinetic differences...

  16. Complications and Adverse Events of a Randomized Clinical Trial Comparing 3 Graft Types for ACL Reconstruction.

    Science.gov (United States)

    Mohtadi, Nicholas; Barber, Rhamona; Chan, Denise; Paolucci, Elizabeth Oddone

    2016-05-01

    Complications/adverse events of anterior cruciate ligament (ACL) surgery are underreported, despite pooled level 1 data in systematic reviews. All adverse events/complications occurring within a 2-year postoperative period after primary ACL reconstruction, as part of a large randomized clinical trial (RCT), were identified and described. Prospective, double-blind randomized clinical trial. Patients and the independent trained examiner were blinded to treatment allocation. University-based orthopedic referral practice. Three hundred thirty patients (14-50 years; 183 males) with isolated ACL deficiency were intraoperatively randomized to ACL reconstruction with 1 autograft type. Graft harvest and arthroscopic portal incisions were identical. Patients were equally distributed to patellar tendon (PT), quadruple-stranded hamstring tendon (HT), and double-bundle (DB) hamstring autograft ACL reconstruction. Adverse events/complications were patient reported, documented, and diagnoses confirmed. Two major complications occurred: pulmonary embolism and septic arthritis. Twenty-four patients (7.3%) required repeat surgery, including 25 separate operations: PT = 7 (6.4%), HT = 9 (8.2%), and DB = 8 (7.3%). Repeat surgery was performed for meniscal tears (3.6%; n = 12), intra-articular scarring (2.7%; n = 9), chondral pathology (0.6%; n = 2), and wound dehiscence (0.3%; n = 1). Other complications included wound problems, sensory nerve damage, muscle tendon injury, tibial periostitis, and suspected meniscal tears and chondral lesions. Overall, more complications occurred in the HT/DB groups (PT = 24; HT = 31; DB = 45), but more PT patients complained of moderate or severe kneeling pain (PT = 17; HT = 9; DB = 4) at 2 years. Overall, ACL reconstructive surgery is safe. Major complications were uncommon. Secondary surgery was necessary 7.3% of the time for complications/adverse events (excluding graft reinjury or revisions) within the first 2 years. Level 1 (therapeutic studies

  17. Incidence of anterior cruciate ligament injuries among elite ballet and modern dancers: a 5-year prospective study.

    Science.gov (United States)

    Liederbach, Marijeanne; Dilgen, Faye E; Rose, Donald J

    2008-09-01

    Ballet and modern dance are jump-intensive activities, but little is known about the incidence of anterior cruciate ligament (ACL) injuries among dancers. Rigorous jump and balance training has been shown in some prospective studies to significantly reduce ACL injury rates among athletes. Dancers advance to the professional level only after having achieved virtuosic jump and balance technique. Therefore, dancers on the elite level may be at relatively low risk for ACL injury. Descriptive epidemiology study. Dance exposure, injuries, and injury conditions were systematically recorded at 4 dance organizations over 5 years. Select neuromuscular and psychometric variables were compared between and within ACL-injured and noninjured dancers. Of 298 dancers, 12 experienced an ACL injury over the 5-year period. The incidence of ACL injury was 0.009 per 1000 exposures. Landing from a jump onto 1 leg was the mechanism of injury in 92% of cases. Incidence was not statistically different between gender or dance groups, although women modern dancers had a 3 to 5 times greater relative risk than women ballet dancers and men dancers. No difference between ACL-injured and noninjured dancers emerged with regard to race, oral contraceptive use, or select musculoskeletal measures. Dancers suffer considerably fewer ACL injuries than athletes participating in team ball sports. The training dancers undertake to perfect lower extremity alignment, jump, and balance skills may serve to protect them against ACL injury. Anterior cruciate ligament injuries happened most often late in the day and season, suggesting an effect of fatigue.

  18. Characterization of nitrotyrosine as a biomarker for arthritis and joint injury

    DEFF Research Database (Denmark)

    Misko, T P; Radabaugh, M R; Highkin, M

    2013-01-01

    OBJECTIVES: To characterize the utility of nitrotyrosine (NT) as a biomarker for arthritis and joint injury. DESIGN: Synovial fluid, plasma, and urine from patients diagnosed with osteoarthritis (OA), rheumatoid arthritis (RA), anterior cruciate ligament (ACL) injury, meniscus injury and pseudogout...

  19. Delay in surgery predisposes to meniscal and chondral injuries in anterior cruciate ligament deficient knees

    Directory of Open Access Journals (Sweden)

    Ravi Gupta

    2016-01-01

    Conclusion: Surgical delay predicts an increase in medial meniscal and lateral articular injuries justifying early rather than delayed reconstruction in ACL deficient knees. Increasing age is positively related to intraarticular injuries while females are more susceptible to lateral articular injuries.

  20. Mechanisms for anterior cruciate ligament injuries in badminton.

    Science.gov (United States)

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

    2010-12-01

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

  1. Isokinetic Testing in Evaluation Rehabilitation Outcome After ACL Reconstruction

    OpenAIRE

    Cvjetkovic, Dragana Dragicevic; Bijeljac, Sinisa; Palija, Stanislav; Talic, Goran; Radulovic, Tatjana Nozica; Kosanovic, Milkica Glogovac; Manojlovic, Slavko

    2015-01-01

    Introduction: Numerous rehab protocols have been used in rehabilitation after ACL reconstruction. Isokinetic testing is an objective way to evaluate dynamic stability of the knee joint that estimates the quality of rehabilitation outcome after ACL reconstruction. Our investigation goal was to show importance of isokinetic testing in evaluation thigh muscle strength in patients which underwent ACL reconstruction and rehabilitation protocol. Subjects and methods: In prospective study, we evalua...

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    and return to sport after ACL injury in alpine ski racing. Given that most of the scientific studies on ACL injuries in alpine ski racing have been descriptive, and that very few studies contributed higher level scientific evidence, a nonsystematic narrative review was employed. Three scholarly databases...... were searched for articles on ACL injury or knee injury in alpine ski racing. Studies were classified according to their relevance in relation to epidemiology, etiology, risk factors, and return to sport/reinjury prevention. Alpine ski racers (skiers) were found to be at high risk for knee injuries...... injuries in development-level skiers, there was limited scientific data on ACL injury risk factors among elite skiers. Based on expert opinion, research on injury risk factors should focus on equipment design, course settings/speed, and athlete factors (eg, fitness). While skiers seem to make a successful...

  3. Proof Pad: A New Development Environment for ACL2

    Directory of Open Access Journals (Sweden)

    Caleb Eggensperger

    2013-04-01

    Full Text Available Most software development projects rely on Integrated Development Environments (IDEs based on the desktop paradigm, with an interactive, mouse-driven user interface. The standard installation of ACL2, on the other hand, is designed to work closely with Emacs. ACL2 experts, on the whole, like this mode of operation, but students and other new programmers who have learned to program with desktop IDEs often react negatively to the process of adapting to an unfamiliar form of interaction. This paper discusses Proof Pad, a new IDE for ACL2. Proof Pad is not the only attempt to provide ACL2 IDEs catering to students and beginning programmers. The ACL2 Sedan and DrACuLa systems arose from similar motivations. Proof Pad builds on the work of those systems, while also taking into account the unique workflow of the ACL2 theorem proving system. The design of Proof Pad incorporated user feedback from the outset, and that process continued through all stages of development. Feedback took the form of direct observation of users interacting with the IDE as well as questionnaires completed by users of Proof Pad and other ACL2 IDEs. The result is a streamlined interface and fast, responsive system that supports using ACL2 as a programming language and a theorem proving system. Proof Pad also provides a property-based testing environment with random data generation and automated interpretation of properties as ACL2 theorem definitions.

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  5. Proceedings 10th International Workshop on the ACL2 theorem prover and its applications (ACL2 2011), Austin TX, USA, November 3-4, 2011

    NARCIS (Netherlands)

    Hardin, D.S.; Schmaltz, J.

    2011-01-01

    This volume contains the proceedings of ACL2 2011, the International Workshop on the ACL2 Theorem Prover and its Applications. The workshop was held in Austin, Texas, USA, on November 3-4 2011. ACL2 2011 is the tenth in a series of workshops on the ACL2 Theorem Prover and its Applications. The

  6. Bit-Blasting ACL2 Theorems

    Directory of Open Access Journals (Sweden)

    Sol Swords

    2011-10-01

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

  7. Industrial hardware and software verification with ACL2.

    Science.gov (United States)

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

    2017-10-13

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

  8. Global molecular changes in a tibial compression induced ACL rupture model of post-traumatic osteoarthritis.

    Science.gov (United States)

    Chang, Jiun C; Sebastian, Aimy; Murugesh, Deepa K; Hatsell, Sarah; Economides, Aris N; Christiansen, Blaine A; Loots, Gabriela G

    2017-03-01

    Joint injury causes post-traumatic osteoarthritis (PTOA). About ∼50% of patients rupturing their anterior cruciate ligament (ACL) will develop PTOA within 1-2 decades of the injury, yet the mechanisms responsible for the development of PTOA after joint injury are not well understood. In this study, we examined whole joint gene expression by RNA sequencing (RNAseq) at 1 day, 1-, 6-, and 12 weeks post injury, in a non-invasive tibial compression (TC) overload mouse model of PTOA that mimics ACL rupture in humans. We identified 1446 genes differentially regulated between injured and contralateral joints. This includes known regulators of osteoarthritis such as MMP3, FN1, and COMP, and several new genes including Suco, Sorcs2, and Medag. We also identified 18 long noncoding RNAs that are differentially expressed in the injured joints. By comparing our data to gene expression data generated using the surgical destabilization of the medial meniscus (DMM) PTOA model, we identified several common genes and shared mechanisms. Our study highlights several differences between these two models and suggests that the TC model may be a more rapidly progressing model of PTOA. This study provides the first account of gene expression changes associated with PTOA development and progression in a TC model. © 2016 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 35:474-485, 2017. © 2016 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc.

  9. Global molecular changes in a tibial compression induced ACL rupture model of post‐traumatic osteoarthritis

    Science.gov (United States)

    Chang, Jiun C.; Sebastian, Aimy; Murugesh, Deepa K.; Hatsell, Sarah; Economides, Aris N.; Christiansen, Blaine A.

    2016-01-01

    ABSTRACT Joint injury causes post‐traumatic osteoarthritis (PTOA). About ∼50% of patients rupturing their anterior cruciate ligament (ACL) will develop PTOA within 1–2 decades of the injury, yet the mechanisms responsible for the development of PTOA after joint injury are not well understood. In this study, we examined whole joint gene expression by RNA sequencing (RNAseq) at 1 day, 1‐, 6‐, and 12 weeks post injury, in a non‐invasive tibial compression (TC) overload mouse model of PTOA that mimics ACL rupture in humans. We identified 1446 genes differentially regulated between injured and contralateral joints. This includes known regulators of osteoarthritis such as MMP3, FN1, and COMP, and several new genes including Suco, Sorcs2, and Medag. We also identified 18 long noncoding RNAs that are differentially expressed in the injured joints. By comparing our data to gene expression data generated using the surgical destabilization of the medial meniscus (DMM) PTOA model, we identified several common genes and shared mechanisms. Our study highlights several differences between these two models and suggests that the TC model may be a more rapidly progressing model of PTOA. This study provides the first account of gene expression changes associated with PTOA development and progression in a TC model. © 2016 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 35:474–485, 2017. PMID:27088242

  10. Differences in mechanisms of failure, intraoperative findings, and surgical characteristics between single- and multiple-revision ACL reconstructions: a MARS cohort study.

    Science.gov (United States)

    Chen, James L; Allen, Christina R; Stephens, Thomas E; Haas, Amanda K; Huston, Laura J; Wright, Rick W; Feeley, Brian T

    2013-07-01

    The factors that lead to patients failing multiple anterior cruciate ligament (ACL) reconstructions are not well understood. Multiple-revision ACL reconstruction will have different characteristics than first-time revision in terms of previous and current graft selection, mode of failure, chondral/meniscal injuries, and surgical charactieristics. Case-control study; Level of evidence, 3. A prospective multicenter ACL revision database was utilized for the time period from March 2006 to June 2011. Patients were divided into those who underwent a single-revision ACL reconstruction and those who underwent multiple-revision ACL reconstructions. The primary outcome variable was Marx activity level. Primary data analyses between the groups included a comparison of graft type, perceived mechanism of failure, associated injury (meniscus, ligament, and cartilage), reconstruction type, and tunnel position. Data were compared by analysis of variance with a post hoc Tukey test. A total of 1200 patients (58% men; median age, 26 years) were enrolled, with 1049 (87%) patients having a primary revision and 151 (13%) patients having a second or subsequent revision. Marx activity levels were significantly higher (9.77) in the primary-revision group than in those patients with multiple revisions (6.74). The most common cause of reruptures was a traumatic, noncontact ACL graft injury in 55% of primary-revision patients; 25% of patients had a nontraumatic, gradual-onset recurrent injury, and 11% had a traumatic, contact injury. In the multiple-revision group, a nontraumatic, gradual-onset injury was the most common cause of recurrence (47%), followed by traumatic noncontact (35%) and nontraumatic sudden onset (11%) (P < .01 between groups). Chondral injuries in the medial compartment were significantly more common in the multiple-revision group than in the single-revision group, as were chondral injuries in the patellofemoral compartment. Patients with multiple-revision ACL

  11. Effects of knee injury primary prevention programs on anterior cruciate ligament injury rates in female athletes in different sports: a systematic review.

    Science.gov (United States)

    Michaelidis, Michael; Koumantakis, George A

    2014-08-01

    Anterior Cruciate Ligament (ACL) injury is frequently encountered in sports. To analyze the effects of ACL injury prevention programs on injury rates in female athletes between different sports. A comprehensive literature search was performed in September 2012 using Pubmed Central, Science Direct, CINAHL, PEDro, Cochrane Library, SCOPUS, SPORTDiscus. The key words used were: 'anterior cruciate ligament', 'ACL', 'knee joint', 'knee injuries', 'female', 'athletes', 'neuromuscular', 'training', 'prevention'. The inclusion criteria applied were: (1) ACL injury prevention training programs for female athletes; (2) Athlete-exposure data reporting; (3) Effect of training on ACL incidence rates for female athletes. 13 studies met the inclusion criteria. Three training programs in soccer and one in handball led to reduced ACL injury incidence. In basketball no effective training intervention was found. In season training was more effective than preseason in ACL injury prevention. A combination of strength training, plyometrics, balance training, technique monitoring with feedback, produced the most favorable results. Comparing the main components of ACL injury prevention programs for female athletes, some sports-dependent training specificity issues may need addressing in future studies, related primarily to the individual biomechanics of each sport but also their most effective method of delivery. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Knee extension torque variability after exercise in ACL reconstructed knees.

    Science.gov (United States)

    Goetschius, John; Kuenze, Christopher M; Hart, Joseph M

    2015-08-01

    The purpose of this study was to compare knee extension torque variability in patients with ACL reconstructed knees before and after exercise. Thirty two patients with an ACL reconstructed knee (ACL-R group) and 32 healthy controls (control group) completed measures of maximal isometric knee extension torque (90° flexion) at baseline and following a 30-min exercise protocol (post-exercise). Exercise included 30-min of repeated cycles of inclined treadmill walking and hopping tasks. Dependent variables were the coefficient of variation (CV) and raw-change in CV (ΔCV): CV = (torque standard deviation/torque mean x 100), ΔCV = (post-exercise - baseline). There was a group-by-time interaction (p = 0.03) on CV. The ACL-R group demonstrated greater CV than the control group at baseline (ACL-R = 1.07 ± 0.55, control = 0.79 ± 0.42, p = 0.03) and post-exercise (ACL-R = 1.60 ± 0.91, control = 0.94 ± 0.41, p = 0.001). ΔCV was greater (p = 0.03) in the ACL-R group (0.52 ± 0.82) than control group (0.15 ± 0.46). CV significantly increased from baseline to post-exercise (p = 0.001) in the ACL-R group, while the control group did not (p = 0.06). The ACL-R group demonstrated greater knee extension torque variability than the control group. Exercise increased torque variability more in the ACL-R group than control group. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  13. Injuries in women's basketball.

    Science.gov (United States)

    Trojian, Thomas H; Ragle, Rosemary B

    2008-03-01

    Women's basketball has changed over time. It is a faster paced game than it was 30 years ago. Greatplayers, like Anne Meyers,who was the first, and only, woman to be signed to an NBA contract, would agree today's game is different. The game is played mostly "below the rim" but with players like Candice Parker, Sylvia Fowles and Maya Moore able to dunk the ball, the game is still changing. The one thing that remains constant in basketball, especially women's basketball, is injury. The majority of injuries in women's basketball are similar to those in men's basketball. Studies at the high school and college level show similar injury rates between women and men. ACL injuries are one exception, with female athletes having atwo to four times higher rate ofACL injuries. In this article, we review the common injuries in women's basketball. We discuss treatment issues and possible preventive measures.

  14. STUDY OF ANTERIOR CRUCIATE LIGAMENT INJURY AND ITS MANAGEMENT

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    Tummala Venkata

    2016-03-01

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

  15. High Variability in Outcome Reporting Patterns in High-Impact ACL Literature.

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    Makhni, Eric C; Padaki, Ajay S; Petridis, Petros D; Steinhaus, Michael E; Ahmad, Christopher S; Cole, Brian J; Bach, Bernard R

    2015-09-16

    ACL (anterior cruciate ligament) reconstruction is one of the most commonly performed and studied procedures in modern sports medicine. A multitude of objective and subjective patient outcome measures exists; however, nonstandardized reporting patterns of these metrics may create challenges in objectively analyzing pooled results from different studies. The goal of this study was to document the variability in outcome reporting patterns in high-impact orthopaedic studies of ACL reconstruction. All clinical studies pertaining to ACL reconstruction in four high-impact-factor orthopaedic journals over a five-year period were reviewed. Biomechanical, basic science, and imaging studies were excluded, as were studies with fewer than fifty patients, yielding 119 studies for review. Incorporation of various objective and subjective outcomes was noted for each study. Substantial variability in reporting of both objective and subjective measures was noted in the study cohort. Although a majority of studies reported instrumented laxity findings, there was substantial variability in the type and method of laxity reporting. Most other objective outcomes, including range of motion, strength, and complications, were reported in <50% of all studies. Return to pre-injury level of activity was infrequently reported (24% of studies), as were patient satisfaction and pain assessment following surgery (8% and 13%, respectively). Of the patient-reported outcomes, the International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores were most often reported (71%, 63%, and 42%, respectively). Substantial variability in outcome reporting patterns exists among high-impact studies of ACL reconstruction. Such variability may create challenges in interpreting results and pooling them across different studies. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  16. Tibial and Femoral Tunnel Changes After ACL Reconstruction: A Prospective 2-Year Longitudinal MRI Study.

    Science.gov (United States)

    Weber, Alexander E; Delos, Demetris; Oltean, Hanna N; Vadasdi, Katherine; Cavanaugh, John; Potter, Hollis G; Rodeo, Scott A

    2015-05-01

    Tunnel widening after anterior cruciate ligament reconstruction (ACL-R) is a well-accepted and frequent phenomenon, yet little is known regarding its origin or natural history. To prospectively evaluate the cross-sectional area (CSA) changes in tibial and femoral bone tunnels after ACL-R with serial MRI. Case series; Level of evidence, 4. Patients underwent arthroscopic ACL-R with the same surgeon, surgical technique, and rehabilitation protocol. Each patient underwent preoperative dual-energy x-ray absorptiometry and clinical evaluation, as well as postoperative time zero MRI followed by subsequent MRI and clinical examination, including functional and subjective outcome tests, at 6, 12, 24, 52, and 104 weeks. Tibial and femoral tunnel CSA was measured on each MRI at tunnel aperture (ttA and ftA), midsection (ttM and ftM), and exit (ttE and ftE). Logistic regression modeling was used to examine the predictive value of demographic data and preoperative bone quality (as measured by dual-energy x-ray absorptiometry) on functional outcome scores, manual and instrumented laxity measurements, and changes in tunnel area over time. Eighteen patients (including 12 men), mean age 35.5±8.7 years, underwent ACL-R. There was significant tunnel expansion at ttA and ftA sites 6 weeks postoperatively (P=.024 and .0045, respectively). Expansion continued for 24 weeks, with progressive tunnel narrowing thereafter. Average ttA CSA was significantly larger than ftA CSA at all times. The ttM significantly expanded after 6 weeks (P=.06); continued expansion to week 12 was followed by 21 months of reduction in tunnel diameter. The ftM and both ttE and ftE sites decreased in CSA over the 2 years. Median Lysholm and International Knee Documentation Committee scores significantly improved at final follow-up (P=.0083 and 1 year from time of injury) predicted increased tunnel widening and accelerated expansion in CSA (Pclinical outcome. Younger age, male sex, and delay from injury to ACL

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  18. Feasibility of establishing an Australian ACL registry: a pilot study by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR).

    Science.gov (United States)

    Lekkas, Christina; Clarnette, Richard; Graves, Stephen E; Rainbird, Sophia; Parker, David; Lorimer, Michelle; Paterson, Roger; Roe, Justin; Morris, Hayden; Feller, Julian A; Annear, Peter; Forster, Ben; Hayes, David

    2017-05-01

    Rupture of the anterior cruciate ligament (ACL) is a common and debilitating injury that impacts significantly on knee function and risks the development of degenerative arthritis. The outcome of ACL surgery is not monitored in Australia. The optimal treatment is unknown. Consequently, the identification of best practice in treating ACL is crucial to the development of improved outcomes. The Australian Knee Society (AKS) asked the Australian Orthopaedic Association (AOA) to consider establishing a national ACL registry. As a first step, a pilot study was undertaken by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to test the hypothesis that collecting the required information in the Australian setting was possible. Surgeons completed an operative form which provided comprehensive information on the surgery undertaken. Patients provided pre- and post-operative questionnaires including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Marx Activity Scale (MA Scale). The number of ACL procedures undertaken at each hospital during the recruitment period was compared against State Government Health Department separation data. A total of 802 patients were recruited from October 2011 to January 2013. The overall capture rate for surgeon-derived data was 99%, and the capture rate for the pre-operative patient questionnaire was 97.9%. At 6 months, patient-reported outcomes were obtained from 55% of patients, and 58.5% of patients at 12 months. When checked against State Government Health Department separation data, 31.3% of procedures undertaken at each study hospital were captured in the study. It is possible to collect surgeon-derived and pre-operative patient-reported data, following ACL reconstruction in Australia. The need to gain patient consent was a limiting factor to participation. When patients did consent to participate in the study, we were able to capture nearly 100% of surgical procedures. Patient consent

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

    Science.gov (United States)

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

    2016-10-01

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

  20. Anterior cruciate ligament injury/reinjury in alpine ski racing: a narrative review

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    Jordan MJ

    2017-03-01

    Full Text Available Matthew J Jordan,1 Per Aagaard,2 Walter Herzog1 1Human Performance Laboratory, The University of Calgary, Calgary, AB, Canada; 2Department of Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC, University of Southern Denmark, Odense M, Denmark Abstract: The purpose of the present review was to: 1 provide an overview of the current understanding on the epidemiology, etiology, risk factors, and prevention methods for anterior cruciate ligament (ACL injury in alpine ski racing; and 2 provide an overview of what is known pertaining to ACL reinjury and return to sport after ACL injury in alpine ski racing. Given that most of the scientific studies on ACL injuries in alpine ski racing have been descriptive, and that very few studies contributed higher level scientific evidence, a nonsystematic narrative review was employed. Three scholarly databases were searched for articles on ACL injury or knee injury in alpine ski racing. Studies were classified according to their relevance in relation to epidemiology, etiology, risk factors, and return to sport/reinjury prevention. Alpine ski racers (skiers were found to be at high risk for knee injuries, and ACL tears were the most frequent diagnosis. Three primary ACL injury mechanism were identified that involved tibial internal rotation and anteriorly directed shear forces from ski equipment and the environment. While trunk muscle strength imbalance and genetics were found to be predictive of ACL injuries in development-level skiers, there was limited scientific data on ACL injury risk factors among elite skiers. Based on expert opinion, research on injury risk factors should focus on equipment design, course settings/speed, and athlete factors (eg, fitness. While skiers seem to make a successful recovery following ACL injury, there may be persistent neuromuscular deficits. Future research efforts should be directed toward prospective studies on ACL injury/reinjury prevention in both

  1. Anterior cruciate ligament and meniscal injuries in sports: incidence, time of practice until injury, and limitations caused after trauma.

    Science.gov (United States)

    Astur, Diego Costa; Xerez, Marcos; Rozas, João; Debieux, Pedro Vargas; Franciozi, Carlos Eduardo; Cohen, Moises

    2016-01-01

    To analyze the incidence of ACL and meniscal injuries in a population of recreational and elite athletes from Brazil and the relation of these injuries with their sports activities. This was a prospective observational study of 240 patients with ACL and/or meniscal injuries submitted to surgical treatment. Data of patients and sport modality, as well as Tegner score were registered in the first clinical evaluation. The patients were divided into three groups: (1) isolated rupture of the ACL; (2) ACL injury associated with meniscal injury; (3) isolated menisci injury. The majority of the patients belonged to group 1 (44.58%), followed by group 2 (30.2%) and 3 (25%). Most patients were soccer players. The mean time from sport practice to injury in group 1 was 17.81 years. In group 2, it was 17.3 years, and in group 3, 26.91 years. Soccer athletes presented ACL injury in 0.523/1000 h of practice and meniscal injury in 0.448/1000 h of practice. Before the injury, the mean Tegner score obtained for groups 1, 2, and 3 were 7.18, 7.34, and 6.53, respectively. After knee injury, those values were 3.07, 3.18, and 2.87, respectively. Soccer was the sport that caused the majority of lesions, regardless the group. Furthermore, patients from groups 1 and 2 had less time of practice prior to the injury (17.81 and 17.3 years) than the patients of group 3 (26.91 years). Women presented a higher risk to develop ACL and meniscal injuries in 1000 h of game/practice. Running, volleyball, and weightlifting are in ascending order of risk for ACL and/or meniscal injury. Regarding the return to sport practice, the efficiency of all athletes was impaired because of the injury.

  2. Anterior cruciate ligament and meniscal injuries in sports: incidence, time of practice until injury, and limitations caused after trauma

    Directory of Open Access Journals (Sweden)

    Diego Costa Astur

    Full Text Available ABSTRACT OBJECTIVE: To analyze the incidence of ACL and meniscal injuries in a population of recreational and elite athletes from Brazil and the relation of these injuries with their sports activities. METHODS: This was a prospective observational study of 240 patients with ACL and/or meniscal injuries submitted to surgical treatment. Data of patients and sport modality, as well as Tegner score were registered in the first clinical evaluation. The patients were divided into three groups: (1 isolated rupture of the ACL; (2 ACL injury associated with meniscal injury; (3 isolated menisci injury. RESULTS: The majority of the patients belonged to group 1 (44.58%, followed by group 2 (30.2% and 3 (25%. Most patients were soccer players. The mean time from sport practice to injury in group 1 was 17.81 years. In group 2, it was 17.3 years, and in group 3, 26.91 years. Soccer athletes presented ACL injury in 0.523/1000 h of practice and meniscal injury in 0.448/1000 h of practice. Before the injury, the mean Tegner score obtained for groups 1, 2, and 3 were 7.18, 7.34, and 6.53, respectively. After knee injury, those values were 3.07, 3.18, and 2.87, respectively. CONCLUSION: Soccer was the sport that caused the majority of lesions, regardless the group. Furthermore, patients from groups 1 and 2 had less time of practice prior to the injury (17.81 and 17.3 years than the patients of group 3 (26.91 years. Women presented a higher risk to develop ACL and meniscal injuries in 1000 h of game/practice. Running, volleyball, and weightlifting are in ascending order of risk for ACL and/or meniscal injury. Regarding the return to sport practice, the efficiency of all athletes was impaired because of the injury.

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

    Science.gov (United States)

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

    2017-10-01

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

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

    Science.gov (United States)

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

    2018-05-01

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

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

    Science.gov (United States)

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

    2014-05-01

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

  6. The Financial and Professional Impact of Anterior Cruciate Ligament Injuries in National Football League Athletes.

    Science.gov (United States)

    Secrist, Eric S; Bhat, Suneel B; Dodson, Christopher C

    2016-08-01

    Anterior cruciate ligament (ACL) injuries can have negative consequences on the careers of National Football League (NFL) players, however no study has ever analyzed the financial impact of these injuries in this population. To quantify the impact of ACL injuries on salary and career length in NFL athletes. Cohort study; Level of evidence, 3. Any player in the NFL suffering an ACL injury from 2010 to 2013 was identified using a comprehensive online search. A database of NFL player salaries was used to conduct a matched cohort analysis comparing ACL-injured players with the rest of the NFL. The main outcomes were the percentage of players remaining in the NFL and mean salary at 1, 2, 3, and 4 years after injury. Cohorts were subdivided based on initial salary: group A, $2,000,000. Mean cumulative earnings were calculated by multiplying the percentage of players remaining in the league by their mean salaries and compounding this each season. NFL athletes suffered 219 ACL injuries from 2010 to 2013. The 7504 other player seasons in the NFL during this time were used as controls. Significantly fewer ACL-injured players than controls remained in the NFL at each time point (P negatively affected. This demonstrates the degree of negative impact these injuries have on the careers of NFL players. It also indicates that a player's standing within the league before injury strongly influences how much an ACL injury will affect his career.

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

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    Huang ME Deborah

    2012-07-01

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

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

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    Parag Suresh Mahajan

    2015-01-01

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

  9. Influence of proprioceptive training in the improvement of neuromuscular performance after ACL reconstruction

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    Dubljanin-Raspopović Emilija

    2005-01-01

    Full Text Available ACL injury leads to a decrease in proprioceptive abilities, which can be improved with ACL surgery and postoperative rehabilitation. The goal of our study was to investigate whether the impact of coordinative training can be differentiated from the influence of surgery on proprioceptive improvement, and whether there is a correlation between improvement in coordinative abilities and other objective parameters of functional recovery. This follow-up study included 45 patients who had undergone ACL reconstruction and who were randomized into a conservative (TH-C and an intensive (TH-I rehabilitation group. In the TH-I group, coordinative training began earlier due to unrestricted weight-bearing. The groups were first compared preoperatively, then postoperatively, after 6 weeks, 4,6,9, and 12 months via the single leg stance test, the one leg hop test, the Lysholm knee score, and the Tegner score. A faster recovery of coordinative skills was registered in the TH-I group. Already after 6 weeks, highly statistically significant progress in one leg stance abilities was noticed, while in the TH-C group the same was not noticed until 4 months after surgery (p<0.01. Such a result speaks for the distinct influence of proprioceptive training on coordinative abilities. Also, a highly statistically significant correlation was noticed between the single leg stance, one leg hop, Lysholm, and Tegner tests (p<0.01, which points out the importance of a good rehabilitation programme, since neuromuscular performance cannot be separated from other parameters of functional recovery.

  10. Isokinetic Testing in Evaluation Rehabilitation Outcome After ACL Reconstruction.

    Science.gov (United States)

    Cvjetkovic, Dragana Dragicevic; Bijeljac, Sinisa; Palija, Stanislav; Talic, Goran; Radulovic, Tatjana Nozica; Kosanovic, Milkica Glogovac; Manojlovic, Slavko

    2015-02-01

    Numerous rehab protocols have been used in rehabilitation after ACL reconstruction. Isokinetic testing is an objective way to evaluate dynamic stability of the knee joint that estimates the quality of rehabilitation outcome after ACL reconstruction. Our investigation goal was to show importance of isokinetic testing in evaluation thigh muscle strength in patients which underwent ACL reconstruction and rehabilitation protocol. In prospective study, we evaluated 40 subjects which were divided into two groups. Experimental group consisted of 20 recreational males which underwent ACL reconstruction with hamstring tendon and rehabilitation protocol 6 months before isokinetic testing. Control group (20 subjects) consisted of healthy recreational males. In all subjects knee muscle testing was performed on a Biodex System 4 Pro isokinetic dynamo-meter et velocities of 60°/s and 180°/s. We followed average peak torque to body weight (PT/BW) and classic H/Q ratio. In statistical analysis Student's T test was used. There were statistically significant differences between groups in all evaluated parameters except of the mean value of PT/BW of the quadriceps et velocity of 60°/s (p>0.05). Isokinetic testing of dynamic stabilizers of the knee is need in diagnostic and treatment thigh muscle imbalance. We believe that isokinetic testing is an objective parameter for return to sport activities after ACL reconstruction.

  11. Low Prevalence of Anterior and Posterior Cruciate Ligament Injuries in Patients With Achondroplasia.

    Science.gov (United States)

    Brooks, Jaysson T; Ramji, Alim F; Lyapustina, Tatyana A; Yost, Mary T; Ain, Michael C

    2017-01-01

    Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries and their subsequent reconstructions are common in the general population, but there has been no research regarding ACL or PCL injuries in patients with achondroplasia, the most common skeletal dysplasia. Our goals were to (1) evaluate the prevalence of ACL and PCL injuries in adolescents and adults with achondroplasia, (2) compare this prevalence with that reported for the general population, (3) determine how many patients with ACL or PCL injuries underwent ligament reconstruction as treatment, and (4) determine patient activity levels as they relate to the rate of ACL/PCL injuries and reconstructions. We reviewed medical records of 430 patients with achondroplasia seen in the senior author's clinic from 2002 through 2014. Demographic data were reviewed, as well as any documentation of ACL or PCL injury or reconstruction. We called all 430 patients by telephone, and 148 agreed to participate in our survey, whereas 1 declined. We asked these patients about their history of ACL or PCL injury or reconstruction, as well as current and past physical activity levels. No ACL or PCL injuries were found on chart review. One patient reached by telephone reported an ACL injury that did not require reconstruction. This yielded a theoretical prevalence of 3/430 (0.7%). Of the 148 patients surveyed, 43 (29%) reported low physical activity, 75 (51%) reported moderate physical activity, and 26 (17%) reported high physical activity. There was no significant difference in the rate of ACL injury when stratified by physical activity level (P=0.102). ACL and PCL injuries and reconstructions are extremely rare in patients with achondroplasia, which cannot be completely ascribed to a low level of physical activity. One possible explanation is that patients with achondroplasia, on an average, have a more anterior tibial slope compared with those without achondroplasia, which decreases the force generated

  12. An unusual mechanism for injury of the anterior cruciate ligament in figure skating.

    Science.gov (United States)

    Wilson, Eugene K; Lahurd, Alexandra P; Wilckens, John H

    2012-03-01

    A 20-year-old competitive figure skater presented with an acute disabling knee injury that occurred in the overhead, non-weight-bearing knee during the performance of a Biellmann spin. Examination and magnetic resonance imaging confirmed the diagnosis of a complete anterior cruciate ligament (ACL) tear. To our knowledge, no previous cases of acute injury of the ACL sustained during the execution of a Biellmann spin have been reported. The ACL injury we report is unique because it occurred without the blade contacting the ice. The mechanism of injury has some features that are similar to those of other noncontact ACL injuries, with the addition of centrifugal force as a potential contributor to the injury.

  13. Prevention of anterior cruciate ligament injuries in sports. Part I: systematic review of risk factors in male athletes.

    Science.gov (United States)

    Alentorn-Geli, Eduard; Mendiguchía, Jurdan; Samuelsson, Kristian; Musahl, Volker; Karlsson, Jon; Cugat, Ramon; Myer, Gregory D

    2014-01-01

    The purpose of this study was to report a comprehensive literature review on the risk factors for anterior cruciate ligament (ACL) injuries in male athletes. All abstracts were read and articles of potential interest were reviewed in detail to determine on inclusion status for systematic review. Information regarding risk factors for ACL injuries in male athletes was extracted from all included studies in systematic fashion and classified as environmental, anatomical, hormonal, neuromuscular, or biomechanical. Data extraction involved general characteristics of the included studies (type of study, characteristics of the sample, type of sport), methodological aspects (for quality assessment), and the principal results for each type of risk factor. The principal findings of this systematic review related to the risk factors for ACL injury in male athletes are: (1) most of the evidence is related to environmental and anatomical risk factors; (2) dry weather conditions may increase the risk of non-contact ACL injuries in male athletes; (3) artificial turf may increase the risk of non-contact ACL injuries in male athletes; (4) higher posterior tibial slope of the lateral tibial plateau may increase the risk of non-contact ACL injuries in male athletes. Anterior cruciate ligament injury in male athletes likely has a multi-factorial aetiology. There is a lack of evidence regarding neuromuscular and biomechanical risk factors for ACL injury in male athletes. Future research in male populations is warranted to provide adequate prevention strategies aimed to decrease the risk of this serious injury in these populations.

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

    Science.gov (United States)

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

    2015-12-01

    The femoral enthesis of the human anterior cruciate ligament (ACL) is known to be more susceptible to injury than the tibial enthesis. To determine whether anatomic differences might help explain this difference, we quantified the microscopic appearance of both entheses in 15 unembalmed knee specimens using light microscopy, toluidine blue stain and image analysis. The amount of calcified fibrocartilage and uncalcified fibrocartilage, and the ligament entheseal attachment angle were then compared between the femoral and tibial entheses via linear mixed-effects models. The results showed marked differences in anatomy between the two entheses. The femoral enthesis exhibited a 3.9-fold more acute ligament attachment angle than the tibial enthesis (p<0.001), a 43% greater calcified fibrocartilage tissue area (p<0.001), and a 226% greater uncalcified fibrocartilage depth (p<0.001), with the latter differences being particularly pronounced in the central region. We conclude that the ACL femoral enthesis has more fibrocartilage and a more acute ligament attachment angle than the tibial enthesis, which provides insight into why it is more vulnerable to failure. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

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

    Science.gov (United States)

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

    2017-01-01

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

  16. Impact of High-Fidelity Simulation and Pharmacist-Specific Didactic Lectures in Addition to ACLS Provider Certification on Pharmacy Resident ACLS Performance.

    Science.gov (United States)

    Bartel, Billie J

    2014-08-01

    This pilot study explored the use of multidisciplinary high-fidelity simulation and additional pharmacist-focused training methods in training postgraduate year 1 (PGY1) pharmacy residents to provide Advanced Cardiovascular Life Support (ACLS) care. Pharmacy resident confidence and comfort level were assessed after completing these training requirements. The ACLS training requirements for pharmacy residents were revised to include didactic instruction on ACLS pharmacology and rhythm recognition and participation in multidisciplinary high-fidelity simulation ACLS experiences in addition to ACLS provider certification. Surveys were administered to participating residents to assess the impact of this additional education on resident confidence and comfort level in cardiopulmonary arrest situations. The new ACLS didactic and simulation training requirements resulted in increased resident confidence and comfort level in all assessed functions. Residents felt more confident in all areas except providing recommendations for dosing and administration of medications and rhythm recognition after completing the simulation scenarios than with ACLS certification training and the didactic components alone. All residents felt the addition of lectures and simulation experiences better prepared them to function as a pharmacist in the ACLS team. Additional ACLS training requirements for pharmacy residents increased overall awareness of pharmacist roles and responsibilities and greatly improved resident confidence and comfort level in performing most essential pharmacist functions during ACLS situations. © The Author(s) 2013.

  17. Biomechanical characteristics of an anterior cruciate ligament injury in javelin throwing

    Directory of Open Access Journals (Sweden)

    Boyi Dai

    2015-12-01

    Conclusion: The ACL injury in this study occurred during the first 30% of the delivery phase, most likely during the first 25% of the delivery phase. A stiff landing of the left leg with a small knee flexion angle was the primary contributor to this injury. Javelin throwers may have a soft left leg landing with a flexed knee, which may help them prevent ACL injuries without compromising performance.

  18. Acceleration and Orientation Jumping Performance Differences Among Elite Professional Male Handball Players With or Without Previous ACL Reconstruction: An Inertial Sensor Unit-Based Study.

    Science.gov (United States)

    Setuain, Igor; González-Izal, Miriam; Alfaro, Jesús; Gorostiaga, Esteban; Izquierdo, Mikel

    2015-12-01

    Handball is one of the most challenging sports for the knee joint. Persistent biomechanical and jumping capacity alterations can be observed in athletes with an anterior cruciate ligament (ACL) injury. Commonly identified jumping biomechanical alterations have been described by the use of laboratory technologies. However, portable and easy-to-handle technologies that enable an evaluation of jumping biomechanics at the training field are lacking. To analyze unilateral/bilateral acceleration and orientation jumping performance differences among elite male handball athletes with or without previous ACL reconstruction via a single inertial sensor unit device. Case control descriptive study. At the athletes' usual training court. Twenty-two elite male (6 ACL-reconstructed and 16 uninjured control players) handball players were evaluated. The participants performed a vertical jump test battery that included a 50-cm vertical bilateral drop jump, a 20-cm vertical unilateral drop jump, and vertical unilateral countermovement jump maneuvers. Peak 3-dimensional (X, Y, Z) acceleration (m·s(-2)), jump phase duration and 3-dimensional orientation values (°) were obtained from the inertial sensor unit device. Two-tailed t-tests and a one-way analysis of variance were performed to compare means. The P value cut-off for significance was set at P handball athletes with previous ACL reconstruction demonstrated a jumping biomechanical profile similar to control players, including similar jumping performance values in both bilateral and unilateral jumping maneuvers, several years after ACL reconstruction. These findings are in agreement with previous research showing full functional restoration of abilities in top-level male athletes after ACL reconstruction, rehabilitation and subsequent return to sports at the previous level. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    David S. Hardin

    2013-04-01

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

  20. Influence of the different anteromedial portal on femoral tunnel orientation during anatomic ACL reconstruction

    Directory of Open Access Journals (Sweden)

    Dong-Kyu Moon

    2017-05-01

    Conclusions: In anatomic ACL reconstruction, a mal-positioned AM portal can cause abnormal tunnel orientation, which may lead to mechanical failure during ACL reconstruction. Therefore, it is important to select accurate AM portal positioning, and possibly using an AAM portal by measuring an accurate position when drilling a femoral tunnel in anatomic ACL reconstruction.

  1. Remodeling of ACL Allografts is Inhibited by Peracetic Acid Sterilization

    Science.gov (United States)

    Gonnermann, Johannes; Kamp, Julia; Przybilla, Dorothea; Pruss, Axel

    2008-01-01

    Sterilization of allografts for anterior cruciate ligament (ACL) reconstruction has become an important prerequisite to prevent disease transmission. However, current sterilization techniques impair the biological or mechanical properties of such treated grafts. Peracetic acid (PAA) has been successfully used to sterilize bone allografts without these disadvantages and does not impair the mechanical properties of soft tissue grafts in vitro. We asked whether PAA sterilization would influence recellularization, restoration of crimp length and pattern, and revascularization of ACL grafts during early healing. We used an in vivo sheep model for open ACL reconstruction. We also correlated the histologic findings with the restoration of anteroposterior stability and structural properties during load-to-failure testing. PAA slowed remodeling activity at 6 and 12 weeks compared to nonsterilized allografts and autografts. The mechanical properties of PAA grafts were also reduced compared to these control groups at both time points. We conclude PAA sterilization currently should not be used to sterilize soft tissue grafts typically used in ACL reconstruction. PMID:18491201

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

    NARCIS (Netherlands)

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

    2005-01-01

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

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

    African Journals Online (AJOL)

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

  4. MUSCLE STRENGTH AND QUALITATIVE JUMP-LANDING DIFFERENCES IN MALE AND FEMALE MILITARY CADETS: THE JUMP-ACL STUDY

    Directory of Open Access Journals (Sweden)

    Barry P. Boden

    2009-12-01

    Full Text Available Recent studies have focused on gender differences in movement patterns as risk factors for ACL injury. Understanding intrinsic and extrinsic factors which contribute to movement patterns is critical to ACL injury prevention efforts. Isometric lower- extremity muscular strength, anthropometrics, and jump-landing technique were analyzed for 2,753 cadets (1,046 female, 1,707 male from the U.S. Air Force, Military and Naval Academies. Jump- landings were evaluated using the Landing Error Scoring System (LESS, a valid qualitative movement screening tool. We hypothesized that distinct anthropometric factors (Q-angle, navicular drop, bodyweight and muscle strength would predict poor jump-landing technique in males versus females, and that female cadets would have higher scores (more errors on a qualitative movement screen (LESS than males. Mean LESS scores were significantly higher in female (5.34 ± 1.51 versus male (4.65 ± 1.69 cadets (p < 0.001. Qualitative movement scores were analyzed using factor analyses, yielding five factors, or "patterns", contributing to poor landing technique. Females were significantly more likely to have poor technique due to landing with less hip and knee flexion at initial contact (p < 0.001, more knee valgus with wider landing stance (p < 0. 001, and less flexion displacement over the entire landing (p < 0.001. Males were more likely to have poor technique due to landing toe-out (p < 0.001, with heels first, and with an asymmetric foot landing (p < 0.001. Many of the identified factor patterns have been previously proposed to contribute to ACL injury risk. However, univariate and multivariate analyses of muscular strength and anthropometric factors did not strongly predict LESS scores for either gender, suggesting that changing an athlete's alignment, BMI, or muscle strength may not directly improve his or her movement patterns

  5. Quantitative Comparison of the Microscopic Anatomy of the Human ACL Femoral and Tibial Entheses

    Science.gov (United States)

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

    2015-01-01

    The femoral enthesis of the human anterior cruciate ligament (ACL) is known to be more susceptible to injury than the tibial enthesis. To determine whether anatomic differences might help explain this difference, we quantified the microscopic appearance of both entheses in 15 unembalmed knee specimens using light microscopy, toluidine blue stain and image analysis. The amount of calcified fibrocartilage and uncalcified fibrocartilage, and the ligament entheseal attachment angle were then compared between the femoral and tibial entheses via linear mixed-effects models. The results showed marked differences in anatomy between the two entheses. The femoral enthesis exhibited a 3.9-fold more acute ligament attachment angle than the tibial enthesis (p fibrocartilage tissue area (p fibrocartilage depth (p fibrocartilage and a more acute ligament attachment angle than the tibial enthesis, which provides insight into why it is more vulnerable to failure. PMID:26134706

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

    Directory of Open Access Journals (Sweden)

    Ehsan Saadat

    2014-12-01

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

  7. Effect of Hip-Focused Injury Prevention Training for Anterior Cruciate Ligament Injury Reduction in Female Basketball Players: A 12-Year Prospective Intervention Study.

    Science.gov (United States)

    Omi, Yorikatsu; Sugimoto, Dai; Kuriyama, Setsurou; Kurihara, Tomohisa; Miyamoto, Kenji; Yun, Songjo; Kawashima, Tatsuhiro; Hirose, Norikazu

    2018-03-01

    Programs to prevent anterior cruciate ligament (ACL) injuries in female basketball players are scarce. Also, ACL injury prevention training that focuses on hip joint function has not been reported. To determine the effectiveness of a hip-focused ACL injury prevention program in female basketball players. Cohort study; Level of evidence, 2. A prospective intervention study was conducted for 12 years. Incidence rates of ACL injuries were collected in the first 4 years (observation period) from college female basketball players. After the observation period, a hip-focused ACL injury prevention program was implemented for 8 years (intervention period). A total of 309 players (mean ± SD age, 19.6 ± 1.2 years; height, 163.7 ± 5.6 cm; weight, 59.1 ± 5.1 kg; body mass index, 22.0 ± 1.4) were tracked in the observation period and compared with 448 players (age, 19.6 ± 1.1 years; height, 162.6 ± 5.8 cm; weight, 58.0 ± 5.7 kg; body mass index, 21.9 ± 1.5) who participated in the intervention period. Athlete-exposures (AEs), ACL numbers and mechanisms of injury (MOIs), relative risk (RR), absolute risk reduction (ARR), numbers needed to treat (NNT), and compliance were analyzed. There were 16 ACL injuries (13 noncontact MOIs) in the 4-year observation period, whereas 9 ACL injuries (8 noncontact MOIs) were recorded in the 8-year intervention period. The overall ACL injury incidence was 0.25/1000 AEs in the 4-year observation period compared with 0.10/1000 AEs in the 8-year intervention period, respectively. Compared with the 4-year observation period, significant RR reduction was observed (0.38; 95% CI, 0.17-0.87; P = .017) with ARR and NNT of 0.032 (95% CI, 0.027-0.037) and 31.6 (95% CI, 27.1-37.7), respectively, in the 8-year intervention period. The noncontact ACL injury incidence was 0.21 per 1000 AEs during the 4-year observation period compared with 0.08/1000 AEs in the 8-year intervention period, which also showed significant RR reduction (0.37; 95% CI, 0

  8. Report of the Primary Outcomes for Gait Mechanics in Men of the ACL-SPORTS Trial: Secondary Prevention With and Without Perturbation Training Does Not Restore Gait Symmetry in Men 1 or 2 Years After ACL Reconstruction.

    Science.gov (United States)

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

    2017-10-01

    Movement asymmetries during walking are common after anterior cruciate ligament (ACL) injury and reconstruction and may influence the early development of posttraumatic osteoarthritis. Preoperative neuromuscular training (like perturbation training, which is neuromuscular training requiring selective muscle activation in response to surface perturbations) improves gait asymmetries and functional outcomes among people who are ACL-deficient, but the effect of postoperative perturbation training on gait mechanics after ACL reconstruction is unknown. Among men undergoing ACL reconstruction, we sought to compare strength, agility, and secondary prevention (SAP) treatment with SAP plus perturbation training (SAP+PERT) with respect to (1) gait mechanics; and (2) elimination of gait asymmetries 1 and 2 years after ACL reconstruction. Forty men were randomized into a SAP group or a SAP+PERT group after ACL reconstruction and before returning to preinjury activities. Participants were required to achieve ≥ 80% quadriceps muscle strength symmetry, minimal knee effusion, full ROM, no reports of pain, and completion of a running progression (all between 3 and 9 months postoperatively) before enrollment. Of 94 potentially eligible athletic male patients evaluated knee angles and moments at peak knee flexion angle; (2) sagittal plane hip and knee angles and moments at peak knee extension angle; (3) sagittal plane hip and knee excursion during weight acceptance; and (4) sagittal plane hip and knee excursion during midstance. We also calculated the proportion of athletes in each group who walked with clinically meaningful interlimb asymmetry in sagittal plane hip and knee variables and compared these proportions using odds ratios. There was no differential loss to followup between groups. There were no differences between the SAP or SAP+PERT groups for the biomechanical gait variables. The involved limb's knee excursion during midstance for the SAP (mean ± SD: 1 year: 15° ± 5

  9. Long-term health outcomes of youth sports injuries.

    Science.gov (United States)

    Maffulli, N; Longo, U G; Gougoulias, N; Loppini, M; Denaro, V

    2010-01-01

    Injuries can counter the beneficial effects of sports participation at a young age if a child or adolescent is unable to continue to participate because of residual effects of injury. This paper reviews current knowledge in the field of long-term health outcomes of youth sports injuries to evaluate the evidence regarding children dropping out of sport due to injury, physeal injuries and growth disturbance, studies of injuries affecting the spine and knee of young and former athletes and surgical outcome of anterior cruciate ligament (ACL) reconstruction in children. Studies of dropping out of sport due to injury are limited primarily to gymnasts and implicate such injuries as ACL rupture and osteochondritis dissecans of the elbow joint in the early retirement of young athletes. Although most physeal injuries resolve with treatment and rest, there is evidence of disturbed physeal growth as a result of injury. Radiological findings implicate the effects of intense physical loading and injury in the development of spinal pathology and back pain during the growth of youth athletes; however, long-term effects are unclear. Follow-up studies of young athletes and adults indicate a high risk of osteoarthritis after meniscus or ACL injury. Prospective cohort studies with a follow-up into adulthood are needed to clarify the long-term health outcomes of youth sports injuries. Important to this research is meticulous documentation of injuries on injury report forms that include age-appropriate designations of the type of injury and accurate determination of exposure-based injury rates.

  10. Anterior cruciate ligament injury: Identifying information sources and risk factor awareness among the general population.

    Directory of Open Access Journals (Sweden)

    Yasuharu Nagano

    Full Text Available Raising awareness on a disorder is important for its prevention and for promoting public health. However, for sports injuries like the anterior cruciate ligament (ACL injury no studies have investigated the awareness on risk factors for injury and possible preventative measures in the general population. The sources of information among the population are also unclear. The purpose of the present study was to identify these aspects of public awareness about the ACL injury.A questionnaire was randomly distributed among the general population registered with a web based questionnaire supplier, to recruit 900 participants who were aware about the ACL injury. The questionnaire consisted of two parts: Question 1 asked them about their sources of information regarding the ACL injury; Question 2 asked them about the risk factors for ACL injury. Multivariate logistic regression was used to determine the information sources that provide a good understanding of the risk factors.The leading source of information for ACL injury was television (57.0%. However, the results of logistic regression analysis revealed that television was not an effective medium to create awareness about the risk factors, among the general population. Instead "Lecture by a coach", "Classroom session on Health", and "Newspaper" were significantly more effective in creating a good awareness of the risk factors (p < 0.001.

  11. MRI of normal anterior cruciate ligament (ACL) and reconstructed ACL: comparison of when the knee is extended with when the knee is flexed

    International Nuclear Information System (INIS)

    Nakanishi, K.; Horibe, S.; Shiozaki, Y.; Ishida, T.; Narumi, Y.; Ikezoe, J.; Nakamura, H.

    1997-01-01

    The purpose of this study was to evaluate, using MRI, the morphology of normal anterior cruciate ligament (ACL) and ACL grafts when the knee was extended compared with when the knee was flexed. Eighteen normal controls and 22 ACL graft patients were studied. Spin-echo (SE) T1-weighted images (TR 330 ms/TE 15 ms, NEX 1) were obtained with a slice thickness of 3 mm. Oblique sagittal images parallel to the ACL were obtained at various flexed angles of the knee joint. In 12 of the 18 normal controls the ACL appeared convex toward the posterior side when the knee was extended and gradually became straight when the knee was flexed. In 15 of the 22 ACL graft patients the grafts appeared straight when the knee was extended and became convex toward the anterior side when the knee was flexed. It is concluded that the morphological changes seen on MR images of ACL grafts from when the knee is extended to when the knee is flexed are different from those in the normal ACL. (orig.). With 7 figs., 1 tab

  12. Amount of Minutes Played Does Not Contribute to Anterior Cruciate Ligament Injury in National Basketball Association Athletes.

    Science.gov (United States)

    Okoroha, Kelechi R; Marfo, Kojo; Meta, Fabien; Matar, Robert; Shehab, Ramsy; Thompson, Terry; Moutzouros, Vasilios; Makhni, Eric C

    2017-07-01

    There is limited information on the potential risk factors for sustaining an anterior cruciate ligament (ACL) tear in National Basketball Association (NBA) athletes. This study evaluated 83 NBA players who sustained an ACL injury between 1984 and 2015 to determine the influence of minutes played on injury risk. Minutes played in the injury game, during the season, and over their career were assessed, along with the ability to return to play, player efficiency rating, and playing time after return. Athletes in the NBA played significantly fewer minutes before sustaining an ACL injury (17.1 minutes) than their average minutes per game that season (23.5 minutes; PNBA competition the season following ACL injury. Players who were drafted as lottery picks (draft pick 1 to 15) or those who were starters played significantly more minutes the season following injury than those who were not (both PNBA game did not contribute to the risk of sustaining an ACL injury. Although there was a high rate of return to NBA competition the season following injury, those who were elite athletes played more minutes per game than those who were not. Athletes who returned to play sustained a decrease in player efficiency ratings compared with similar athletes without ACL injury. [Orthopedics. 2017; 40(4):e658-e662.]. Copyright 2017, SLACK Incorporated.

  13. Study of cervical cord injury without radiological abnormality using MRI at injury

    International Nuclear Information System (INIS)

    Park, Jin-Soo; Ei, Terumi; Uchida, Yoko; Kodai, Yujiro; Yasumatsu, Hideo; Yoshino, Kazutaka; Hirakawa, Takashi.

    1994-01-01

    This study was undertaken, using MRI at the time of injury, to examine cervical cord injury without radiological abnormality. The subjects were 30 patients (24 men and 6 women) seen during the 4-year period 1989-1993, who ranged in age from 31 to 83 years (an average age of 62.8 years). Of these patients, 10 had a slightly irregular alignment of the vertebral body on plain X-rays. These 10 patients were examined using MRI early after sustaining trauma (within 24 hours in 9 and 48 hours in one). As a result, spinal cord was seen as isointensity on T1-weighted images and hyperintensity on T2-weighted images, corresponding to irregular alignment. These findings suggest that reduction of a dislocation may transiently occur due to patient transfer or natural elasticity, as plain X-rays indicated no evidence of bone abnormalities. Thus injuries like dislocations may have occurred at the time of trauma, and structural changes of the vertebral body may be responsible for the occurrence of cervical spinal cord. Spinal cord injuries, even if not evidenced on plain X-rays, should not be categorized as non-osseous injuries. (N.K.)

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

    Science.gov (United States)

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

    2004-02-01

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

  15. In vitro comparison of human fibroblasts from intact and ruptured ACL for use in tissue engineering

    Directory of Open Access Journals (Sweden)

    T Brune

    2007-12-01

    Full Text Available The present study compares fibroblasts extracted from intact and ruptured human anterior cruciate ligaments (ACL for creation of a tissue engineered ACL-construct, made of porcine small intestinal submucosal extracellular matrix (SIS-ECM seeded with these ACL cells. The comparison is based on histological, immunohistochemical and RT-PCR analyses. Differences were observed between cells in a ruptured ACL (rACL and cells in an intact ACL (iACL, particularly with regard to the expression of integrin subunits and smooth muscle actin (SMA. Despite these differences in the cell source, both cell populations behaved similarly when seeded on an SIS-ECM scaffold, with similar cell morphology, connective tissue organization and composition, SMA and integrin expression. This study shows the usefulness of naturally occurring scaffolds such as SIS-ECM for the study of cell behaviour in vitro, and illustrates the possibility to use autologous cells extracted from ruptured ACL biopsies as a source for tissue engineered ACL constructs.

  16. Anterior Cruciate Ligament Injuries in the National Hockey League: Epidemiology and Performance Impact.

    Science.gov (United States)

    Longstaffe, Robert; Leiter, Jeff; MacDonald, Peter

    2018-03-27

    To determine the incidence of anterior cruciate ligament (ACL) injuries in the National Hockey League (NHL) and to examine the effects of this injury on return-to-play status and performance. Case series; level of evidence, 4. This was a 2-phase study. Phase I used the NHL electronic injury surveillance system and Athlete Health Management System to collect data on ACL injuries and man games lost over 10 seasons (2006/2007-2015/2016). Data collected in phase I were received in deidentified form. Phase II examined the performance impact of an ACL injury. Players were identified through publically available sources, and performance-related statistics were analyzed. Data collected in phase II were not linked to data collected in phase I. A paired t test was used to determine any difference in the matching variables between controls and cases in the preinjury time period. A General linear model (mixed) was used to determine the performance impact. Phase I: 67 ACL injuries occurred over 10 seasons. The incidence for all players was 0.42/1000 player game hours (forward, 0.61; defenseman, 0.32, goalie, 0.08) and by game exposure was 0.2/1000 player game exposures (forward, 0.33; defenseman, 0.11; goalie, 0.07). Forwards had a greater incidence rate of ACL tears with both game hours and game exposures when compared with defensemen and goalies (P game (P game (0.001). Number of games and seasons played after an ACL injury did not differ compared with controls (P = 0.068, 0.122, respectively). Anterior cruciate ligament injuries occur infrequently, as it relates to other hockey injuries. Despite a high return to play, the performance after an ACL injury demonstrated a decrease in points and goals per game and per season.

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

    NARCIS (Netherlands)

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

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

  18. Clinical Efficacy of Jump Training Augmented With Body Weight Support After ACL Reconstruction: A Randomized Controlled Trial.

    Science.gov (United States)

    Elias, Audrey R C; Harris, Kari J; LaStayo, Paul C; Mizner, Ryan L

    2018-06-01

    Limited knee flexion and increased muscle co-contraction during jump landing are believed to diminish outcomes after anterior cruciate ligament (ACL) reconstruction. The efficacy of jump training to improve patients' mechanical and neuromuscular deficits is understudied. Jump training will improve functional, mechanical, and neuromuscular outcomes and higher repetition training augmented by body weight support will result in better retention of gains. Randomized controlled trial; Level of evidence, 1. Thirty athletes (18 months after surgery) were screened, and 19 with mechanical deficits and limited clinical outcomes were enrolled in the trial. Testing included the International Knee Documentation Committee (IKDC) questionnaire, leg landing mechanics via motion analysis, knee joint effusion using a stroke test, and a surface electromyography-generated co-contraction index during a single-legged landing. Participants were randomly assigned to 1 of 2 groups: jump training with normal body weight (JTBW) and high-repetition jump training with body weight support (JTBWS). Knee effusion grading throughout training was used to assess joint tolerance. Changes in outcomes over time were analyzed with mixed-effects modeling. Immediate outcomes were compared with retention testing at 8 weeks after training by use of 2-way analyses of variance with effects of time and group. Significant effects of time were found during the training phase for all outcome measures, but no effects of group or sex were found. IKDC score (pooled; mean ± SD) increased from 76 ± 12 to 87 ± 8 ( P Jump training mitigated some risk factors for second injury and osteoarthritis in patients after ACL reconstruction. Training made lasting improvements in physical function measures as well as mechanical and neuromuscular coordination deficits. Higher repetitions used with body weight support did not improve retention but substantially reduced risk for effusion. Jump training is an efficacious

  19. Modeling Algorithms in SystemC and ACL2

    Directory of Open Access Journals (Sweden)

    John W. O'Leary

    2014-06-01

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

  20. Hyperextension injuries of the knee. Do patterns of bone bruising predict soft tissue injury?

    Energy Technology Data Exchange (ETDEWEB)

    Ali, A.M.; Gibbons, C.E.R. [Chelsea and Westminster Hospital, Department of Orthopaedic Surgery, London (United Kingdom); Pillai, J.K.; Roberton, B.J. [Chelsea and Westminster Hospital, Department of Radiology, London (United Kingdom); Gulati, V. [Homerton University Hospital, Department of Orthopaedic Surgery, London (United Kingdom)

    2018-02-15

    To establish whether patterns of soft tissue injury following knee hyperextension are associated with post-traumatic 'bone bruise' distribution. Patients with a knee MRI within one year of hyperextension injury were identified at our institution over a 7 year period. MRIs, plain radiographs and clinical details of these patients were reviewed. Twenty-five patients were identified (median time from injury to MRI = 24 days). The most common sites of bone bruising were the anteromedial tibial plateau (48%) and anterolateral tibial plateau (44%). There were high rates of injury to the posterior capsule (52%), ACL (40%) and PCL (40%) but lower rates of injury to the menisci (20%), medial and lateral collateral ligaments (16%) and posterolateral corner (16%). Anterior tibial plateau oedema and rupture of the posterior capsule predicted cruciate ligament injury [OR = 10.5 (p = 0.02) and 24.0 (p = 0.001) respectively]. Whilst anterolateral tibial plateau oedema strongly predicted PCL injury [OR = 26.0, p = 0.003], ACL injury was associated with a variable pattern of bone bruising. Meniscal injury was unrelated to the extent or pattern of bone bruising. 5 out of 8 patients with a 'double sulcus' on the lateral radiograph had ACL injury. The presence of a double sulcus showed significant association with anteromedial kissing contusions (OR = 7.8, p = 0.03). Following knee hyperextension, bone bruising patterns may be associated with cruciate ligament injury. Other structures are injured less frequently and have weaker associations with bone bruise distribution. The double sulcus sign is a radiographic marker that confers a high probability of ACL injury. (orig.)

  1. Intra-ligamentary autologous conditioned plasma and healing response to treat partial ACL ruptures.

    Science.gov (United States)

    Koch, Matthias; Matteo, Berardo Di; Eichhorn, Jürgen; Zellner, Johannes; Mayr, Felix; Krutsch, Werner; Achenbach, Leonard; Woehl, Rebecca; Nerlich, Michael; Angele, Peter

    2018-05-01

    Conservative treatment of partial ACL ruptures is associated with a high failure rate, and often patients undergo ACL reconstruction. ACL preservation by trephination of the ACL origin and application of Autologous Conditioned Plasma (ACP) seems to be an intriguing new treatment option to favour ACL tissue healing and avoid traditional reconstruction. The aim of this study was to describe the mid-term outcomes of this new ACL preserving technique. Twenty-four patients (mean age 41.8 years) affected by partial rupture of one or both ACL bundles were included in the present trial. The partial ACL tears were arthroscopically assessed and classified according to a new five step grading system. All patients were treated by trephination of the femoral ACL stump and intra-ligamentary application of ACP. The postoperative outcome was evaluated by both subjective scores and stability testing up to a mean of 25.1 months' follow-up. Adverse events and failure rate were also documented. Clinical outcome was good to excellent with IKDC subjective 82.7 (SD 11.8), Lysholm 87.6 (SD 8.1), Tegner 5.3 (SD 2.1), Cincinnati 88.7 (SD 14.8). The failure rate (i.e. persisting knee instability assessed clinically or by rolimeter) was 12.5%. At objective measurements, knee joints showed a firm endpoint in Lachman test, negative pivot shift phenomenon and a significant reduction in AP-laxity compared to pre-operative status by rolimeter testing (p = 0.002). Return to sport practice was achieved after mean 4.8 months (SD 4.1). ACL stump trephination and concomitant intra-ligamentary application of ACP revealed promising results at mid-term follow-up to treat partial ACL lesions.

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

    Science.gov (United States)

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

    2016-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Emilton Lima Júnior

    2002-12-01

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

  4. Assessing the progress of rehabilitation in patients with ACL reconstruction using the International Knee Documentation Committee Subjective Knee Form

    International Nuclear Information System (INIS)

    Leguizamon, J H; Braidot, A; Catalfamo Formento, P

    2011-01-01

    There are numerous assessment tools designed to provide information on the results of reconstructive surgery of anterior cruciate ligament (ACL). They are also used for monitoring progress and facilitating clinical decision-making during the rehabilitation process. A brief summary of some existing tools specifically designed to evaluate knee ligament injuries is presented in this article. Then, one of those outcome measures, the International Knee Documentation Committee Subjective Knee Form (IKDC) was applied to a group of patients (N = 10) who had undergone surgery for ACL reconstruction. The patients attended the same physiotherapy service and followed a unified rehabilitation protocol. The assessment was performed twice: four and six months after surgery. The results showed an improvement in the rehabilitation of most patients tested (verified by a difference equal to or greater than 9 points on the IKDC outcome between measurements 1 and 2). The IKDC probed to be an instrument of quick and easy application. It provided quantitative data about the progress of rehabilitation and could be applied in everyday clinical physiotherapy practice. However, the results suggested considering the IKDC as one component of an evaluation kit to make decisions regarding the progress of the rehabilitation treatment.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  6. Histological characteristics of ligament healing after bio-enhanced repair of the transected goat ACL

    NARCIS (Netherlands)

    Nguyen, D. Tan; Dellbrügge, Sietske; Tak, Paul P.; Woo, Savio L.-Y.; Blankevoort, Leendert; van Dijk, Niek C.

    2015-01-01

    Recently, healing of a ruptured anterior cruciate ligament (ACL) is reconsidered. In a previous study, we have shown that the transected ACL can heal after treatment with the triple X locking suture alone or combined with small intestine submucosa (SIS). The first research question of this study was

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-02-15

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

  8. 3D-Printed Patient-Specific ACL Femoral Tunnel Guide from MRI.

    Science.gov (United States)

    Rankin, Iain; Rehman, Haroon; Frame, Mark

    2018-01-01

    Traditional ACL reconstruction with non-anatomic techniques can demonstrate unsatisfactory long-term outcomes with regards instability and the degenerative knee changes observed with these results. Anatomic ACL reconstruction attempts to closely reproduce the patient's individual anatomic characteristics with the aim of restoring knee kinematics, in order to improve patient short and long-term outcomes. We designed an arthroscopic, patient-specific, ACL femoral tunnel guide to aid anatomical placement of the ACL graft within the femoral tunnel. The guide design was based on MRI scan of the subject's uninjured contralateral knee, identifying the femoral footprint and its anatomical position relative to the borders of the femoral articular cartilage. Image processing software was used to create a 3D computer aided design which was subsequently exported to a 3D-printing service. Transparent acrylic based photopolymer, PA220 plastic and 316L stainless steel patient-specific ACL femoral tunnel guides were created; the models produced were accurate with no statistical difference in size and positioning of the center of the ACL femoral footprint guide to MRI ( p =0.344, p =0.189, p =0.233 respectively). The guides aim to provide accurate marking of the starting point of the femoral tunnel in arthroscopic ACL reconstruction. This study serves as a proof of concept for the accurate creation of 3D-printed patient-specific guides for the anatomical placement of the femoral tunnel during ACL reconstruction.

  9. Neuromuscular Retraining in Female Adolescent Athletes: Effect on Athletic Performance Indices and Noncontact Anterior Cruciate Ligament Injury Rates

    Directory of Open Access Journals (Sweden)

    Frank R. Noyes

    2015-05-01

    Full Text Available While many anterior cruciate ligament (ACL prevention programs have been published, few have achieved significant reductions in injury rates and improvements in athletic performance indices; both of which may increase compliance and motivation of athletes to participate. A supervised neuromuscular retraining program (18 sessions was developed, aimed at achieving both of these objectives. The changes in neuromuscular indices were measured after training in 1000 female athletes aged 13–18 years, and the noncontact ACL injury rate in 700 of these trained athletes was compared with that of 1120 control athletes. There were significant improvements in the drop-jump test, (p < 0.0001, effect size [ES] 0.97, the single-leg triple crossover hop (p < 0.0001, ES 0.47, the t-test (p < 0.0001, ES 0.64, the multi-stage fitness test (p < 0.0001, ES 0.57, hamstring strength (p < 0.0001, and quadriceps strength (p < 0.01. The trained athletes had a significant reduction in the noncontact ACL injury incidence rate compared with the controls (1 ACL injury in 36,724 athlete-exposures [0.03] and 13 ACL injuries in 61,244 exposures [0.21], respectively, p = 0.03. The neuromuscular retraining program was effective in reducing noncontact ACL injury rate and improving athletic performance indicators.

  10. Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years

    Energy Technology Data Exchange (ETDEWEB)

    Facchetti, Luca [University of California, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); University of Brescia, Department of Radiology, Brescia (Italy); Schwaiger, Benedikt J.; Gersing, Alexandra S.; Nardo, Lorenzo; Majumdar, Sharmila; Link, Thomas M.; Li, Xiaojuan [University of California, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Guimaraes, Julio Brandao [University of California, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Federal University of Sao Paulo (UNIFESP), Department of Radiology, Sao Paulo (Brazil); Ma, Benjamin C. [University of California, Department of Orthopedic Surgery, San Francisco, CA (United States); Collaboration: UCSF-P50-ACL Consortium; AF-ACL Consortium

    2017-08-15

    To assess the impact of cyclops lesions with MRI in patients treated for anterior cruciate ligament (ACL) tears on clinical outcome. In 113 patients (age 29.8 ± 10.5y; 55 females; BMI 24.8 ± 3.7 kg/m{sup 2}) with complete ACL tear, 3 T-MRI scans were obtained before, 6-months, 1-year (n = 75) and 2-years (n = 33) after ACL reconstruction. Presence and volume of cyclops lesions were assessed. Clinical outcomes were measured using the Knee injury and Osteoarthritis Outcome Score (KOOS) and differences between time points (∇KOOS) were calculated. Changes of KOOS subscales were compared between patients with and without cyclops lesion. KOOS was also correlated with lesion volume. Cyclops lesions were found in 25% (28/113), 27% (20/75) and 33% (11/33) of patients after 6-months, 1- and 2-years, respectively. The lesion volume did not change significantly (P > 0.05) between time points, measuring 0.65 ± 0.59, 0.81 ± 0.70 and 0.72.9 ± 0.96 cm{sup 3}, respectively. Clinical outcomes based on KOOS subscales were not significantly different in patients with cyclops lesions compared to those without cyclops lesions (each comparison P > 0.05), and no significant associations of clinical outcomes with lesion volume were found (P > 0.05). Neither presence nor size of cyclops lesions within the first 2-years after ACL surgery were associated with inferior clinical outcome. (orig.)

  11. Prevention of Lower Extremity Injuries in Basketball

    Science.gov (United States)

    Taylor, Jeffrey B.; Ford, Kevin R.; Nguyen, Anh-Dung; Terry, Lauren N.; Hegedus, Eric J.

    2015-01-01

    Context: Lower extremity injuries are common in basketball, yet it is unclear how prophylactic interventions affect lower extremity injury incidence rates. Objective: To analyze the effectiveness of current lower extremity injury prevention programs in basketball athletes, focusing on injury rates of (1) general lower extremity injuries, (2) ankle sprains, and (3) anterior cruciate ligament (ACL) tears. Data Sources: PubMed, MEDLINE, CINAHL, SPORTDiscus, and the Cochrane Register of Controlled Trials were searched in January 2015. Study Selection: Studies were included if they were randomized controlled or prospective cohort trials, contained a population of competitive basketball athletes, and reported lower extremity injury incidence rates specific to basketball players. In total, 426 individual studies were identified. Of these, 9 met the inclusion criteria. One other study was found during a hand search of the literature, resulting in 10 total studies included in this meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 2. Data Extraction: Details of the intervention (eg, neuromuscular vs external support), size of control and intervention groups, and number of injuries in each group were extracted from each study. Injury data were classified into 3 groups based on the anatomic diagnosis reported (general lower extremity injury, ankle sprain, ACL rupture). Results: Meta-analyses were performed independently for each injury classification. Results indicate that prophylactic programs significantly reduced the incidence of general lower extremity injuries (odds ratio [OR], 0.69; 95% CI, 0.57-0.85; P basketball athletes. Conclusion: In basketball players, prophylactic programs may be effective in reducing the risk of general lower extremity injuries and ankle sprains, yet not ACL injuries. PMID:26502412

  12. The effect of targeted exercise on knee-muscle function in patients with persistent hamstring deficiency following ACL reconstruction

    DEFF Research Database (Denmark)

    Bregenhof, Bo; Jørgensen, Uffe; Aagaard, Per

    2018-01-01

    BACKGROUND: Anterior cruciate ligament (ACL) reconstruction, using hamstring auto-graft is a common surgical procedure, which often leads to persistent hamstring muscle-strength deficiency and reduced function. The purpose of this randomized controlled trial (RCT) is to investigate the effect...... at 12-24 months' post surgery, will be recruited through outpatient clinics and advertisements. Patients will be randomized to a 12-week progressive, strength and neuromuscular exercise group (SNG) with supervised training twice weekly or a control intervention (CON) consisting of a home-based, low......-intensity exercise program. Outcome measures include between-group change in maximal isometric knee-flexor strength (primary outcome) and knee-extensor muscle strength, hamstring-to-quadriceps strength ratios of the leg that has been operated on and Knee injury and Osteoarthritis Outcome Score (KOOS) (secondary...

  13. A-B Hourglass Technique in Anterior Cruciate Ligament (ACL) Reconstruction

    International Nuclear Information System (INIS)

    Abuhamella, Tamer M.; Batterjee, Khaled A.

    2006-01-01

    Within a period of 2 years starting from April 2000 to November 2002, fifty (50) cases of torn anterior cruciate ligament (ACL) were treated and followed up using our simple modified technique in a retrospective non-randomized study conducted in Saudi-German Hospital, Saudi Arabia. All of which had torn ACL either isolated or associated with meniscal tear. Some of our study group was subjected arthroscopic interference in the same knee before either in the form of ACL reconstruction using P-T-B graft or for menisectomy. During this study per-operative evaluation, intra-operative technique and post-operative follow-up were standardized, with maximum follow-up period of 19 months and minimum follow-up period of 9 month. The final outcome was graded according to Lyshom knee score (1982). The mean age at surgery was 26.5 (from 17 to 36 years). The study group included 11 isolated torn ACL, 29 torn ACL with tear in the medial meniscus, 4 torn ACL with lateral meniscus tear and 6 cases with torn ACL associated with tear in both menisci. All of the cases were treated using the same technique. (author)

  14. Assessing participation in the ACL injured population: Selecting a patient reported outcome measure on the basis of measurement properties.

    Science.gov (United States)

    Letchford, Robert; Sparkes, Valerie; van Deursen, Robert W M

    2015-06-01

    A return to pre injury activity participation remains a common but often elusive goal following ACL injury. Investigations to improve our understanding of participation restrictions are limited by inconsistent use of insufficiently investigated measurement tools. The aim of this study was to follow the consensus based standards for the selection of health measurement instruments (COSMIN) guideline to provide a comparative evaluation of four patient reported outcomes (PROMs) on the basis of measurement properties. This will inform recommendations for measuring participation of ACL injured subjects, particularly in the United Kingdom (UK) National Health Service (NHS). Thirteen criteria were compiled from the COSMIN guideline. These included reliability, measurement error, content validity, construct validity, responsiveness and interpretability. Data from 51 subjects collected as part of a longitudinal observational study of recovery over the first year following ACLR was used in the analysis. Of the thirteen criteria, the required standard was met in 11 for Tegner, 11 for International Knee Documentation Committee (IKDC), 6 for Cincinnati Sports Activity Scale (CSAS) and 6 for Marx. The two weaknesses identified for the Tegner are more easily compensated for during interpretation than those in the IKDC; for this reason the Tegner is the recommended PROM. The Tegner activity rating scale performed consistently well in respect of all measurement properties in this sample, with clear benefits over the other PROMs. The measurement properties presented should be used to inform implementation and interpretation of this outcome measure in clinical practice and research. Level II prospective study. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Biomechanical and neuromuscular characteristics of male athletes: implications for the development of anterior cruciate ligament injury prevention programs.

    Science.gov (United States)

    Sugimoto, Dai; Alentorn-Geli, Eduard; Mendiguchía, Jurdan; Samuelsson, Kristian; Karlsson, Jon; Myer, Gregory D

    2015-06-01

    Prevention of anterior cruciate ligament (ACL) injury is likely the most effective strategy to reduce undesired health consequences including reconstruction surgery, long-term rehabilitation, and pre-mature osteoarthritis occurrence. A thorough understanding of mechanisms and risk factors of ACL injury is crucial to develop effective prevention programs, especially for biomechanical and neuromuscular modifiable risk factors. Historically, the available evidence regarding ACL risk factors has mainly involved female athletes or has compared male and female athletes without an intra-group comparison for male athletes. Therefore, the principal purpose of this article was to review existing evidence regarding the investigation of biomechanical and neuromuscular characteristics that may imply aberrant knee kinematics and kinetics that would place the male athlete at risk of ACL injury. Biomechanical evidence related to knee kinematics and kinetics was reviewed by different planes (sagittal and frontal/coronal), tasks (single-leg landing and cutting), situation (anticipated and unanticipated), foot positioning, playing surface, and fatigued status. Neuromuscular evidence potentially related to ACL injury was reviewed. Recommendations for prevention programs for ACL injuries in male athletes were developed based on the synthesis of the biomechanical and neuromuscular characteristics. The recommendations suggest performing exercises with multi-plane biomechanical components including single-leg maneuvers in dynamic movements, reaction to and decision making in unexpected situations, appropriate foot positioning, and consideration of playing surface condition, as well as enhancing neuromuscular aspects such as fatigue, proprioception, muscle activation, and inter-joint coordination.

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

    Directory of Open Access Journals (Sweden)

    Duncan KJ

    2016-01-01

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

  17. Acute Management of Anterior Cruciate Ligament Injuries Using Novel Canine Models.

    Science.gov (United States)

    Bozynski, Chantelle C; Stannard, James P; Smith, Pat; Hanypsiak, Bryan T; Kuroki, Keiichi; Stoker, Aaron; Cook, Cristi; Cook, James L

    2016-10-01

    The objective of this study was to compare treatment options for acute management of anterior cruciate ligament (ACL) injuries using preclinical models. Twenty-seven adult purpose-bred research hounds underwent knee surgery (sham control, exposed ACL, or partial-tear ACL) and were assessed over the following 8 weeks. Dogs were randomized into three treatment groups: standard of care (i.e., rest and nonsteroidal anti-inflammatory drugs [NSAIDs]), washout, or leukoreduced platelet-rich plasma (PRP) so that a total of nine dogs received each treatment. Data from the two ACL-injury groups were pooled for each treatment ( n  = 6 per treatment group) and analyzed for treatment effects. The washout and PRP groups experienced less lameness, pain, and effusion, and greater function and comfortable range of motion compared with the NSAID group, with the PRP group showing most benefits. PRP was associated with the lowest severity of ACL pathology based on arthroscopic assessment. Measurable levels of inflammatory and degradative biomarkers were present in synovial fluid with significant differences noted over time. Based on these findings, washout had positive clinical effects compared with the standard-of-care group especially within the first week of treatment, but became less beneficial over time. A single injection of leukoreduced PRP was associated with favorable clinical results. However, no treatment was significantly "protective" against progression toward osteoarthritis after ACL injury. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  18. Expression of modulators of extracellular matrix structure after anterior cruciate ligament injury.

    Science.gov (United States)

    Haslauer, Carla M; Proffen, Benedikt L; Johnson, Victor M; Murray, Martha M

    2014-01-01

    The ability of the anterior cruciate ligament (ACL) to heal after injury declines within the first 2 weeks after ACL rupture. To begin to explore the mechanism behind this finding, we quantified the expression of genes for collagen I and III, decorin, tenascin-C, and alpha smooth muscle actin, as well as matrix metalloproteinase (MMP)-1 and -13 gene expression within multiple tissues of the knee joint after ACL injury in a large animal model over a 2-week postinjury period. Gene expression of collagen I and III, decorin, and MMP-1 was highest in the synovium, whereas the highest MMP-13 gene expression levels were found in the ACL. The gene expression for collagen and decorin increased over the 2 weeks to levels approaching that in the ligament and synovium; however, no significant increase in either of the MMPs was found in the provisional scaffold. This suggests that although the ACL and synovium up-regulate both anabolic and catabolic factors, the provisional scaffold is primarily anabolic in function. The relative lack of provisional scaffold formation within the joint environment may thus be one of the key reasons for ACL degradation after injury. © 2014 by the Wound Healing Society.

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

    Science.gov (United States)

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

    2016-10-01

    Female soccer players have a well-known risk for anterior cruciate ligament (ACL) injury, but few studies have reported on second ACL injuries in this population. To (1) report the rates of subsequent ACL injury (ipsilateral graft rupture or contralateral tear) in competitive female soccer players, (2) compare these rates with those of other female athletes of similar competitive level, (3) determine risk factors for second ACL injury, and (4) report clinical outcome scores in this population. Cohort study; Level of evidence, 3. The medical records at a single institution were reviewed for female patients who were injured during a competitive athletic event and treated with primary ACL reconstruction (ACLR) between 1998 and 2013. Patients were followed for a mean of 68.8 months postoperatively (range, 24-115.2 months). Clinical outcome was obtained via Lysholm and International Knee Documentation Committee (IKDC) scores. Soccer players were matched 1:1 to non-soccer athletes for age, activity level, and graft type. A total of 180 female ACLR patients with a mean ± SD age of 19.6 ± 6.9 years met the study inclusion and exclusion criteria (90 soccer players and 90 non-soccer players). Soccer players sustained more second ACL injuries, including both graft failures (11% vs 1%; P soccer players. Of the 67 patients who returned to soccer after ACLR (mean age, 17.5 years; range, 13-27 years), significantly more had graft tears compared with those who did not return to soccer (15% vs 0%, respectively; P = .04); however, the difference in contralateral ACL tears (19% for returning players vs 9% for those who did not return; P = .34) was not significant. Relatively older age (odds ratio, 1.5 per year; P = .03) was a significant risk factor for ACL graft tear but not for contralateral ACL injury. Both groups had similar mean Lysholm (96 vs 95) and IKDC scores (95 vs 96) at final follow-up. Twenty-eight percent of all female soccer players and 34% of those players who

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    INTRODUCTION: Coactivation of the hamstring muscles during dynamic knee extension may compensate for increased knee joint laxity in anterior cruciate ligament (ACL) deficient subjects. This study examined if antagonist muscle coactivation during maximal dynamic knee extension was elevated...

  1. Chronic injuries of the cruciate ligaments

    International Nuclear Information System (INIS)

    Pricca, P.; Cecchini, A.; Vecchioni, G.; Mariani, P.M.; Tansini, A.; Ferrario, A.

    1988-01-01

    The high incidence of cruciate ligament injuries as a result of acute knee trauma with hemartrosis and abuse of diagnostic arthroscopies call for a suitable radiological imaging of the central pivot. Computed Arthrotomography (CAT) was used to examine the knee joint in 20 cases of clinically suspected chronic cruciate ligament injury. The images were correlated with arthroscopic and/or arthrotomic findings. Thirteen lesions of the anterior cruciate ligament (ACL) (65%) were found, plus 1 lesion of the posterior cruciate ligament (PCL) (5%), 2 associated lesions of ACL + PCL (10%), and 4 normal cases. Confirmation of pathology was available in all cases but one by arthroscopy and/or surgery. The central pivot diseases were classified as follows: absence, detachement, partial or complete tear. CAT findings of cruciate ligament injuries are emphasized and the role of the technique as compared to arthroscopy is discussed. CAT is useful in 3-D evaluation of central pivot and detection of different cruciate ligament injuries, with high sensitivity-specifity for ACL and high specifity-moderate sensitivity for PCL. In the evaluation of the chronic unstable knee, CAT is highly accurate and gives the surgeon useful information towards the planning of therapeutic procedures. CAT is almost non-invasive, well tolerated and easy to perform in out-patients, which make it a first-choice procedure in the screening of chronic ligament injuries

  2. TRANSTIBIAL VERSUS ANTEROMEDIAL PORTAL TECHNIQUES IN ACL RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Luiz Gabriel Betoni Guglielmetti

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

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

    Science.gov (United States)

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

    2016-11-01

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

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

    OpenAIRE

    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 f...

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

    Science.gov (United States)

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

    2016-01-01

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

  6. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors.

    Science.gov (United States)

    Alentorn-Geli, Eduard; Myer, Gregory D; Silvers, Holly J; Samitier, Gonzalo; Romero, Daniel; Lázaro-Haro, Cristina; Cugat, Ramón

    2009-07-01

    Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players by 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes the most time lost from competition in soccer which has influenced a strong research focus to determine the risk factors for injury. This research emphasis has afforded a rapid influx of literature defining potential modifiable and non-modifiable risk factors that increase the risk of injury. The purpose of the current review is to sequence the most recent literature that reports potential mechanisms and risk factors for non-contact ACL injury in soccer players. Most ACL tears in soccer players are non-contact in nature. Common playing situations precluding a non-contact ACL injury include: change of direction or cutting maneuvers combined with deceleration, landing from a jump in or near full extension, and pivoting with knee near full extension and a planted foot. The most common non-contact ACL injury mechanism include a deceleration task with high knee internal extension torque (with or without perturbation) combined with dynamic valgus rotation with the body weight shifted over the injured leg and the plantar surface of the foot fixed flat on the playing surface. Potential extrinsic non-contact ACL injury risk factors include: dry weather and surface, and artificial surface instead of natural grass. Commonly purported intrinsic risk factors include: generalized and specific knee joint laxity, small and narrow intercondylar notch width (ratio of notch width to the diameter and cross sectional area of the ACL), pre-ovulatory phase of menstrual cycle in females not using oral contraceptives, decreased relative (to quadriceps) hamstring strength and recruitment, muscular fatigue by altering neuromuscular control, decreased "core" strength and proprioception, low trunk, hip, and knee flexion angles, and high

  7. 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...

  8. MR imaging of posterior cruciate ligament injuries

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Nobuyuki [Tsukuba Univ., Ibaraki (Japan). Hospital; Niitsu, Mamoru; Itai, Yuji; Sato, Motohiro; Kujiraoka, Yuka; Ikeda, Kotaro; Kanamori, Akihiro

    2001-07-01

    Posterior cruciate ligament (PCL) injuries are less frequent than anterior cruciate ligament (ACL) injuries, but are presumably more common than once thought. Thirty-nine patients with PCL injuries identified on MR images were studied. The criteria for PCL injury were complete tear, partial tear, and avulsion fracture. The approximate site of a partial tear was categorized as proximal, midsubstance, distal, or combination. Fourteen patients (35.9%) had complete tears of the PCL, 21 patients (53.8%) had partial tears, and four patients (10.3%) had avulsion fractures. A total of 12 patients (30.7%) had isolated PCL injuries, while the remaining 27 patients demonstrated evidence of other coexistent knee injuries, such as meniscal tears and ligamentous injuries. Of coexistent knee injuries, meniscal tears (18 patients, 46.2%) were most often seen. (author)

  9. MR imaging of posterior cruciate ligament injuries

    International Nuclear Information System (INIS)

    Takahashi, Nobuyuki; Niitsu, Mamoru; Itai, Yuji; Sato, Motohiro; Kujiraoka, Yuka; Ikeda, Kotaro; Kanamori, Akihiro

    2001-01-01

    Posterior cruciate ligament (PCL) injuries are less frequent than anterior cruciate ligament (ACL) injuries, but are presumably more common than once thought. Thirty-nine patients with PCL injuries identified on MR images were studied. The criteria for PCL injury were complete tear, partial tear, and avulsion fracture. The approximate site of a partial tear was categorized as proximal, midsubstance, distal, or combination. Fourteen patients (35.9%) had complete tears of the PCL, 21 patients (53.8%) had partial tears, and four patients (10.3%) had avulsion fractures. A total of 12 patients (30.7%) had isolated PCL injuries, while the remaining 27 patients demonstrated evidence of other coexistent knee injuries, such as meniscal tears and ligamentous injuries. Of coexistent knee injuries, meniscal tears (18 patients, 46.2%) were most often seen. (author)

  10. Hamstring Activity in the Anterior Cruciate Ligament Injured Patient: Injury Implications and Comparison With Quadriceps Activity.

    Science.gov (United States)

    Frank, Rachel M; Lundberg, Hannah; Wimmer, Markus A; Forsythe, Brian; Bach, Bernard R; Verma, Nikhil N; Cole, Brian J

    2016-08-01

    To investigate the potential causes of diminished knee extension after acute anterior cruciate ligament (ACL) injury using both surface electromyography (sEMG) analysis of the quadriceps and hamstrings, and gait analysis to assess muscle action and tone. Consecutive patients with an acute ACL tear underwent sEMG and gait analysis within 2 weeks of injury, before ACL reconstruction. Standard motion analysis techniques were used and sEMG data were collected simultaneously with gait data. T-tests were used to determine differences between the ACL-deficient and control subjects in knee flexion angles, peak external knee joint moments, and total time that a muscle was activated ("on") during gait. External knee moments were expressed as a percentage of body weight times height. Ten patients (mean age 24 ± 4 years) were included at a mean 10.2 days between injury and analysis; 10 uninjured, matched control subjects were included for comparison. There were significant increases in minimum flexion angle at heel strike (5.92 ± 3.39 v -3.49 ± 4.55, P hamstring activity "on" time during gait (P > .05). In patients with acute ACL injury, the ACL-deficient limb does not reach as much extension as controls. Although the rectus femoris is "on" for shorter periods during the gait cycle, there is no difference in hamstring time on during gait. This information may help clinicians better understand muscle function and gait patterns in the acute time period after ACL injury. Level III, case control study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  11. Passive Anterior Tibial Subluxation in the Setting of Anterior Cruciate Ligament Injuries: A Comparative Analysis of Ligament-Deficient States.

    Science.gov (United States)

    McDonald, Lucas S; van der List, Jelle P; Jones, Kristofer J; Zuiderbaan, Hendrik A; Nguyen, Joseph T; Potter, Hollis G; Pearle, Andrew D

    2017-06-01

    Static anterior tibial subluxation after an anterior cruciate ligament (ACL) injury highlights the abnormal relationship between the tibia and femur in patients with ACL insufficiency, although causal factors including injuries to secondary stabilizers or the time from injury to reconstruction have not been examined. To determine static relationships between the tibia and femur in patients with various states of ACL deficiency and to identify factors associated with anterior tibial subluxation. Cross-sectional study; Level of evidence, 3. Patients treated for ACL injuries were identified from an institutional registry and assigned to 1 of 4 cohorts: intact ACL, acute ACL disruption, chronic ACL disruption, and failed ACL reconstruction (ACLR). Anterior tibial subluxation of the medial and lateral compartments relative to the femoral condyles were measured on magnetic resonance imaging (MRI), and an MRI evaluation for meniscal tears, chondral defects, and injuries to the anterolateral ligament (ALL) was performed. One hundred eighty-six ACL-insufficient knees met inclusion criteria, with 26 patients without an ACL injury utilized as a control group. In the lateral compartment, the mean anterior tibial subluxation measured 0.78 mm for the control group (n = 26), 2.81 mm for the acute ACL injury group (n = 74), 3.64 mm for the chronic ACL injury group (n = 40), and 4.91 mm for the failed ACLR group (n = 72). In the failed ACLR group, 37.5% of patients demonstrated lateral compartment anterior subluxation ≥6 mm, and 11.1% of this group had anterior subluxation of the lateral compartment ≥10 mm. Multivariate regression revealed that the presence of both medial and lateral chondral defects was associated with a mean 1.09-mm increase in subluxation of the medial compartment ( P = .013). The combination of medial and lateral meniscal tears was an independent predictor of increased lateral tibia subluxation by 1.611 mm ( P = .0022). Additionally, across all knee states

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

    Science.gov (United States)

    Heinich, Christina Marie

    2014-01-01

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

  13. Return to National Basketball Association Competition Following Anterior Cruciate Ligament and Fibular Collateral Ligament Injuries: A Case Report.

    Science.gov (United States)

    LaPrade, Robert F; O'Brien, Luke; Kennedy, Nicholas I; Cinque, Mark E; Chahla, Jorge

    2017-01-01

    Numerous outcome studies regarding anterior cruciate ligament (ACL) reconstruction demonstrate the ability of athletes to return to a high level of play. However, to our knowledge, there is limited literature regarding return to play following injury to both the ACL and the fibular collateral ligament (FCL). We describe the case of a National Basketball Association (NBA) player who sustained a combined ACL and FCL knee injury and subsequently underwent surgical reconstruction of both affected ligaments. He was able to return to a preinjury level of competition at 9 months postoperatively. It is possible for athletes to return to competitive basketball and maintain a high production level following a single-staged reconstruction of both the ACL and the FCL.

  14. Contribution of thin slice (1 mm) oblique coronal proton density-weighted MR images for assessment of anteromedial and posterolateral bundle damage in anterior cruciate ligament injuries

    International Nuclear Information System (INIS)

    Gokalp, Gokhan; Demirag, Burak; Nas, Omer Fatih; Aydemir, Mehmet Fatih; Yazici, Zeynep

    2012-01-01

    Purpose: To evaluate the diagnostic efficacy of using additional oblique coronal 1 mm proton density-weighted (PDW) MR imaging of the knee for detection and grading anterior cruciate ligament (ACL), anteromedial bundle (AMB) and posterolateral bundle (PLB) injuries. Materials and methods: We prospectively assessed preoperative MR images of 50 patients (36 men, 14 women; age range, 18–62 years). First, we compared the diagnostic performance of routine sagittal (3 mm) and additional oblique coronal images (1 mm) for ACL tears. Then, we compared the tear types (AMB or PLB) and grade presumed from oblique coronal MR imaging with arthroscopy. Results: Arthroscopy revealed ACL tear in 24 (48%) patients. There was significant difference between sagittal images and arthroscopy results for ACL tear recognition (p 0.05). Conclusion: Addition of thin slice oblique coronal images to conventional sequences could better contribute to better verifying the presence of ACL tear and in determining its grade

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

    Science.gov (United States)

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

    2018-02-03

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

  16. Mediolateral Differences of Proteoglycans Distribution at the ACL Tibial Footprint: Experimental Study of 16 Cadaveric Knees

    Directory of Open Access Journals (Sweden)

    Joon Ho Wang

    2018-01-01

    Full Text Available This study aimed to identify the staining pattern of ACL attachment blended with cartilage of the medial tibial plateau at the tibial insertion and histologically characterize the tibial footprint. Sixteen fresh frozen cadaveric knees (mean age: 52.0±6.2 years were used for this study. The specimens were bisected in the coronal plane, in accordance with the fiber orientation of the ACL tibial attachment. Adjacent sections were then stained with hematoxylin and eosin (H&E to observe the morphology of the ACL insertion and with fast green and Safranin-O protocols to evaluate for collagen and proteoglycans (PG. The insertion area on the tibial footprint was divided into five zones in the medial to lateral direction, which was determined by division of the section from most prominent medial tibial spine to most lateral margin of ACL attachment. Then rectangular area with a vertical length that is twice the width of respective five zones was set. Stained areas of all images were quantified positively by using ImageJ software, and the value for staining area measured was defined in percentage by multiplying whole image area by 100. The mean proportion of Safranin-O staining is significantly greater nearer to the medial tibial spine (59% in zone 1, 32% in zone 2, 13% in zone 3, 13% in zone 4, and 4% in zone 5, P<0.001. The medial section of the tibial insertion area grew in size and increased in PG staining with more densely organized collagen arrangement with more fibrocartilage cells. The ACL tibial insertion showed a medially eccentric staining pattern by histological evaluation of the ACL attachment to cartilage. Our histological results of the eccentric biomaterial property in the medial tibial spine of ACL insertion area can be considered in making a more functional anatomic tibial tunnel placement.

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

    Directory of Open Access Journals (Sweden)

    Abdelbadie Ahmed

    2018-01-01

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

  18. The possibility of physiotherapy treatment after injury of anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Katarzyna Korabiusz

    2017-09-01

    Full Text Available Introduction: Damage of ACL represents approximately 50% of all internal damages of knee joint after its injury. According to statistics, 1 person out of 1000 residents suffers from ACL injury. Approximately 3 thousand reconstructions of ACL are performed yearly therefore it is very important to work out an optimal post-operative rehabilitation. Through this, it is possible to reduce pain indispositions and restore a good joint stabilization and improved quality of life. Goal of dissertation: Goal of this dissertation is a review of literature about available physiotherapy methods used after injury of anterior cruciate ligament. Conclusion: There are many physiotherapy methods used after injury of ACL. Methods proposed in literature increase range of movement in knee joint,  reduce pain  and restore a good joint stabilization The most often used methods are: transdermal nerves stimulation TENS, criotherapy,  magnetic field, ultrasounds, LASER, electrostimulation, interferention, kinesitherapy and kinesiotaping, Rehabilitation significantly reduces pain indispositions and has a positive influence on quality of life of patients after ACL injuring.

  19. Dynamic knee stability and ballistic knee movement after ACL reconstruction: an application on instep soccer kick.

    Science.gov (United States)

    Cordeiro, Nuno; Cortes, Nelson; Fernandes, Orlando; Diniz, Ana; Pezarat-Correia, Pedro

    2015-04-01

    The instep soccer kick is a pre-programmed ballistic movement with a typical agonist-antagonist coordination pattern. The coordination pattern of the kick can provide insight into deficient neuromuscular control. The purpose of this study was to investigate knee kinematics and hamstrings/quadriceps coordination pattern during the knee ballistic extension phase of the instep kick in soccer players after anterior cruciate ligament reconstruction (ACL reconstruction). Seventeen players from the Portuguese Soccer League participated in this study. Eight ACL-reconstructed athletes (experimental group) and 9 healthy individuals (control group) performed three instep kicks. Knee kinematics (flexion and extension angles at football contact and maximum velocity instants) were calculated during the kicks. Rectus femoris (RF), vastus lateralis, vastus medialis, biceps femoralis, and semitendinosus muscle activations were quantified during the knee extension phase. The ACL-reconstructed group had significantly lower knee extension angle (-1.2 ± 1.6, p ballistic control movement pattern between normal and ACL-reconstructed subjects. Performing open kinetic chain exercises using ballistic movements can be beneficial when recovering from ACL reconstruction. The exercises should focus on achieving multi-joint coordination and full knee extension (range of motion). III.

  20. Relative strain in the anterior cruciate ligament and medial collateral ligament during simulated jump landing and sidestep cutting tasks: implications for injury risk.

    Science.gov (United States)

    Bates, Nathaniel A; Nesbitt, Rebecca J; Shearn, Jason T; Myer, Gregory D; Hewett, Timothy E

    2015-09-01

    The medial collateral (MCL) and anterior cruciate ligaments (ACL) are, respectively, the primary and secondary ligamentous restraints against knee abduction, which is a component of the valgus collapse often associated with ACL rupture during athletic tasks. Despite this correlation in function, MCL ruptures occur concomitantly in only 20% to 40% of ACL injuries. The purpose of this investigation was to determine how athletic tasks load the knee joint in a manner that could lead to ACL failure without concomitant MCL failure. It was hypothesized that (1) the ACL would provide greater overall contribution to intact knee forces than the MCL during simulated motion tasks and (2) the ACL would show greater relative peak strain compared with the MCL during simulated motion tasks. Controlled laboratory study. A 6-degrees-of-freedom robotic manipulator articulated 18 cadaveric knees through simulations of kinematics recorded from in vivo drop vertical jump and sidestep cutting tasks. Specimens were articulated in the intact-knee and isolated-ligament conditions. After simulation, each ACL and MCL was failed in uniaxial tension along its fiber orientations. During a drop vertical jump simulation, the ACL experienced greater peak strain than the MCL (6.1% vs 0.4%; P < .01). The isolated ACL expressed greater peak anterior force (4.8% vs 0.3% body weight; P < .01), medial force (1.6% vs 0.4% body weight; P < .01), flexion torque (8.4 vs 0.4 N·m; P < .01), abduction torque (2.6 vs 0.3 N·m; P < .01), and adduction torque (0.5 vs 0.0 N·m; P = .03) than the isolated MCL. During failure testing, ACL specimens preferentially loaded in the anteromedial bundle failed at 637 N, while MCL failure occurred at 776 N. During controlled physiologic athletic tasks, the ACL provides greater contributions to knee restraint than the MCL, which is generally unstrained and minimally loaded. Current findings support that multiplanar loading during athletic tasks preferentially loads the ACL

  1. Abnormal tibiofemoral contact stress and its association with altered kinematics following center-center ACL reconstruction: an in vitro study

    Science.gov (United States)

    Imhauser, Carl; Mauro, Craig; Choi, Daniel; Rosenberg, Eric; Mathew, Stephen; Nguyen, Joseph; Ma, Yan; Wickiewicz, Thomas

    2014-01-01

    Background Abnormal tibiofemoral contact stress and aberrant kinematics may influence the progression of osteoarthritis in the ACL-deficient and the ACL-reconstructed knee. However, relationships between contact stress and kinematics following ACL reconstruction are poorly understood. Therefore, we posed the following research questions: (1) How do ACL deficiency and reconstruction affect kinematics of and contact stress in the tibiofemoral joint? (2) What kinematic differences are associated with abnormal contact stress following ACL reconstruction? Hypothesis/Purpose Center-center ACL reconstruction will not restore knee kinematics and contact stress. Correlations will exist between abnormal contact stress and aberrant kinematics following ACL reconstruction will exist. Study Design Controlled laboratory study Methods Clinical tests of anterior and rotational stability were simulated on eleven cadaveric knees using an industrial robot. Tests were conducted with the ACL intact, sectioned, and after single bundle ACL reconstruction using a quadrupled hamstring autograft with tunnels drilled through the center of the native footprints. Kinematics were recorded during the tests. Contact stress was continuously recorded from a stress transducer fixed to the tibial plateau and mean contact stress was calculated regionally. Results ACL deficiency resulted in increased mean contact stress in the posterior sectors of the medial and lateral compartments under anterior and rotational loads, respectively. Reconstruction reduced stress in these locations; however contact stress abnormalities remained. On average, kinematics were overconstrained following ACL reconstruction (≤1.8mm and ≤2.6° in all directions). However, combinations of overconstrained and underconstrained motions in ab/adduction and medial-lateral translation in response to combined moments, and axial rotation, anterior-posterior and medial-lateral translation in response to an anterior load were

  2. Acute posterior cruciate ligament injuries: effect of location, severity, and associated injuries on surgical management.

    Science.gov (United States)

    Anderson, Mark A; Simeone, F Joseph; Palmer, William E; Chang, Connie Y

    2018-06-01

    To correlate MRI findings of patients with posterior cruciate ligament (PCL) injury and surgical management. A retrospective search yielded 79 acute PCL injuries (36 ± 16 years old, 21 F, 58 M). Two independent readers graded PCL tear location (proximal, middle, or distal third) and severity (low-grade or high-grade partial/complete) and evaluated injury of other knee structures. When available, operative reports were examined and the performed surgical procedure was compared with injury grade, location, and presence of associated injuries. The most commonly injured knee structures in acute PCL tears were posterolateral corner (58/79, 73%) and anterior cruciate ligament (ACL) (48/79, 61%). Of the 64 patients with treatment information, 31/64 (48%) were managed surgically: 12/31 (39%) had PCL reconstruction, 13/31 (42%) had ACL reconstruction, 10/31 (32%) had posterolateral corner reconstruction, 9/31 (29%) had LCL reconstruction, 8/31 (26%) had meniscectomy, and 8/31 (26%) had fixation of a fracture. Proximal third PCL tear and multiligamentous injury were more commonly associated with surgical management (P < 0.05). Posterolateral and posteromedial corner, ACL, collateral ligament, meniscus, patellar retinaculum, and gastrocnemius muscle injury, and fracture were more likely to result in surgical management (P < 0.05). Patients with high-grade partial/complete PCL tear were more likely to have PCL reconstruction as a portion of surgical management (P < 0.05). Location of PCL tear and presence of other knee injuries were associated with surgical management while high-grade/complete PCL tear grade was associated with PCL reconstruction. MRI reporting of PCL tear location, severity, and of other knee structure injuries is important for guiding clinical management.

  3. When to Stop CPR and When to Perform Rhythm Analysis: Potential Confusion Among ACLS Providers.

    Science.gov (United States)

    Giberson, Brandon; Uber, Amy; F Gaieski, David; Miller, Joseph B; Wira, Charles; Berg, Katherine; Giberson, Tyler; Cocchi, Michael N; S Abella, Benjamin; Donnino, Michael W

    2016-09-01

    Health care providers nationwide are routinely trained in Advanced Cardiac Life Support (ACLS), an American Heart Association program that teaches cardiac arrest management. Recent changes in the ACLS approach have de-emphasized routine pulse checks in an effort to promote uninterrupted chest compressions. We hypothesized that this new ACLS algorithm may lead to uncertainty regarding the appropriate action following detection of a pulse during a cardiac arrest. We conducted an observational study in which a Web-based survey was sent to ACLS-trained medical providers at 4 major urban tertiary care centers in the United States. The survey consisted of 5 multiple-choice, scenario-based ACLS questions, including our question of interest. Adult staff members with a valid ACLS certification were included. A total of 347 surveys were analyzed. The response rate was 28.1%. The majority (53.6%) of responders were between 18 and 32 years old, and 59.9% were female. The majority (54.2%) of responders incorrectly stated that they would continue CPR and possibly administer additional therapies when a team member detects a pulse immediately following defibrillation. Secondarily, only 51.9% of respondents correctly chose to perform a rhythm check following 2 minutes of CPR. The other 3 survey questions were correctly answered an average of 89.1% of the time. Confusion exists regarding whether or not CPR and cardiac medications should be continued in the presence of a pulse. Education may be warranted to emphasize avoiding compressions and medications when a palpable pulse is detected. © The Author(s) 2014.

  4. Contact area between femoral tunnel and interference screw in anatomic rectangular tunnel ACL reconstruction: a comparison of outside-in and trans-portal inside-out techniques.

    Science.gov (United States)

    Hiramatsu, Kunihiko; Mae, Tatsuo; Tachibana, Yuta; Nakagawa, Shigeto; Shino, Konsei

    2018-02-01

    The purpose of this study was to compare the femoral tunnel length, the femoral graft bending angle at the femoral tunnel aperture, and the contact area between the femoral tunnel wall and an interference screw used for fixation in anatomic rectangular tunnel anterior cruciate ligament (ACL) reconstruction (ART ACLR). The study included 149 patients with primary ACL injury who underwent ART ACLR. Preoperatively, flexion angle of the index knee was checked under general anaesthesia. Those of less than 130° of passive flexion were assigned to the outside-in (OI) technique (78 patients), while the others to the trans-portal inside-out (TP) technique (71 patients). The patients underwent computed tomography with multiplanar reconstruction at 3-5 weeks post-operatively. Femoral tunnel length, graft bending angle, and contact ratio between the IFS and femoral tunnel were assessed. P contact ratio in the OI technique was significantly larger than that in the TP technique at every point in the femoral tunnel (P contact ratio than the TP technique after ART ACLR. Retrospective comparative study, Level III.

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

    DEFF Research Database (Denmark)

    Stensbirk, Frederik; Thorborg, Kristian; Konradsen, Lars

    2014-01-01

    PURPOSE: The long-term results after using the iliotibial band autograft (ITB) in anterior cruciate ligament (ACL) reconstruction are not fully known. If equal in quality to conventional methods, the ITB graft could be a useful alternative as a primary graft, in revision surgery or multi-ligament......PURPOSE: The long-term results after using the iliotibial band autograft (ITB) in anterior cruciate ligament (ACL) reconstruction are not fully known. If equal in quality to conventional methods, the ITB graft could be a useful alternative as a primary graft, in revision surgery or multi...

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

    NARCIS (Netherlands)

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

    2011-01-01

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

  7. 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

  8. ETHIOLOGY AND MECHANISMS OF INJURIES OF KNEE ANTERIOR CRUCIATE LIGAMENT IN ATHLETES

    Directory of Open Access Journals (Sweden)

    Nikola Bulatović

    2011-08-01

    Full Text Available The examined group was composed of 60 patients with injuries of Anterior Cruciate Ligament (ACL treated at the Clinical Center of Montenegro from 2006- 2010. Among general population the frequency is 1:3000, and around 70% of ACL injuries occur as a consequence of sports activity. These traumas represent 15-30% of all sports injuries. Normal kinematics of a knee joint means intact ligament. The purpose of our work was to determine the risk factors of injury, regarding training and competing process, daily activity and their connection with the mechanism of injury. In our inquiry, recreational athletes represented 70% of patients.The most common mechanism of injury is a non-contact, deceleration, valgus angulation with an external rotation as a consequence of landing, sudden change of direction, running rhythm, or fall. The largest number of injuries occurs in training, recreation, tournaments, and everyday activities. In diagnostics we employed clinical tests, ECHO finding, NMR and arthroscopy. Sports activity during which our patients obtained most of their injuries is soccer. Traumas were frequently followed by damages to their joint structures (meniscus, cartilage. Injuries of ACL are multifactorial etiologies, but through external and internal factors, adequate communication, and sports culture of partakers (athletes, trainers and physicians can be acted preventively on decreasing injury incidence and timely and adequate treatment

  9. Motor coordination during gait after anterior cruciate ligament injury: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Gustavo Leporace

    2013-08-01

    Full Text Available To investigate the state of art about motor coordination during gait in patients with anterior cruciate ligament (ACL injury. Searches were carried out, limited from 1980 to 2010, in various databases with keywords related to motor coordination, gait and ACL injury. From the analysis of titles and applying the inclusion/exclusion criteria 24 studies were initially selected and, after reading the abstract, eight studies remained in the final analysis. ACL deficient patients tend to have a more rigid and less variable gait, while injured patients with ACL reconstruction have less rigid and more variable gait with respect to healthy individuals. The overall results suggest the existence of differences in motor coordination between the segments with intact and those with injured knee, regardless of ligament reconstruction. ACL injured patients present aspects related to the impairment of the capability to adapt the gait pattern to different environmental conditions, possibly leading to premature knee degeneration. However, the techniques used for biomechanical gait data processing are limited with respect to obtaining information that leads to the development of intervention strategies aimed at the rehabilitation of that injury, since it is not possible to identify the location within the gait cycle where the differences could be explained.

  10. Knee Kinematics During Noncontact Anterior Cruciate Ligament Injury as Determined From Bone Bruise Location.

    Science.gov (United States)

    Kim, Sophia Y; Spritzer, Charles E; Utturkar, Gangadhar M; Toth, Alison P; Garrett, William E; DeFrate, Louis E

    2015-10-01

    The motions causing noncontact anterior cruciate ligament (ACL) injury remain unclear. Tibiofemoral bone bruises are believed to be the result of joint impact near the time of ACL rupture. The locations and frequencies of these bone bruises have been reported, but there are limited data quantifying knee position and orientation near the time of injury based on these contusions. Knee position and orientation near the time of noncontact ACL injury include extension and anterior tibial translation. Descriptive laboratory study. Magnetic resonance images of 8 subjects with noncontact ACL injuries were acquired within 1 month of injury and were subsequently analyzed. All subjects exhibited bruises on both the femur and tibia in both medial and lateral compartments. The outer margins of bone and the bone bruise surfaces were outlined on each image to create a 3-dimensional model of each subject's knee in its position during magnetic resonance imaging (MRI position). Numerical optimization was used to maximize overlap of the bone bruises on the femur and tibia and to predict the position of injury. Flexion angle, valgus orientation, internal tibial rotation, and anterior tibial translation were measured in both the MRI position and the predicted position of injury. Differences in kinematics between the MRI position, which served as an unloaded reference, and the predicted position of injury were compared by use of paired t tests. Flexion angle was near full extension in both the MRI position and the predicted position of injury (8° vs 12°; P = .2). Statistically significant increases in valgus orientation (5°; P = .003), internal tibial rotation (15°; P = .003), and anterior tibial translation (22 mm; P injury relative to the MRI position. These results suggest that for the bone bruise pattern studied, landing on an extended knee is a high risk for ACL injury. Extension was accompanied by increased anterior tibial translation (22 mm), internal tibial rotation (15

  11. ACL injury prevention, more effective with a different way of motor learning?

    NARCIS (Netherlands)

    Benjaminse, Anne; Otten, Egbert

    What happens to the transference of learning proper jump-landing technique in isolation when an individual is expected to perform at a competitive level yet tries to maintain proper jump-landing technique? This is the key question for researchers, physical therapists, athletic trainers and coaches

  12. Identification of Suitable Reference Genes for Investigating Gene Expression in Anterior Cruciate Ligament Injury by Using Reverse Transcription-Quantitative PCR.

    Directory of Open Access Journals (Sweden)

    Mariana Ferreira Leal

    Full Text Available The anterior cruciate ligament (ACL is one of the most frequently injured structures during high-impact sporting activities. Gene expression analysis may be a useful tool for understanding ACL tears and healing failure. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR has emerged as an effective method for such studies. However, this technique requires the use of suitable reference genes for data normalization. Here, we evaluated the suitability of six reference genes (18S, ACTB, B2M, GAPDH, HPRT1, and TBP by using ACL samples of 39 individuals with ACL tears (20 with isolated ACL tears and 19 with ACL tear and combined meniscal injury and of 13 controls. The stability of the candidate reference genes was determined by using the NormFinder, geNorm, BestKeeper DataAssist, and RefFinder software packages and the comparative ΔCt method. ACTB was the best single reference gene and ACTB+TBP was the best gene pair. The GenEx software showed that the accumulated standard deviation is reduced when a larger number of reference genes is used for gene expression normalization. However, the use of a single reference gene may not be suitable. To identify the optimal combination of reference genes, we evaluated the expression of FN1 and PLOD1. We observed that at least 3 reference genes should be used. ACTB+HPRT1+18S is the best trio for the analyses involving isolated ACL tears and controls. Conversely, ACTB+TBP+18S is the best trio for the analyses involving (1 injured ACL tears and controls, and (2 ACL tears of patients with meniscal tears and controls. Therefore, if the gene expression study aims to compare non-injured ACL, isolated ACL tears and ACL tears from patients with meniscal tear as three independent groups ACTB+TBP+18S+HPRT1 should be used. In conclusion, 3 or more genes should be used as reference genes for analysis of ACL samples of individuals with and without ACL tears.

  13. Association of anterior cruciate ligament injury with knee osteoarthritis and total knee replacement: A retrospective cohort study from the Taiwan National Health Insurance Database.

    Directory of Open Access Journals (Sweden)

    Sheng-Hsiung Lin

    Full Text Available This study aimed to support the potential protective role of anterior cruciate ligament (ACL reconstruction against the development of osteoarthritis (OA.In this retrospective cohort study, the long-term results of ACL reconstruction in Taiwan were evaluated based on data from the National Health Insurance Research Database (NHIRD. In total, 8,769 eligible cases were included from 11,921 ACL-injured patients. The cumulative incidence rates of OA and total knee replacement (TKR were analyzed using the Kaplan-Meier estimator. Cox proportional hazards models were applied to estimate the hazard ratios (HRs and 95% confidence intervals (CIs of OA.There was a lower cumulative incidence of OA among ACL-reconstructed patients (271, 33.1% than among non-reconstructed patients (1,874, 40.3%; p < 0.001. Patients who underwent ACL reconstruction had a lower cumulative incidence of TKR during the follow-up period (0.6% than the non-reconstructed patients (4.6%, p < 0.001. After adjusting for covariates, ACL-injured patients who underwent reconstruction within one month after ACL injury showed a significantly lower risk of OA than those who never underwent reconstruction (adjusted HR = 0.83, 95% CI = 0.69-0.99.These results indicate that ACL reconstruction might not provide complete protection from OA development after traumatic knee injury but does yield a lower cumulative incidence of OA development and TKR. Moreover, based on the present study, ACL-injured patients should undergo reconstruction as early as possible (within one month to lower the risk of OA.

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

    Science.gov (United States)

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

    2017-12-01

    There are few published studies with very long-term follow-up of combined intra- and extra-articular anterior cruciate ligament (ACL) reconstruction. To analyze clinical and radiographic outcomes of over-the-top ACL reconstruction plus extra-articular lateral tenodesis with autologous hamstrings at minimum 20-year follow-up. Case series; Level of evidence, 4. Of 60 originally eligible patients who underwent over-the-top ACL reconstruction with double-stranded hamstring tendon (leaving intact graft tibial insertions) and extra-articular lateral plasty (performed with the remnant part of tendons), 52 were prospectively evaluated at a minimum 20-year follow-up (mean follow-up, 24 years; 41 men, 11 women; mean age at time of surgery, 25.5 ± 7.6 years). Twenty-nine patients were available for prospective evaluations: clinical (Lysholm, Tegner, and objective International Knee Documentation Committee [IKDC]), instrumented (KT-2000), and radiographic (standard, long-standing, and Merchant views). Subjective KOOS (Knee injury and Osteoarthritis Outcome Score) and objective inertial sensor pivot-shift analysis (KiRA) were carried out at final follow-up. Twenty-three patients were investigated by phone interview for subjective Tegner score and documented complications, rerupture, or revision surgery. At final follow-up, mean Lysholm score was 85.7 ± 14.6; median Tegner score, 4 (range, 3-5); sport activity resumption, 86.2%; and objective IKDC score, good or excellent in 86% of patients (31%, A; 55%, B). Only 3 of 26 patients (12%) had >5-mm manual maximum KT-2000 side-to-side difference. KiRA system documented positive pivot-shift (>0.9-m/s 2 tibial acceleration side-to-side difference) in these 3 of 26 patients (12%). Statistically significant changes were as follows: decrease in Tegner score from 7 (range, 6-8) at 5-year follow-up to 4 (range, 3-5) at 10 years ( P < .0001) and decrease in Lysholm score from 96.1 ± 7.3 at 10-year follow-up to 85.7 ± 14.6 at 20 years

  15. A pair-matched comparison of return to pivoting sports at 1 year in ACL-injured patients after a nonoperative versus operative treatment course

    Science.gov (United States)

    Grindem, Hege; Eitzen, Ingrid; Moksnes, Håvard; Snyder-Mackler, Lynn; Risberg, May Arna

    2013-01-01

    Background The wish to return to level I pivoting sports is a major indication of ACL-reconstruction. Patients usually return to pivoting sports between 6 months and 1 year postoperatively, but no matched study has so far examined 1-year return to sport rates in nonoperatively and operatively treated ACL-injured patients. Hypothesis ACL-injured patients following a nonoperative treatment course, including recommendation of activity modification, will have lower return to pivoting sport rates than operatively treated patients 1 year after baseline testing/surgery, when matched by preinjury sports activity, age and sex. Study Design Pair-matched cohort study Methods Sixty-nine nonoperatively treated ACL-injured patients were pair-matched with 69 operatively treated patients (n=138), based on specific preinjury sport, age and sex. Nonoperatively treated patients were recommended not to return to level I sports. Patients were defined as nonoperatively or operatively treated according to their status at follow-up. The baseline and follow-up testing included registration of sports participation, KT-1000 measurements, 4 hop tests, and patient-reported outcome measures. McNemar’s test and paired t-tests or Wilcoxon’s test were used to compare outcomes of nonoperatively and operatively treated patients. Results No significant baseline differences were found. At 12.9±1.2 months (mean ± standard deviation) after baseline testing (nonoperative) and 12.7±1.2 months after surgery (operative), there was no significant difference in overall return to sport rates (nonoperative: 68.1 %, operative: 68.1 %, p=1.000), or in return to level I sport rates (nonoperative: 54.8 %, operative: 61.9 %, p=0.664). Nonoperatively treated patients who participated in level I sports prior to injury had a significantly lower return to sport rate (54.8 %) than nonoperatively treated patients who participated in level II sports (88.9 %, p=0.003). The nonoperatively treated patients had

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

    NARCIS (Netherlands)

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

    2009-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-08-15

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

  18. Experimental and mathematical methods for representing relative surface elongation of the ACL

    NARCIS (Netherlands)

    Pioletti, D. P.; Heegaard, J. H.; Rakotomanana, R. L.; Leyvraz, P. F.; Blankevoort, L.

    1995-01-01

    The common approach to assess the stabilizing role of the ACL in the knee has been to measure the elongation of a few marked fibers in the ligament. A comparison of the relative elongation (RE) of these marked fibers between different specimens and studies is delicate due to the difficulty of

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

    NARCIS (Netherlands)

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

    2013-01-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    The benefit of anterior cruciate ligament (ACL) reconstruction has been questioned based on patient-reported outcome measures (PROMs). Valid interpretation of such results requires confirmation of the psychometric properties of the PROM. Rasch analysis is the gold standard for validation of PROMs...

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

    NARCIS (Netherlands)

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

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    Patient-related outcome measures (PROMs) are commonly used to gauge treatment effects in patients with anterior cruciate ligament (ACL) deficiency. Valid measures of specific conditions depend on relevant item content. While item content can be derived either from clinicians (face validity) or fr...

  3. A Multisport Epidemiologic Comparison of Anterior Cruciate Ligament Injuries in High School Athletics

    Science.gov (United States)

    Joseph, Allan M.; Collins, Christy L.; Henke, Natalie M.; Yard, Ellen E.; Fields, Sarah K.; Comstock, R. Dawn

    2013-01-01

    Background: The knee joint is the second most commonly injured body site after the ankle and the leading cause of sport-related surgeries. Knee injuries, especially of the anterior cruciate ligament (ACL), are among the most economically costly sport injuries, frequently requiring expensive surgery and rehabilitation. Objective: To investigate the epidemiology of ACL injuries among high school athletes by sport and sex. Design: Descriptive epidemiology study. Main Outcome Measure(s): Using an Internet-based data-collection tool, Reporting Information Online (RIO), certified athletic trainers from 100 nationally representative US high schools reported athlete-exposure and injury data for athletes from 9 sports during the 2007/08–2011/12 academic years. The outcome of interest in this study was ACL injuries. Results: During the study period, 617 ACL injuries were reported during 9 452 180 athlete exposures (AEs), for an injury rate of 6.5 per 100 000 AEs. Nationally, in the 9 sports studied, an estimated 215 628 ACL injuries occurred during the study period. The injury rate was higher in competition (17.6) than practice (2.4; rate ratio [RR] = 7.3, 95% confidence interval [CI] = 6.08, 8.68). Girls' soccer had the highest injury rate (12.2) followed by boys' football (11.1), with boys' basketball (2.3) and boys' baseball (0.7) having the lowest rates. In sex-comparable sports, girls had a higher rate (8.9) than boys (2.6; RR = 3.4, 95% CI = 2.64, 4.47). Overall, 76.6% of ACL injuries resulted in surgery. The most common mechanisms of injury were player-to-player contact (42.8%) and no contact (37.9%). Conclusions: Anterior cruciate ligament injury rates vary by sport, sex, and type of exposure. Recognizing such differences is important when evaluating the effectiveness of evidence-based, targeted prevention efforts. PMID:24143905

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

    Directory of Open Access Journals (Sweden)

    Yamamoto Yuji

    2010-11-01

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

  5. Muscle morphometric effect of anterior cruciate ligament injury measured by computed tomography: aspects on using non-injured leg as control

    Science.gov (United States)

    2013-01-01

    Background Anterior cruciate ligament (ACL) tears are common, functionally disabling, and predispose to subsequent injuries and early onset of osteoarthritis in the knee. Injuries result in muscular atrophy and impaired muscular activation. To optimize surgical methods and rehabilitation strategies, knowledge of the effects of ACL injuries on muscles size and function is needed. Asymmetry due to limb dominance implies that the effect of ACL-injury might be different in right-sided and left-sided injuries which, should be taken in account when evaluating the effect of an injury. Evaluation of the effects of injuries is usually made with the contralateral leg as control. The aim of this study is to describe the effect of ACL-injuries on thigh muscle size and also to analyze feasibility of using contralateral limb as control. Methods Sixty-two patients scheduled to undergo ACL reconstruction were examined with computed tomography (CT). Muscle cross sectional area (CSA) was recorded for quadriceps, hamstrings, gracilis and sartorius 15 cm above the knee joint. Comparisons were made between the injured and non-injured side and between individuals separated by gender and side of injury. Comparisons were also made for patients with or without concomitant meniscal tear, for patients differing in time between injury and examinations and for patients with different level of physical activity after the injury. Results Quadriceps CSA was 5% smaller on the injured side. There was an indication that the muscles of the right thigh were generally bigger than those of the left thigh. The difference between the injured and the non-injured side was larger for right-sided injuries than for left-sided. There was also a greater difference in semimembranosus for women than for men. There were no differences related to meniscal injury, time since injury or physical activity. Conclusion The use of contralateral leg for evaluating the effect of ACL-injury is often the only available

  6. A new knee arthrometer, the GNRB: experience in ACL complete and partial tears.

    Science.gov (United States)

    Robert, H; Nouveau, S; Gageot, S; Gagnière, B

    2009-05-01

    Clinical diagnosis of anterior cruciate ligament (ACL) tears (Lachman test and Pivot shift test in valgus and internal rotation) is reliable in case of complete ACL tear but reveals elusive in case of partial tears. Quantitative assessment of anterior tibial translation proves to be imprecise, subjective and poorly reproducible especially with the KT-1000 arthrometer. We developed the GNRB, an alternative original anterior knee laxity measurement device. The lower limb is placed in a rigid support with the knee at 0 degrees of rotation, the restraining power being recorded. A 0-250 N thrust force is transmitted by a jack to the upper segment of the calf. This force is only applied in the absence of hamstring muscles contraction. Displacement of the anterior tibial tubercle is recorded using a sensor with a 0.1mm precision. We hypothesize that this knee laxity measurement device is more reliable and reproducible than other currently available arthrometers. During a first validation study, the GNRB was compared to the KT-1000 arthrometer, in 20 pairs of healthy knees, measurements being performed by two investigators. Variance analyses were carried out at 134 N. In a second clinical study, 21 complete ACL tears (the notch is devoid of ACL) and 24 partial ACL tears (anterior or posterior bundle tear and cicatricial ACL remnant in continuity) were tested with these arthrometers to exact a differential laxity threshold value between both knees at 250 N. Statistical analysis was subsequently performed using variance and ROC curves analysis. The GNRB arthrometer reveals to be significantly more reproducible than the KT-1000, irrespectively of the tester's experience level. Moreover, unlike the KT-1000, the achieved measurement is independent from the uninvolved side. Reproducibility of laximetry proves to be significantly better with the GNRB than with the KT-1000, wherever the examiner's experience stands and whatever the evaluated side condition could be. When

  7. How does a combined pre-operative and post-operative rehabilitation program influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian Knee Ligament Registry

    Science.gov (United States)

    Grindem, H.; Granan, LP.; Risberg, MA.; Engebretsen, L.; Snyder-Mackler, L.; Eitzen, I.

    2014-01-01

    Background Preoperative knee function is associated with successful postoperative outcome after ACL reconstruction (ACLR). However, there are few longer-term studies of patients who underwent progressive preoperative and postoperative rehabilitation compared to usual care Objectives To compare preoperative and 2 year postoperative patient-reported outcomes (PROs) in patients undergoing progressive preoperative and postoperative rehabilitation at a sports medicine clinic compared with usual care Methods We included patients aged 16–40 years undergoing primary unilateral ACLR. The preoperative and 2 year postoperative KOOS of 84 patients undergoing progressive pre- and postoperative rehabilitation at a sports medicine clinic (Norwegian Research Center for Active Rehabilitation [NAR] cohort) were compared with the scores of 2690 patients from the Norwegian Knee Ligament Registry (NKLR). The analyses were adjusted for sex, age, months from injury to surgery, and cartilage/meniscus injury at ACLR. Results The NAR cohort had significantly better preoperative KOOS in all subscales, with clinically relevant differences (>10 points) observed in KOOS Pain, ADL, Sports and Quality of Life. At 2 years, the NAR cohort still had significantly better KOOS with clinically relevant differences in KOOS Symptoms, Sports and Quality of Life. At 2 years, 85.7–94.0 % of the patients in the NAR cohort scored within the normative range of the different KOOS subscales, compared to 51.4–75.8 % of the patients in the NKLR cohort. Conclusion Patients in a prospective cohort who underwent progressive pre- and postoperative rehabilitation at a sports medicine clinic showed superior patient-reported outcomes both preoperatively and 2 year postoperatively compared to patients in the Norwegian Knee Ligament Registry who received usual care. PMID:25351782

  8. One-stage Revision ACL reconstruction with hamstring autograft results in satisfactory outcome

    Science.gov (United States)

    Kejriwal, Ritwik; Buelow, Jens

    2017-01-01

    Objectives: Revision anterior cruciate ligament (ACL) reconstruction is associated with poorer outcomes and higher rerupture rates when compared to primary ACL reconstruction. There is also a significant heterogeneity in surgical technique, number of stages, and graft options. We report a large single surgeon case series with hamstring autograft as a graft option. Methods: Observational series of revision ACL reconstructions performed by the senior author between 2005 and 2015 was carried out. Chart reviews and clinic follow-ups were performed with the following recorded – re-rupture rate, radiographic grading of osteoarthritis, KT-1000 arthrometer test, IKDC outcome scores and knee range of motion. All patients underwent single bundle four-strand hamstring autograft performed in one stage with use of new tunnels in majority of the cases. Results: 66 patients underwent hamstring autograft one-stage revision ACL reconstruction by Dr Jens Buelow. Chart review was carried out on all patients, and 26 (39%) were followed up in clinic and/or by phone with a mean follow up of 4.7 years. Outcomes included re-rupture rate of 4.5%, reoperation rate of 12%, mean visual analogue scale score of 7.6, mean side-to-side difference of 2.6 mm for KT-1000 arthrometer test, and mean IKDC score of 79. Of the 17 patients with radiographs, 40% had moderate osteoarthritis (grade 2 or 3) at follow-up. Conclusion: Revision ACL reconstruction can result in a satisfactory outcome when performed with a hamstring autograft in one stage.

  9. A Prospective Investigation of Biomechanical Risk Factors for Patellofemoral Pain Syndrome. The Joint Undertaking to Monitor and Prevent ACL Injury (JUMP-ACL) Cohort

    Science.gov (United States)

    2009-09-24

    tors: Brent Arnold, Shrikant Bangdiwala, Barry Boden, Kenneth Cameron, Thomas DeBerardino, David Keblish, Marjorie King, Robert Sullivan, John Tokish...Clin Biomech. 2007;22:681-688. 24. Shrier I, Ehrmann-Feldman D, Rossignol M, Abenhaim L. Risk fac- tors for development of lower limb pain in

  10. 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 reconstructiv...

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

    Directory of Open Access Journals (Sweden)

    Helen Dawes

    2003-03-01

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

  12. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture.

    Science.gov (United States)

    Dejour, David; Saffarini, Mo; Demey, Guillaume; Baverel, Laurent

    2015-10-01

    Revision ACL reconstruction requires careful analysis of failure causes particularly in cases of two previous graft ruptures. Intrinsic factors as excessive tibial slope or narrow femoral notch increase failure risks but are rarely addressed in revision surgery. The authors report outcomes, at minimum follow-up of 2 years, for second revision ACL reconstructions combined with tibial deflexion osteotomy for correction of excessive slope (>12°). Nine patients that underwent second revision ACL reconstruction combined with tibial deflexion osteotomy were retrospectively studied. The mean age was 30.3 ± 4.4 years (median 28; range 26-37), and mean follow-up was 4.0 ± 2.0 years (median 3.6; range 2.0-7.6). Autografts were harvested from the quadriceps tendon (n = 8) or hamstrings (n = 1), and tibial osteotomy was done by anterior closing wedge, without detachment of the patellar tendon, to obtain a slope of 3° to 5°. All patients had fused osteotomies, stable knees, and there were no intraoperative or postoperative complications. The mean posterior tibial slope decreased from 13.2° ± 2.6° (median 13°; range 12°-18°) preoperatively to 4.4° ± 2.3° (median 4°; range 2°-8°) postoperatively. The mean Lysholm score was 73.8 ± 5.8 (median 74; range 65-82), and the IKDC-SKF was 71.6 ± 6.1 (median 72.8; range 62.2-78.5). The satisfactory results of second revision ACL reconstruction combined with tibial deflexion osteotomy at minimum follow-up of 2 years suggest that tibia slope correction protects reconstructed ACL from fatigue failure in this study. The authors stress the importance of careful analysis failure causes prior to revision ACL reconstruction, and recommend correction of tibial slope if it exceeds 12°, to reduce the risks of graft retear. III.

  13. Rasch analysis of the Knee injury and Osteoarthritis Outcome Score (KOOS): a statistical re-evaluation

    DEFF Research Database (Denmark)

    Comins, J; Brodersen, J; Krogsgaard, M

    2008-01-01

    The knee injury and Osteoarthritis Outcome Score (KOOS), based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), is widely used to evaluate subjective outcome in anterior cruciate ligament (ACL) reconstructed patients. However, the validity of KOOS has not been assessed...

  14. Contribution of thin slice (1 mm) oblique coronal proton density-weighted MR images for assessment of anteromedial and posterolateral bundle damage in anterior cruciate ligament injuries

    Energy Technology Data Exchange (ETDEWEB)

    Gokalp, Gokhan, E-mail: drgokhangokalp@yahoo.com [Department of Radiology, Uludag University Medical Faculty, Gorukle, Bursa (Turkey); Demirag, Burak, E-mail: bdemirag@uludag.edu.tr [Department of Orthopedy, Uludag University Medical Faculty, Gorukle, Bursa (Turkey); Nas, Omer Fatih, E-mail: omerfatihnas@gmail.com [Department of Radiology, Uludag University Medical Faculty, Gorukle, Bursa (Turkey); Aydemir, Mehmet Fatih, E-mail: fatiha@yahoo.com [Department of Orthopedy, Uludag University Medical Faculty, Gorukle, Bursa (Turkey); Yazici, Zeynep, E-mail: zyazici@uludag.edu.tr [Department of Radiology, Uludag University Medical Faculty, Gorukle, Bursa (Turkey)

    2012-09-15

    Purpose: To evaluate the diagnostic efficacy of using additional oblique coronal 1 mm proton density-weighted (PDW) MR imaging of the knee for detection and grading anterior cruciate ligament (ACL), anteromedial bundle (AMB) and posterolateral bundle (PLB) injuries. Materials and methods: We prospectively assessed preoperative MR images of 50 patients (36 men, 14 women; age range, 18–62 years). First, we compared the diagnostic performance of routine sagittal (3 mm) and additional oblique coronal images (1 mm) for ACL tears. Then, we compared the tear types (AMB or PLB) and grade presumed from oblique coronal MR imaging with arthroscopy. Results: Arthroscopy revealed ACL tear in 24 (48%) patients. There was significant difference between sagittal images and arthroscopy results for ACL tear recognition (p < 0.001). No significant difference was detected for oblique coronal images when compared with arthroscopy results (p = 0.180). Sensitivity and specificity values for ACL tear diagnosis were 37.04% and 95.65% for sagittal images; 74.07% and 91.30% for oblique coronal images. There was no significant difference between arthroscopy and oblique coronal MR images in grading AMB and PLB injuries (p > 0.05). Conclusion: Addition of thin slice oblique coronal images to conventional sequences could better contribute to better verifying the presence of ACL tear and in determining its grade.

  15. The effect of protein and carbohydrate supplementation on strength training outcome of rehabilitation in ACL patients

    DEFF Research Database (Denmark)

    Holm, Lars; Esmarck, Birgitte; Mizuno, Masao

    2006-01-01

    supplementation groups: Protein+Carbohydrate (PC), Isocaloric-Carbohydrate (IC), or Placebo (PL), ingesting the supplementation immediately after each of 36 training sessions. Determined from images of thigh cross-sections (magnetic resonance imaging) the hypertrophy of the quadriceps muscle differed....... The results from this study demonstrate that restoration of the distal vasti muscle mass and knee extension muscle strength with resistance training is promoted further by protein-containing nutrient supplementation immediately after single exercise sessions. Thus, exercise-related protein supplementation may...... was therefore to investigate if nutrient supplementation during 12 weeks of conservative rehabilitation strength training could enhance hypertrophy and strength of the quadriceps muscle in ACL-injured patients. Twenty-six ACL-injured men and women were included and randomly distributed into three...

  16. The angle of inclination of the native ACL in the coronal and sagittal planes.

    Science.gov (United States)

    Reid, Jonathan C; Yonke, Bret; Tompkins, Marc

    2017-04-01

    The purpose of this cross-sectional study was to evaluate the angle of inclination of the native anterior cruciate ligament (ACL) in both the sagittal and coronal planes and to evaluate these findings based on sex, height, BMI, and skeletal maturity. Inclusion criteria for the study included patients undergoing routine magnetic resonance imaging (MRI) of the knee at a single outpatient orthopedic center who had an intact ACL on MRI. Measurements of the angle of inclination were made on MRIs in both the sagittal and coronal planes. Patients were compared based on sex, height, BMI, and skeletal maturity. One-hundred and eighty-eight patients were included (36 skeletally immature/152 skeletally mature; 98 male/90 female). The overall angle of inclination was 74.3° ± 4.8° in the coronal plane and 46.9° ± 4.9° in the sagittal plane. Skeletally immature patients (coronal: 71.8° ± 6.1°; sagittal: 44.7° ± 5.5°) were significantly different in both coronal and sagittal planes (P = 0.04 and 0.01, respectively) from skeletally mature patients (coronal: 75.3° ± 4.7°; sagittal: 47.4° ± 4.7°). There were no differences based on sex, height, or BMI. There are differences between the angle of inclination findings in this study and other studies, which could be due to MRI and measurement techniques. Clinically, skeletal maturity may be important to account for when using the ACL angle of inclination to evaluate anatomic ACL reconstruction. Prognostic retrospective study, Level of evidence III.

  17. 3-T MRI assessment of osteophyte formation in patients with unilateral anterior cruciate ligament injury and reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Panzer, Stephanie [Department of Radiology, Trauma Center Murnau, Murnau (Germany); Augat, Peter [Trauma Center Murnau and Paracelsus Medical University, Institute of Biomechanics, Murnau (Germany); Atzwanger, Joerg; Hergan, Klaus [University Hospital Salzburg, Paracelsus Medical University, Department of Radiology, Salzburg (Austria)

    2012-12-15

    To define the number and distribution of osteophytes (OPs) in bilateral knee MRI (magnetic resonance imaging) of patients with unilateral anterior cruciate ligament (ACL) rupture. Bilateral knee MRIs of 20 patients with unilateral ACL rupture and reconstruction were retrospectively analyzed for OPs. OPs were graded following the KOSS (knee OA scoring system) classification and their compartmental distribution was assessed following the WORMS (Whole-Organ Magnetic Resonance Imaging Score) classification. All examined knees revealed OPs. Knees with ACL rupture showed significant (p < 0.001) higher total numbers of OPs (mean 11.6; SD {+-} 4.4) than knees with intact ACL (mean 5.1; SD {+-} 2.3). Knees with ACL rupture showed increased OP formation in all knee compartments with predominance of marginal OPs in the lateral femorotibial compartment especially on the tibia. Our results show that after knee injury with ACL rupture and reconstruction, all knee compartments were involved in post-traumatic increase of OP formation. The most affected compartment was the lateral femorotibial compartment on the tibial side. (orig.)

  18. 3-T MRI assessment of osteophyte formation in patients with unilateral anterior cruciate ligament injury and reconstruction

    International Nuclear Information System (INIS)

    Panzer, Stephanie; Augat, Peter; Atzwanger, Joerg; Hergan, Klaus

    2012-01-01

    To define the number and distribution of osteophytes (OPs) in bilateral knee MRI (magnetic resonance imaging) of patients with unilateral anterior cruciate ligament (ACL) rupture. Bilateral knee MRIs of 20 patients with unilateral ACL rupture and reconstruction were retrospectively analyzed for OPs. OPs were graded following the KOSS (knee OA scoring system) classification and their compartmental distribution was assessed following the WORMS (Whole-Organ Magnetic Resonance Imaging Score) classification. All examined knees revealed OPs. Knees with ACL rupture showed significant (p < 0.001) higher total numbers of OPs (mean 11.6; SD ± 4.4) than knees with intact ACL (mean 5.1; SD ± 2.3). Knees with ACL rupture showed increased OP formation in all knee compartments with predominance of marginal OPs in the lateral femorotibial compartment especially on the tibia. Our results show that after knee injury with ACL rupture and reconstruction, all knee compartments were involved in post-traumatic increase of OP formation. The most affected compartment was the lateral femorotibial compartment on the tibial side. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Kaseb Mohammad Hasan

    2009-05-01

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

  20. Knee flexion with quadriceps cocontraction: A new therapeutic exercise for the early stage of ACL rehabilitation.

    Science.gov (United States)

    Biscarini, Andrea; Contemori, Samuele; Busti, Daniele; Botti, Fabio M; Pettorossi, Vito E

    2016-12-08

    Quadriceps strengthening exercises designed for the early phase of anterior cruciate ligament (ACL) rehabilitation should limit the anterior tibial translation developed by quadriceps contraction near full knee extension, in order to avoid excessive strain on the healing tissue. We hypothesize that knee-flexion exercises with simultaneous voluntary contraction of quadriceps (voluntary quadriceps cocontraction) can yield considerable levels of quadriceps activation while preventing the tibia from translating forward relative to the femur. Electromyographic activity in quadriceps and hamstring muscles was measured in 20 healthy males during isometric knee-flexion exercises executed near full knee extension with maximal voluntary effort of quadriceps cocontraction and external resistance (R) ranging from 0% to 60% of the 1-repetition maximum (1RM). Biomechanical modeling was applied to derive the shear (anterior/posterior) tibiofemoral force developed in each exercise condition. Isometric knee-flexion exercises with small external resistance (R=10% 1RM) and maximal voluntary effort of quadriceps cocontraction yielded a net posterior (ACL-unloading) tibial pull (P=0.005) and levels of activation of 32%, 50%, and 45% of maximum voluntary isometric contraction, for the rectus femoris, vastus medialis, and vastus lateralis, respectively. This exercise might potentially rank as one of the most appropriate quadriceps strengthening interventions in the early phase of ACL rehabilitation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Do exercises used in injury prevention programmes modify cutting task biomechanics? A systematic review with meta-analysis.

    Science.gov (United States)

    Pappas, Evangelos; Nightingale, Elizabeth J; Simic, Milena; Ford, Kevin R; Hewett, Timothy E; Myer, Gregory D

    2015-05-01

    Some injury prevention programmes aim to reduce the risk of ACL rupture. Although the most common athletic task leading to ACL rupture is cutting, there is currently no consensus on how injury prevention programmes influence cutting task biomechanics. To systematically review and synthesise the scientific literature regarding the influence of injury prevention programme exercises on cutting task biomechanics. The three largest databases (Medline, EMBASE and CINAHL) were searched for studies that investigated the effect of injury prevention programmes on cutting task biomechanics. When possible meta-analyses were performed. Seven studies met the inclusion criteria. Across all studies, a total of 100 participants received exercises that are part of ACL injury prevention programmes and 76 participants served in control groups. Most studies evaluated variables associated with the quadriceps dominance theory. The meta-analysis revealed decreased lateral hamstrings electromyography activity (p ≤ 0.05) while single studies revealed decreased quadriceps and increased medial hamstrings activity and decreased peak knee flexion moment. Findings from single studies reported that ACL injury prevention exercises reduce neuromuscular deficits (knee valgus moment, lateral trunk leaning) associated with the ligament and trunk dominance theories, respectively. The programmes we analysed appear most effective when they emphasise individualised biomechanical technique correction and target postpubertal women. The exercises used in injury prevention programmes have the potential to improve cutting task biomechanics by ameliorating neuromuscular deficits linked to ACL rupture, especially when they emphasise individualised biomechanical technique correction and target postpubertal female athletes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. Knee function among elite handball and football players 1-6 years after anterior cruciate ligament injury.

    Science.gov (United States)

    Myklebust, G; Bahr, R; Nilstad, A; Steffen, K

    2017-05-01

    The aim of the study was to describe objective and self-reported knee function for athletes who have returned to elite handball and football play after an ACL injury, comparing these to non-injured players at the same level. A total of 414 handball and 444 football players completed baseline tests from 2007 through 2014, examining lower extremity strength, dynamic balance, knee laxity, and knee function (KOOS questionnaire). Measures were compared between injured and non-injured legs and between injured legs and legs of controls. Eighty (9.3%) of the 858 players reported a previous ACL injury, 1-6 years post-injury (3.5±2.5 years), 49 handball (61.3%) and 31 football players (38.7%). We found no difference in strength or dynamic balance between previously ACL-injured (N=80) and non-injured players legs (N=1556). However, lower quadriceps (6.3%, 95% CI: 3.2-9.2) and hamstrings muscle strength (6.1%, 95% CI: 3.3-8.1) were observed in previously ACL-injured legs compared to the non-injured contralateral side (N=80). ACL-injured knees displayed greater joint laxity than the contralateral knee (N=80, 17%, 95% CI: 8-26) and healthy knees (N=1556, 23%, 95% CI: 14-33). KOOS scores were significantly lower for injured knees compared to knees of non-injured players. ACL-injured players who have successfully returned to elite sport have comparable strength and balance measures as their non-injured teammates. Subjective perception of knee function is strongly affected by injury history, with clinically relevant lower scores for the KOOS subscores Pain, Function, Sport, and Quality Of Life. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

    Science.gov (United States)

    Çelik, Derya; Turkel, Nilgun

    2017-08-01

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

  4. Trunk and hip control neuromuscular training for the prevention of knee joint injury.

    Science.gov (United States)

    Myer, Gregory D; Chu, Donald A; Brent, Jensen L; Hewett, Timothy E

    2008-07-01

    This article provide evidences to outline a novel theory used to define the mechanisms related to increased risk of ACL injury in female athletes. In addition, this discussion will include theoretical constructs for the description of the mechanisms that lead to increased risk. Finally, a clinical application section will outline novel neuromuscular training techniques designed to target deficits that underlie the proposed mechanism of increased risk of knee injury in female athletes.

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

    Science.gov (United States)

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

    2016-06-01

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

  6. Mechanisms and situations of anterior cruciate ligament injuries in professional male soccer players: a YouTube-based video analysis.

    Science.gov (United States)

    Grassi, Alberto; Smiley, Stephen Paul; Roberti di Sarsina, Tommaso; Signorelli, Cecilia; Marcheggiani Muccioli, Giulio Maria; Bondi, Alice; Romagnoli, Matteo; Agostini, Alessandra; Zaffagnini, Stefano

    2017-10-01

    Soccer is considered the most popular sport in the world concerning both audience and athlete participation, and the incidence of ACL injury in this sport is high. The understanding of injury situations and mechanisms could be useful as substratum for preventive actions. To conduct a video analysis evaluating the situations and mechanisms of ACL injury in a homogeneous population of professional male soccer players, through a search entirely performed on the YouTube.com Web site focusing on the most recent years. A video analysis was conducted obtaining videos of ACL injury in professional male soccer players from the Web site YouTube. Details regarding injured players, events and situations were obtained. The mechanism of injury was defined on the basis of the action, duel type, contact or non-contact injury, and on the hip, knee and foot position. Thirty-four videos were analyzed, mostly from the 2014-2015 season. Injuries occurred mostly in the first 9 min of the match (26%), in the penalty area (32%) or near the side-lines (44%), and in non-rainy conditions (97%). Non-contact injuries occurred in 44% of cases, while indirect injuries occurred in 65%, mostly during pressing, dribbling or tackling. The most recurrent mechanism was with an abducted and flexed hip, with knee at first degrees of flexion and under valgus stress. Through a YouTube-based video analysis, it was possible to delineate recurrent temporal, spatial and mechanical characteristics of ACL injury in male professional soccer players. Level IV, case series.

  7. Surgical management of anterior cruciate ligament injuries in Belgium anno 2013.

    Science.gov (United States)

    Van der Bracht, Hans; Goubau, Laurent; Stuyts, Bart; Schepens, Alexander; Verdonk, Peter; Victor, Jan

    2015-12-01

    Anatomic ACL surgery, including double bundle ACL reconstruction, has been investigated widely. The purpose of this study was to gain insight in the currently used surgical management of anterior cruciate ligament injuries amongst Belgian orthopaedic surgeons. A survey consisting of epidemiological questions, ACL surgery related questions and questions concerning rehabilitation was submitted to all members of the Belgian Knee Society. Anatomic single bundle ACL repair with transportal femoral tunnel drilling, using an autologous hamstring graft fixed with a cortical suspension system proximal and an interference screw distal is currently the most common technique. The surgery is usually performed under general anesthesia with a one-night stay in the hospital. Postoperatively a hinge brace is mostly used. Although much research concerning double bundle ACL surgery is performed, only few surgeons perform this technique. Most surgeons perform an anatomic single bundle repair. This is in accordance with the current knowledge regarding cost effective care. Performing this procedure in day care with the aid of loco-regional anesthesia and avoidance of a hinged brace can help to reduce the cost for the healthcare system without compromising the outcome.

  8. A HYPOTHESIS: COULD PORTABLE NATURAL GRASS BE A RISK FACTOR FOR KNEE INJURIES?

    Directory of Open Access Journals (Sweden)

    John Orchard

    2008-03-01

    Full Text Available Previous study has shown a likely link between increased shoe- surface traction and risk of knee Anterior Cruciate Ligament (ACL injury. Portable natural grass systems are being used more often in sport, but no study to date has investigated their relative safety. By their nature, they must have high resistance to falling apart and therefore newly laid systems may be at risk of creating excessive shoe-surface traction. This study describes two clusters of knee injuries (particularly non-contact ACL injuries, each occurring to players of one professional football team at single venue, using portable grass, in a short space of time. The first series included two ACL injuries, one posterolateral complex disruption and one lateral ligament tear occurring in two rugby league games on a portable bermudagrass surface in Brisbane, Australia. The second series included four non-contact ACL injuries over a period of ten weeks in professional soccer games on a portable Kentucky bluegrass/perennial ryegrass surface in Barcelona, Spain. Possible intrinsic risk factors are discussed but there was no common risk shared by the players. Although no measures of traction were made at the Brisbane venue, average rotational traction was measured towards the end of the injury cluster at Camp Nou, Barcelona, to be 48 Nm. Chance undoubtedly had a part to play in these clusters, but the only obvious common risk factor was play on a portable natural grass surface soon after it was laid. Further study is required to determine whether portable natural grass systems may exhibit high shoe-surface traction soon after being laid and whether this could be a risk factor for knee injury

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

    Directory of Open Access Journals (Sweden)

    Dilpreet Kaur

    2015-12-01

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

  10. Pain level after ACL reconstruction: A comparative study between free quadriceps tendon and hamstring tendons autografts.

    Science.gov (United States)

    Buescu, Cristian Tudor; Onutu, Adela Hilda; Lucaciu, Dan Osvald; Todor, Adrian

    2017-03-01

    The objective of this study was to compare the pain levels and analgesic consumption after single bundle ACL reconstruction with free quadriceps tendon autograft versus hamstring tendon autograft. A total of 48 patients scheduled for anatomic single-bundle ACL reconstruction were randomized into two groups: the free quadriceps tendon autograft group (24 patients) and the hamstring tendons autograft group (24 patients). A basic multimodal analgesic postoperative program was used for all patients and rescue analgesia was provided with tramadol, at pain scores over 30 on the Visual Analog Scale. The time to the first rescue analgesic, the number of doses of tramadol and pain scores were recorded. The results within the same group were compared with the Wilcoxon signed test. Supplementary analgesic drug administration proved significantly higher in the group of subjects with hamstring grafts, with a median (interquartile range) of 1 (1.3) dose, compared to the group of subjects treated with a quadriceps graft, median = 0.5 (0.1.25) (p = 0.009). A significantly higher number of subjects with a quadriceps graft did not require any supplementary analgesic drug (50%) as compared with subjects with hamstring graft (13%; Z-statistics = 3.01, p = 0.002). The percentage of subjects who required a supplementary analgesic drug was 38% higher in the HT group compared with the FQT group. The use of the free quadriceps tendon autograft for ACL reconstruction leads to less pain and analgesic consumption in the immediate postoperative period compared with the use of hamstrings autograft. Level I Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  11. Assessment of gastrocnemius tensiomyographic neuromuscular characteristics as risk factors for anterior cruciate ligament injury in male soccer players.

    Science.gov (United States)

    Alentorn-Geli, Eduard; Alvarez-Diaz, Pedro; Ramon, Silvia; Marin, Miguel; Steinbacher, Gilbert; Rius, Marta; Seijas, Roberto; Ares, Oscar; Cugat, Ramon

    2015-09-01

    There is a large number of publications evaluating neuromuscular risk factors for anterior cruciate ligament (ACL) injury in athletes. However, most of them have involved the female athlete and, in addition, the gastrocnemius muscles have been less investigated by far compared with the quadriceps and hamstring. The purpose of this study was to investigate the role of the gastrocnemius muscles as neuromuscular risk factors for ACL injury in male soccer players, through tensiomyography (TMG). All competitive male soccer players with confirmed ACL tear included in this study underwent resting TMG assessment of gastrocnemius medialis (GM) and gastrocnemius lateralis muscles of the uninjured side. The same values were obtained from a sex-, and sports level-matched control group in both sides. The maximal displacement (D m), delay time (T d), contraction time (T c), sustained time (T s), and half-relaxation time (T r) were obtained for both muscles. TMG values of the uninjured side in ACL-injured group were compared with the mean values between both sides in the control subjects. There were no significant between-group differences in demographic characteristics. Most TMG parameters of the gastrocnemius muscles were not significantly different between the two groups. Only the GM-T r (p = 0.02) and GM-D m (p = 0.006) were significantly higher in the ACL-injured group compared with control group. Neuromuscular characteristics in terms of mechanical and contractile properties of the gastrocnemius muscles may not be significant risk factors for ACL injury in male soccer players.

  12. 2018 International Olympic Committee Consensus Statement on Prevention, Diagnosis, and Management of Pediatric Anterior Cruciate Ligament Injuries

    Science.gov (United States)

    Ardern, Clare L.; Ekås, Guri; Grindem, Hege; Moksnes, Håvard; Anderson, Allen F.; Chotel, Franck; Cohen, Moises; Forssblad, Magnus; Ganley, Theodore J.; Feller, Julian A.; Karlsson, Jón; Kocher, Mininder S.; LaPrade, Robert F.; McNamee, Mike; Mandelbaum, Bert; Micheli, Lyle; Mohtadi, Nicholas G.H.; Reider, Bruce; Roe, Justin P.; Seil, Romain; Siebold, Rainer; Silvers-Granelli, Holly J.; Soligard, Torbjørn; Witvrouw, Erik; Engebretsen, Lars

    2018-01-01

    In October 2017, the International Olympic Committee hosted an international expert group of physical therapists and orthopaedic surgeons who specialize in treating and researching pediatric anterior cruciate ligament (ACL) injuries. The purpose of this meeting was to provide a comprehensive, evidence-informed summary to support the clinician and help children with ACL injury and their parents/guardians make the best possible decisions. Representatives from the following societies attended: American Orthopaedic Society for Sports Medicine; European Paediatric Orthopaedic Society; European Society for Sports Traumatology, Knee Surgery, and Arthroscopy; International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine; Pediatric Orthopaedic Society of North America; and Sociedad Latinoamericana de Artroscopia, Rodilla, y Deporte. Physical therapists and orthopaedic surgeons with clinical and research experience in the field and an ethics expert with substantial experience in the area of sports injuries also participated. This consensus statement addresses 6 fundamental clinical questions regarding the prevention, diagnosis, and management of pediatric ACL injuries. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision making with children and the potential long-term ramifications of the injury. PMID:29594177

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

    Science.gov (United States)

    Dacombe, Peter Jonathan; Robinson, James

    2012-03-27

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

  14. Preventive Biomechanics: A Paradigm Shift With a Translational Approach to Injury Prevention.

    Science.gov (United States)

    Hewett, Timothy E; Bates, Nathaniel A

    2017-09-01

    Preventive medicine techniques have alleviated billions of dollars' worth of the economic burden in the medical care system through the implementation of vaccinations and screenings before the onset of disease symptoms. Knowledge of biomechanical tendencies has progressed rapidly over the past 20 years such that clinicians can identify, in healthy athletes, the underlying mechanisms that lead to catastrophic injuries such as anterior cruciate ligament (ACL) ruptures. As such, preventive medicine concepts can be applied to noncontact musculoskeletal injuries to reduce the economic burden of sports medicine treatments and enhance the long-term health of athletes. To illustrate the practical medical benefits that could be gained from preventive biomechanics applied to the ACL as well as the need and feasibility for the broad implementation of these principles. Literature review. The recent literature pertinent to the screening and prevention of musculoskeletal injuries was reviewed and compiled into a clinical commentary on the current state and applicability of preventive biomechanics. Investigators have identified neuromuscular training protocols that screen for and correct the underlying biomechanical deficits that lead to ACL injuries. The literature shows that when athletes comply with these prescribed training protocols, the incidence of injuries is significantly reduced within that population. Such preventive biomechanics practices employ basic training methods that would be familiar to athletic coaches and have the potential to save billions of dollars in cost in sports medicine. The widespread implementation of preventive biomechanics concepts could profoundly affect the field of sports medicine with a minimum of initial investment.

  15. Factors contributing to anterior cruciate ligament injury and pattern of presentations

    International Nuclear Information System (INIS)

    Shah, F.; Riaz, M.U.; Hassan, D.; Abbas, Z.

    2017-01-01

    Objectives: To determine the factors contributing to Anterior cruciate ligament (ACL) injury and their pattern of presentation. Methodology: This descriptive study included 45 patients diagnosed with ACL injury that were selected using non probability convenience sampling technique from department of orthopaedic and physical therapy of Mayo Hospital and Gurki Trust Hospital, Lahore, Pakistan. The study was completed in 6 months of duration. Subjects that were diagnosed with ACL injury using MRI with positive Lachman and Anterior Drawer test. Data regarding demographics, onset of injury, mechanism, occupational, recreational, daily routines and clinical presentations were recorded. Data were analysed by SPSS. Results: Out of 45 patients, 38(84.4%) cases were male and 7(16.5%) were female. 76% belonged to 20 to 30 age range. Regarding source of injury to anterior cruciate ligament, 32% got it during cricket, 21% during mild to severe road side accident, 20% during running and other 27% during daily life activities twisting, jumping and other high impact activities. The individual involved very often in high impact activities were 8%, often 13% and less often 79%. Conclusion: Major risk factors found were engaging in high impact activities such as sports, running and jumping nature. Clinical presentations were edema, decreased mobility, mild to moderate pain and limited range of knee range of motion. (author)

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

    International Nuclear Information System (INIS)

    Park, Lawrence S.; Jacobson, Jon A.; Jamadar, David A.; Caoili, Elaine; Kalume-Brigido, Monica; Wojtys, Edward

    2007-01-01

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

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

    Science.gov (United States)

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

    2015-11-11

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

  18. Pilot study of female high school basketball players' anterior cruciate ligament injury knowledge, attitudes, and practices.

    Science.gov (United States)

    Iversen, M D; Friden, C

    2009-08-01

    An anterior cruciate ligament (ACL) injury prevention program was evaluated. One hundred and thirteen female high school varsity and junior varsity basketball players and 12 coaches participated in an 8-week educational and skills program. Demographic and injury history data were collected. At pre-intervention and at the end of season, knowledge, attitudes, and practices about ACL risk and injury prevention were assessed via questionnaires, and frequency of two-footed landings were videotaped during games. Univariate statistics described the sample. Paired t-tests evaluated the program's impact. Cronbach's alpha, correlations, and kappa statistics assessed the validity and reliability of questionnaires and video analysis. Of the 113 players, 74 completed the study. The players' mean age was 16.25 years (SD=1.07; range=14.2-18.8). Baseline knowledge score was 57.2%, practice 58.4%, and attitude 73.5%. The mean baseline knowledge score of the 12 coaches (mean age=40.8 years; SD=10.3; range=26.9-56.3) was 68.7%. Players' knowledge about ACL injury prevention improved (t=2.57; P<0.01). No changes in attitudes toward injury prevention were found (t(diff)=1.88; P<0.06). Inter-rater reliability of two-footed landings observed was acceptable (kappa=0.72). Videotape analyses revealed a 5.5% increase in landing performance (t(diff)=9.6; P<0.0001). The program increased knowledge about ACL injury risk and improved player's landing skills.

  19. ACL reconstruction

    Science.gov (United States)

    ... changes in direction, such as soccer, basketball, and football, may require up to 9 to 12 months ... herein should not be used during any medical emergency or for the diagnosis or treatment of any ...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-07-15

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  2. Anterior cruciate ligament injury: post-traumatic bone marrow oedema correlates with long-term prognosis.

    Science.gov (United States)

    Filardo, Giuseppe; Kon, Elizaveta; Tentoni, Francesco; Andriolo, Luca; Di Martino, Alessandro; Busacca, Maurizio; Di Matteo, Berardo; Marcacci, Maurilio

    2016-01-01

    Bone marrow oedema (BME) in the knee is a feature of several pathological conditions, and it has been described with high frequency in patients with acute anterior cruciate ligament (ACL) injury. The aim of this study is to evaluate the significance of BME, assessed in MRIs performed for ACL injury, with regards to clinical outcome and return to sport. A total of 134 patients (98 men, 36 women) with ACL tear and MRI knee scan within six months from trauma were analysed. The presence of BME was evaluated on MRI images considering: extension and hyperintensity, the WORMS score oedema classification, and measuring the BME area. The clinical results were documented by IKDC-subjective score and the sport activity level by Tegner score at a minimum of five years follow up. BME was present in 74 knees (55.2 %), with a mean area of 523 ± 370 mm². The presence of BME showed a gradual decrease over time (p = 0.008), being detectable in MRIs performed more than three months after trauma in just 25.0 % of cases. Although 54 % of the patients without BME after three months returned to their previous sport level, no patients with oedema reached a full sport recovery (p = 0.01). In the group that underwent ACL reconstruction, the BME area was significantly correlated with a return to the previous sport level at the mid/long-term follow-up (p = 0.038). BME is a common finding, which decreases over time after injury. However, when BME is still detectable it correlates with clinical prognosis, and even in sport-active patients undergoing ACL reconstruction, a higher BME area is a negative predictive factor for a successful outcome at the mid/long-term follow-up.

  3. A CLINICAL STUDY OF ARTHROSCOPIC MANAGEMENT OF ANTERIOR C RUCIATE LIGAMENT INJURIES OF KNEE JOINT

    Directory of Open Access Journals (Sweden)

    Paragjyoti

    2015-09-01

    Full Text Available BACKGROUND : Anterior C ruciate L igament (ACL tear is a common sports injury of the knee. There are a lot of controversies related to the management of this injury and more than 2000 papers have been published on the various aspects of the topic. Arthroscopic reconstruction of the ACL with autogenous graft material is widely used nowadays. The two most commonly used grafts are the central one - third of the patellar ligament (bone - tendon - bone, BTB and the hamstring tendon ( S emitendinosus - gracilis, STG construct but the former graft leads to increased donor site morbidity & hurdles in postoperative rehab & pain. The aim of the study is to study the Arthroscopic management of anterior cruciate ligament injury of knee joint using quadrupled hamstring graft. METHOD: The study was carried out on 30 cases of anterior cruciate ligament injury of knee joint attending the OPD and emergency of department of Orthopaedics, Silchar Medical College & Hospital who met the inclusion criteria. An informed consent was obtained from each patient prior to participation in the study. All the patients were examined in detail and worked up to obtain pre - anaesthetic clearance. X - rays and MRI were done routinely in all the cases. Clinical and radiological parameters were recorded. Arthroscopic anterior cruciate ligament reconstruction with quadrupled hamstring graft was done in all the patients. Concomitant meniscal inju ries were treated according to the merit of the injury. Patients were followed up at regular intervals and outcome variables were assessed and recorded. RESULTS: Results of our study clearly showed that arthroscopic ACL reconstruction using quadrupled hamstring graft is a safe, effective and reproducible procedure in restoring knee function with minimal donor site morbidity. At follow up evaluation, all patients had good outcomes in terms of clinical stability, range of motion and general symptoms. CONCLUSION: From the results in this study

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-10-15

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

  5. Magnetic resonance imaging of knee injuries in children

    International Nuclear Information System (INIS)

    King, S.J.

    1997-01-01

    The appearances of knee injuries on MR imaging are less well documented in children than adults. Some patterns of injury are shared by both groups of patients, e. g. meniscal damage. The frequency of specific injuries may differ, e. g. anterior cruciate ligament (ACL) tear. Congenital abnormality, coexistent pathology and previous treatment of the knee appear to be associated with meniscal problems. Discoid menisci are seen most frequently in children and have unique features on MR scans. Cruciate ligament tears are difficult to diagnose in the smallest children. The ACL may not be identified due to its small size. Normal bone marrow signal may be confused with marrow infiltration or bone microfracture. Radiographically occult fractures around the knee appear to be strongly associated with ligamentous injury as in adult patients. Osteochondral fractures, osteochondral lesions and articular cartilage damage are revealed on MR scans, but their long-term effects are uncertain. It is possible to diagnose a range of knee injuries on MR scans in children. The biggest diagnostic challenge is in pre-school children. (orig.). With 9 figs., 1 tab

  6. MR imaging of medial collateral ligament injury and associated internal knee joint injury

    International Nuclear Information System (INIS)

    Lim, Chae Ha; Lee, Sun Kyoung; Lim, Dong Hun; Kim, Young Sook; Byun, Ju Nam; Kim, Young Chul; Oh, Jae Hee

    1996-01-01

    To assess the value of MR imaging in the diagnosis of medial collateral ligament injury of the knee, we used MR imaging to evaluate the characteristic findings in MCL tears and the frequency of associated knee joint injury. We retrospectively reviewed 26 patients within four weeks of MCL injury, analysed MR findings and correlated them with surgical findings. We evaluated discontinuity, heterogeneous signal intensity of MCL, thin band- like low signal intensity at MCL, facial edema, loss of clear demarcation of adjacent fat also combined bone injury, meniscus injury and other ligament injury. Complete MCL tears were present in 14 patients and partial tears in 12. Complete tears showed discontinuity of MCL, fascial edema and loss of clear demarcation from adjacent fat in 11 patients(79%);proximal MCL tears are more common than distal tears. Partial tears showed thin band-like low signal intensity within MCL, fascial edema and loss of clear demarcation from adjacent fat in seven patients (58%);all patient s with MCL injury showed fascial edema;in 12 patients there was loss of clear demarcation from adjacent fat. We could not, however, distinguish between complete tears and partial tears when MCL showed heterogeneous high signal intensity. Combined bone injury in MCL tears was found in eight patients(62%);the most common sites of this were the lateral femoral condyle and lateral tibial plateau. There was associated injury involving other ligaments(ACL:50%;PCL:27%). Combined meniscus injury in MCL tears was present in 17 patients and the most common meniscus site(50%) is the posterior horn of the medial meniscus. Complete MCL tears showed discontinuity of MCL and partial tears showed a thin band-like low signal intensity within MCL. All patients with MCL injury showed fascial edema, and loss of clear demarcation from adjacent fat. Various other injuries combine with MCL tears. MR imaging is therefore useful in the evaluation of medial collateral ligament injury and

  7. Balance index score as a predictive factor for lower sports results or anterior cruciate ligament knee injuries in Croatian female athletes--preliminary study.

    Science.gov (United States)

    Vrbanić, Tea Schnurrer-Luke; Ravlić-Gulan, Jagoda; Gulan, Gordan; Matovinović, Damir

    2007-03-01

    Female athletes participating in high-risk sports suffer anterior cruciate ligament (ACL) knee injury at a 4- to 6-fold greater rate than do male athletes. ACL injuries result either from contact mechanisms or from certain unexplained non-contact mechanisms occurring during daily professional sports activities. The occurrence of non-contact injuries points to the existence of certain factors intrinsic to the knee that can lead to ACL rupture. When knee joint movement overcomes the static and the dynamic constraint systems, non-contact ACL injury may occur. Certain recent results suggest that balance and neuromuscular control play a central role in knee joint stability, protection and prevention of ACL injuries. The purpose of this study is to evaluate balance neuromuscular skills in healthy Croatian female athletes by measuring their balance index score, as well as to estimate a possible correlation between their balance index score and balance effectiveness. This study is conducted in an effort to reduce the risk of future injuries and thus prevent female athletes from withdrawing from sports prematurely. We analysed fifty-two female athletes in the high-risk sports of handball and volleyball, measuring for their static and dynamic balance index scores, using the Sport KAT 2000 testing system. This method may be used to monitor balance and coordination systems and may help to develop simpler measurements of neuromuscular control, which can be used to estimate risk predictors in athletes who withdraw from sports due to lower sports results or ruptured anterior cruciate ligament and to direct female athletes to more effective, targeted preventive interventions. The tested Croatian female athletes with lower sports results and ACL knee injury incurred after the testing were found to have a higher balance index score compared to healthy athletes. We therefore suggest that a higher balance index score can be used as an effective risk predictor for lower sports results

  8. Cross-cultural translation of the Lysholm knee score in Chinese and its validation in patients with anterior cruciate ligament injury.

    Science.gov (United States)

    Wang, W; Liu, L; Chang, X; Jia, Z Y; Zhao, J Z; Xu, W D

    2016-10-19

    The Lysholm Knee Score (LKS) is widely used and is one of the most effective questionnaires employed to assess knee injuries. Although LKS has been translated into multiple languages, there is no Chinese version even though China has the largest population of patients with knee-joint injuries. The objective of our study was to develop the Chinese version of LKS (C-LKS) and assess its reliability, validity and responsiveness in Chinese patients with anterior cruciate ligament (ACL) injuries. Study participants were mainly recruited among patients with ACL injuries scheduled for arthroscopic ACL reconstruction at our hospital. First, we developed the C-LKS in a five-step translation and cross-cultural adaptation procedure. Next, we calculated the Cronbach's alpha, intraclass correlation coefficient (ICC), Pearson's correlation coefficient (r), effect size (ES), and standardized response mean (SRM) to evaluate the reliability, validity, and responsiveness of C-LKS respectively. Overall, 126 patients with ACL injuries successfully completed the questionnaires. Acceptable internal consistency (Cronbach's alpha = 0.726) as well as excellent test-retest reliability (ICC = 0.935) was found for C-LKS. Good or moderate correlation (r = 0.514-0.837) was determined among C-LKS and International Knee Documentation Committee Subjective Knee Form (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), physical subscales of SF-36; C-LKS also had fair or moderate correlation (r = 0.207-0.462) with the other subscales of SF-36, which adequately illustrated that good validity was included in C-LKS. In addition, good responsiveness was also observed in C-LKS (ES = 1.36,SRM = 1.26). We have shown that our developed C-LKS questionnaire is reliable, valid and responsible for the evaluation of Chinese-speaking patients with ACL injuries and it would be an effective instrument.

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

    Science.gov (United States)

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

    2017-01-01

    The function of the anterior cruciate ligament (ACL) patients' non-injured leg is relevant in light of the high incidence of secondary ACL injuries on the contralateral side. However, the non-injured leg's function has only been examined for a selected number of neuromuscular outcomes and often without appropriate control groups. We measured a broad array of neuromuscular functions between legs of ACL patients and compared outcomes to age, sex, and physical activity matched controls. Thirty-two ACL-deficient patients (208 ± 145 days post-injury) and active and less-active controls (N = 20 each) participated in the study. We measured single- and multi-joint neuromuscular function in both legs in each group and expressed the overall neuromuscular function in each leg by calculating a mean z-score across all neuromuscular measures. A group by leg MANOVA and ANOVA were performed to examine group and leg differences for the selected outcomes. After an ACL injury, duration (-4.3 h/week) and level (Tegner activity score of -3.9) of sports activity decreased and was comparable to less-active controls. ACL patients showed bilateral impairments in the star excursion balance test compared to both control groups (P ≤ 0.004) and for central activation ratio compared to active controls (P ≤ 0.002). There were between-leg differences within each group for maximal quadriceps and hamstring strength, voluntary quadriceps activation, star excursion balance test performance, and single-leg hop distance (all P joint proprioception, and static balance. Overall neuromuscular function (mean z-score) did not differ between groups, but ACL patients' non-injured leg displayed better neuromuscular function than the injured leg (P neuromuscular deficits despite reductions in physical activity after injury. Therapists can use the non-injured leg as a reference to assess the injured leg's function for tasks measured in the present study, excluding dynamic balance and quadriceps

  10. Anterior cruciate ligament injury profile in Italian Serie A1-A2 women's volleyball league.

    Science.gov (United States)

    Devetag, Francesca; Mazzilli, Massimiliano; Benis, Roberto; LA Torre, Antonio; Bonato, Matteo

    2018-01-01

    The aim of this study was to assess how anterior cruciate ligament (ACL) ruptures with subsequent surgery reconstruction impact on the professional career of A1-A2 Italian women's volleyball league players. Using an observational study with a retrospective case-series design for ACL ruptures, 125 teams with 1488 players were monitored. Subjects had to report level, role, injury modality, lower limb injured, laterality, period of the season and age. A total of 34 ACL ruptures were reported. Thirty-three (97%) were non-contact and 1 (3%) with contact. Twenty-one (61.7%) occurred in landing from a jump attack, 3 (8.8%) in landing from wall jump, 1 (3%) with apparent contact and 9 (26.5%) in other landing conditions. The most injured knee was the left limb (22, 64.7%) respect to the right limb (12, 35.3%). Fourteen (41.2%) ruptures occurred in spikers, 10 (29.4%) in middle blockers, 6 (17.6%) in setters, 3 (8.8%) in liberos and 1 (3%) in opposite hitters. Nine (26.5%) occurred in pre-season period, 16 (47%) in the first round, 4 (11.8%) in the second round, and 5 (14.7%) during play-off. The average age of the first ACL rupture was 23±3 years. We observed that female volleyball players of A1-A2 Italian volleyball league occurred mostly in a left non-contact ACL rupture during a landing condition and the spikers were the players most at risk. Therefore, it is desirable that coaches teach players variations of landing in order to avoid possible chronic overloading of ACL.

  11. Perceived personal importance of exercise and fears of re-injury: a longitudinal study of psychological factors related to activity after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Gignac, Monique Am; Cao, Xingshan; Ramanathan, Subha; White, Lawrence M; Hurtig, Mark; Kunz, Monica; Marks, Paul H

    2015-01-01

    Psychological perceptions are increasingly being recognized as important to recovery and rehabilitation post-surgery. This research longitudinally examined perceptions of the personal importance of exercise and fears of re-injury over a three-year period post anterior cruciate ligament (ACL) reconstruction. Stability and change in psychological perceptions was examined, as well as the association of perceptions with time spent in different types of physical activity, including walking, household activities, and lower and higher risk for knee injury activities. Participants were athletes, 18-40 years old, who underwent ACL reconstruction for first-time ACL injuries. They were recruited from a tertiary care centre in Toronto, Canada. Participants completed interviewer-administered questionnaires pre-surgery and at years one, two and three, postoperatively. Questions assessed demographics, pain, functional limitations, perceived personal importance of exercise, fear of re-injury and physical activities (i.e., walking; household activities; lower risk for knee injury activities; higher risk for knee injury activities). Analyses included fixed-effect longitudinal modeling to examine the association of a fear of re-injury and perceived personal importance of exercise and changes in these perceptions with the total hours spent in the different categories of physical activities, controlling for other factors. Baseline participants were 77 men and 44 women (mean age = 27.6 years; SD = 6.2). At year three, 78.5% of participants remained in the study with complete data. Fears of re-injury decreased over time while personal importance of exercise remained relatively stable. Time spent in walking and household activities did not significantly change with ACL injury or surgery. Time spent in lower and higher risk of knee injury physical activity did not return to pre-injury levels at three years, post-surgery. Greater time spent in higher risk of knee injury activities

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

    NARCIS (Netherlands)

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

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

  13. Radiographic positions of femoral ACL, AM and PL centres : accuracy of guidelines based on the lateral quadrant method

    NARCIS (Netherlands)

    Luites, Joan W.H.; Verdonschot, Nico

    2017-01-01

    Purpose: Femoral tunnel positioning is an important factor in anatomical ACL reconstructions. To improve accuracy, lateral radiographic support can be used to determine the correct tunnel location, applying the quadrant method. Piefer et al. (Arthroscopy 28:872–881, 2012) combined various outcomes

  14. Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury.

    Science.gov (United States)

    Wellsandt, Elizabeth; Failla, Mathew J; Snyder-Mackler, Lynn

    2017-05-01

    Study Design Prospective cohort. Background The high risk of second anterior cruciate ligament (ACL) injuries after return to sport highlights the importance of return-to-sport decision making. Objective return-to-sport criteria frequently use limb symmetry indexes (LSIs) to quantify quadriceps strength and hop scores. Whether using the uninvolved limb in LSIs is optimal is unknown. Objectives To evaluate the uninvolved limb as a reference standard for LSIs utilized in return-to-sport testing and its relationship with second ACL injury rates. Methods Seventy athletes completed quadriceps strength and 4 single-leg hop tests before anterior cruciate ligament reconstruction (ACLR) and 6 months after ACLR. Limb symmetry indexes for each test compared involved-limb measures at 6 months to uninvolved-limb measures at 6 months. Estimated preinjury capacity (EPIC) levels for each test compared involved-limb measures at 6 months to uninvolved-limb measures before ACLR. Second ACL injuries were tracked for a minimum follow-up of 2 years after ACLR. Results Forty (57.1%) patients achieved 90% LSIs for quadriceps strength and all hop tests. Only 20 (28.6%) patients met 90% EPIC levels (comparing the involved limb at 6 months after ACLR to the uninvolved limb before ACLR) for quadriceps strength and all hop tests. Twenty-four (34.3%) patients who achieved 90% LSIs for all measures 6 months after ACLR did not achieve 90% EPIC levels for all measures. Estimated preinjury capacity levels were more sensitive than LSIs in predicting second ACL injuries (LSIs, 0.273; 95% confidence interval [CI]: 0.010, 0.566 and EPIC, 0.818; 95% CI: 0.523, 0.949). Conclusion Limb symmetry indexes frequently overestimate knee function after ACLR and may be related to second ACL injury risk. These findings raise concern about whether the variable ACL return-to-sport criteria utilized in current clinical practice are stringent enough to achieve safe and successful return to sport. Level of Evidence

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    The forward lunge movement may be used as a functional performance test of anterior cruciate ligament (ACL) deficient and reconstructed subjects. The purposes were 1) to determine the test-retest reliability of a forward lunge in healthy subjects and 2) to determine the required numbers...... of repetitions necessary to yield satisfactory reliability. Nineteen healthy subjects performed four trials of a forward lunge on two different days. The movement time, impulses of the ground reaction forces (IFz, IFy), knee joint kinematics and dynamics during the forward lunge were calculated. The relative...... reliability was determined by calculation of Intraclass Correlation Coefficients (ICC). The IFz, IFy and the positive work of the knee extensors showed excellent reliability (ICC >0.75). All other variables demonstrated acceptable reliability (0.4>ICCreliability increased when more than...

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

    DEFF Research Database (Denmark)

    Alkjaer, T; Wieland, MR; Andersen, MS

    2010-01-01

    are loaded during forward lunge? 2) Does the mechanical equilibrium cause ACL loads? Design: Computational modeling. Setting: The biomechanical forward lunge model was based on experimental motion capture data. Patients or Other Participants: One healthy female subject (height 5 169 cm, weight 5 59.6 kg, age....... The model and the pelvis. The hips were modeled as spherical joints, the knees as hinge joints, and the ankles as universal joints. Each according to a minimum fatigue criterion. Main Outcome Measures: Muscle and joint reaction forces that pulled the tibia in anterior or posterior direction. The forces were...... at the time of peak knee flexion. At peak knee flexion, the knee reaction was the only force that pulled the tibia anteriorly (2880 N). This was primarily counterbalanced by the musculus gluteus maximus (21940 N). Conclusions: The loading of the knee joint during lunging never required any stabilization...

  17. An ACL2 Mechanization of an Axiomatic Framework for Weak Memory

    Directory of Open Access Journals (Sweden)

    Benjamin Selfridge

    2014-06-01

    Full Text Available Proving the correctness of programs written for multiple processors is a challenging problem, due in no small part to the weaker memory guarantees afforded by most modern architectures. In particular, the existence of store buffers means that the programmer can no longer assume that writes to different locations become visible to all processors in the same order. However, all practical architectures do provide a collection of weaker guarantees about memory consistency across processors, which enable the programmer to write provably correct programs in spite of a lack of full sequential consistency. In this work, we present a mechanization in the ACL2 theorem prover of an axiomatic weak memory model (introduced by Alglave et al.. In the process, we provide a new proof of an established theorem involving these axioms.

  18. Anatomic single-bundle ACL surgery: consequences of tibial tunnel diameter and drill-guide angle on tibial footprint coverage.

    Science.gov (United States)

    Van der Bracht, H; Verhelst, L; Stuyts, B; Page, B; Bellemans, J; Verdonk, P

    2014-05-01

    To investigate the consequences of differences in drill-guide angle and tibial tunnel diameter on the amount of tibial anatomical anterior cruciate ligament (ACL) footprint coverage and the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint. Twenty fresh-frozen adult human knee specimens with a median age of 46 years were used for this study. Digital templates mimicking the ellipsoid aperture of tibial tunnels with a different drill-guide angle and a different diameter were designed. The centres of these templates were positioned over the geometric centre of the tibial ACL footprint. The amount of tibial ACL footprint coverage and overhang was calculated. Risk factors for overhang were determined. Footprint coverage and the risk of overhang were also compared between a lateral tibial tunnel and a classic antero-medial tibial tunnel. A larger tibial tunnel diameter and a smaller drill-guide angle both will create significant more footprint coverage and overhang. In 45% of the knees, an overhang was created with a 10-mm diameter tibial tunnel with drill-guide angle 45°. Furthermore, a lateral tibial tunnel was found not to be at increased risk of overhang. A larger tibial tunnel diameter and a smaller drill-guide angle both will increase the amount of footprint coverage. Inversely, larger tibial tunnel diameters and smaller drill-guide angles will increase the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint. A lateral tibial tunnel does not increase the risk of overhang.

  19. Reliability of tunnel angle in ACL reconstruction: two-dimensional versus three-dimensional guide technique.

    Science.gov (United States)

    Leiter, Jeff R S; de Korompay, Nevin; Macdonald, Lindsey; McRae, Sheila; Froese, Warren; Macdonald, Peter B

    2011-08-01

    To compare the reliability of tibial tunnel position and angle produced with a standard ACL guide (two-dimensional guide) or Howell 65° Guide (three-dimensional guide) in the coronal and sagittal planes. In the sagittal plane, the dependent variables were the angle of the tibial tunnel relative to the tibial plateau and the position of the tibial tunnel with respect to the most posterior aspect of the tibia. In the coronal plane, the dependent variables were the angle of the tunnel with respect to the medial joint line of the tibia and the medial and lateral placement of the tibial tunnel relative to the most medial aspect of the tibia. The position and angle of the tibial tunnel in the coronal and sagittal planes were determined from anteroposterior and lateral radiographs, respectively, taken 2-6 months postoperatively. The two-dimensional and three-dimensional guide groups included 28 and 24 sets of radiographs, respectively. Tibial tunnel position was identified, and tunnel angle measurements were completed. Multiple investigators measured the position and angle of the tunnel 3 times, at least 7 days apart. The angle of the tibial tunnel in the coronal plane using a two-dimensional guide (61.3 ± 4.8°) was more horizontal (P guide (64.7 ± 6.2°). The position of the tibial tunnel in the sagittal plane was more anterior (P guide group compared to the three-dimensional guide group (43.3 ± 2.9%). The Howell Tibial Guide allows for reliable placement of the tibial tunnel in the coronal plane at an angle of 65°. Tibial tunnels were within the anatomical footprint of the ACL with either technique. Future studies should investigate the effects of tibial tunnel angle on knee function and patient quality of life. Case-control retrospective comparative study, Level III.

  20. Performance of PROMIS Physical Function Compared with KOOS, SF-36, Eq5d And Marx Activity Scale in Patients Who Undergo ACL Reconstruction

    Science.gov (United States)

    Scott, Elizabeth; Glass, Natalie; Wolf, Brian R.; Hettrich, Carolyn M.; Bollier, Matthew

    2018-01-01

    Objectives: Anterior cruciate ligament reconstruction is a commonly performed orthopaedic procedure. PROMIS (Patient-Reported Outcome Measurement Information System) was developed by the National Institutes of Health in an effort to advance patient-reported outcome (PRO) instruments by developing question banks for major health domains. Our goal was to compare the responsiveness and construct validity of the PROMIS physical function (PF) computer adaptive test (CAT) with current PRO instruments utilized in patients who undergo anterior cruciate ligament reconstruction. Methods: A total of 174 patients ages 14-53 scheduled to undergo anterior cruciate ligament reconstruction were asked to complete PROMIS PF-CAT, Short Form-36 Health Survey (SF36-PF and -GH), Marx activity rating scale (Marx), Knee Injury and Osteoarthritis Score (KOOS-ADL, -Sport, -QOL), and the EuroQol five dimensions questionnaire (EQ5D) at their preoperative visit. These surveys were repeated at six weeks and six months after surgery. Correlations between PRO instruments was defined as excellent (>0.7), excellent-good (0.61-0.7), good (0.4-0.6), and poor (0.2-0.3) using Spearman Correlation Coefficients. The effect size (Cohen d) and standardized response mean (SRM) were used to describe the responsiveness of each PRO at the 6 week and 6 month follow-up visits and were defined as small (0.2), medium (0.5) and large (0.8). Ceiling and floor effects were defined as present if ≥15% of participants scored the highest or lowest score on a PRO, respectively. Subgroup analyses were performed comparing change in PRO scores at follow-up between participants with and without additional arthroscopic procedures (meniscal debridement and/or repair, microfracture, or OATS vs ACL reconstruction only) using linear mixed models. Results: There were excellent and excellent-good correlations between the PROMIS PF-CAT and physical function PROs including the SF36-PF (r=0.75-0.80, p0.05) to poor correlation with

  1. Retrospective case evaluation of gender differences in sports injuries in a Japanese sports medicine clinic.

    Science.gov (United States)

    Iwamoto, Jun; Takeda, Tsuyoshi; Sato, Yoshihiro; Matsumoto, Hideo

    2008-12-01

    Although both gender- and sports-specific injuries exist among athletes, gender differences in the types of injuries caused by sports activities, except for anterior cruciate ligament (ACL) injury and anterior knee pain, are not well established. An observational study with a retrospective case-series design was conducted to investigate gender-specific differences in the types of injuries sustained while engaging in sports activities common to both males and females. We analyzed injuries sustained during sports activities including basketball, volleyball, tennis, skiing, track and field, and swimming, using data on age, sex, sports activities, activity levels, and sports injuries that had been computerized at our sports medicine (orthopedics) clinic. Inclusion criteria were sports activities that had a record of >100 injuries in total and athletes aged sports activity. We determined the absolute number of patients in each category and their percentage (proportion) of our cohort. The proportions of common injuries caused by sports activities were investigated, and gender-specific differences in the types of common injuries caused by sports activities were clarified. The Fisher exact test was used to determine the significance (P gender-specific differences in the types of sports injuries. According to our database, during the 14-year period between October 1992 and December 2006, a total of 2,989 athletes (1,624 males and 1,365 females) aged sports activities described consulted our sports medicine clinic. The most common sports injuries were ACL injury (14.3%) and knee pain (13.7%), followed by ankle sprain (9.4%), lumbar disc disease (7.0%), meniscus injury (5.1%), stress fracture (2.9%), low back pain (2.5%), patellar tendinitis (2.1%), injury of the medial collateral ligament of the knee (2.0%), lumbar spondylolysis (1.7%), and muscle strain (1.5%). Among these 11 types of sports injuries, a significantly higher proportion of females who engaged in basketball

  2. Online registration of monthly sports participation after anterior cruciate ligament injury: a reliability and validity study.

    Science.gov (United States)

    Grindem, Hege; Eitzen, Ingrid; Snyder-Mackler, Lynn; Risberg, May Arna

    2014-05-01

    The current methods measuring sports activity after anterior cruciate ligament (ACL) injury are commonly restricted to the most knee-demanding sports, and do not consider participation in multiple sports. We therefore developed an online activity survey to prospectively record the monthly participation in all major sports relevant to our patient-group. To assess the reliability, content validity and concurrent validity of the survey and to evaluate if it provided more complete data on sports participation than a routine activity questionnaire. 145 consecutively included ACL-injured patients were eligible for the reliability study. The retest of the online activity survey was performed 2 days after the test response had been recorded. A subsample of 88 ACL-reconstructed patients was included in the validity study. The ACL-reconstructed patients completed the online activity survey from the first to the 12th postoperative month, and a routine activity questionnaire 6 and 12 months postoperatively. The online activity survey was highly reliable (κ ranging from 0.81 to 1). It contained all the common sports reported on the routine activity questionnaire. There was a substantial agreement between the two methods on return to preinjury main sport (κ=0.71 and 0.74 at 6 and 12 months postoperatively). The online activity survey revealed that a significantly higher number of patients reported to participate in running, cycling and strength training, and patients reported to participate in a greater number of sports. The online activity survey is a highly reliable way of recording detailed changes in sports participation after ACL injury. The findings of this study support the content and concurrent validity of the survey, and suggest that the online activity survey can provide more complete data on sports participation than a routine activity questionnaire.

  3. Online registration of monthly sports participation after anterior cruciate ligament injury: a reliability and validity study

    Science.gov (United States)

    Grindem, Hege; Eitzen, Ingrid; Snyder-Mackler, Lynn; Risberg, May Arna

    2013-01-01

    Background Current methods measuring sports activity after anterior cruciate ligament (ACL) injury are commonly restricted to the most knee-demanding sport, and do not consider participation in multiple sports. We therefore developed an online activity survey to prospectively record monthly participation in all major sports relevant to our patient-group. Objective To assess the reliability, content validity, and concurrent validity of the survey, and evaluate if it provided more complete data on sports participation than a routine activity questionnaire. Methods One hundred and forty-five consecutively included ACL-injured patients were eligible for the reliability study. The retest of the online activity survey was performed two days after the test response had been recorded. A subsample of 88 ACL-reconstructed patients were included in the validity study. The ACL-reconstructed patients completed the online activity survey from the first to the twelfth postoperative month, and a routine activity questionnaire 6 and 12 months postoperatively. Results The online activity survey was highly reliable (κ ranging from 0.81 to 1). It contained all the common sports reported on the routine activity questionnaire. There was substantial agreement between the two methods on return to preinjury main sport (κ = 0.71 and 0.74 at 6 and 12 months postoperatively). The online activity survey revealed that a significantly higher number of patients reported to participate in running, cycling and strength training, and patients reported to participate in a greater number of sports. Conclusion The online activity survey is a highly reliable way of recording detailed changes in sports participation after ACL injury. The findings of this study support the content and concurrent validity of the survey, and suggest that the online activity survey can provide more complete data on sports participation than a routine activity questionnaire. PMID:23645830

  4. A Hypothesis: Could Portable Natural Grass be a Risk Factor for Knee Injuries?

    Science.gov (United States)

    Orchard, John; Rodas, Gil; Til, Lluis; ArdevÒl, Jordi; Chivers, Ian

    2008-01-01

    Previous study has shown a likely link between increased shoe- surface traction and risk of knee Anterior Cruciate Ligament (ACL) injury. Portable natural grass systems are being used more often in sport, but no study to date has investigated their relative safety. By their nature, they must have high resistance to falling apart and therefore newly laid systems may be at risk of creating excessive shoe-surface traction. This study describes two clusters of knee injuries (particularly non-contact ACL injuries), each occurring to players of one professional football team at single venue, using portable grass, in a short space of time. The first series included two ACL injuries, one posterolateral complex disruption and one lateral ligament tear occurring in two rugby league games on a portable bermudagrass surface in Brisbane, Australia. The second series included four non-contact ACL injuries over a period of ten weeks in professional soccer games on a portable Kentucky bluegrass/perennial ryegrass surface in Barcelona, Spain. Possible intrinsic risk factors are discussed but there was no common risk shared by the players. Although no measures of traction were made at the Brisbane venue, average rotational traction was measured towards the end of the injury cluster at Camp Nou, Barcelona, to be 48 Nm. Chance undoubtedly had a part to play in these clusters, but the only obvious common risk factor was play on a portable natural grass surface soon after it was laid. Further study is required to determine whether portable natural grass systems may exhibit high shoe-surface traction soon after being laid and whether this could be a risk factor for knee injury. Key pointsExcessive shoe-surface traction is a hypothesised risk factor for knee ligament injuries, including anterior cruciate ligament injuries.Portable natural grass systems (by their nature in order to prevent grass rolls or squares from falling apart) will tend to exhibit high resistance to tearing when first

  5. WITHDRAWN: Exercise for treating isolated anterior cruciate ligament injuries in adults.

    Science.gov (United States)

    Trees, Amanda H; Howe, Tracey E; Dixon, John; White, Lisa

    2011-05-11

    The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. Injury causes pain, effusion and inflammation leading to the inability to fully activate the thigh muscles. Regaining muscular control is essential if the individual wishes to return to pre-injury level of function and patients will invariably be referred for rehabilitation. To present the best evidence for effectiveness of exercise used in the rehabilitation of isolated ACL injuries in adults, on return to work and pre-injury levels of activity. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (Feb 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2005), MEDLINE (1996 to March 2005), EMBASE (1980 to March 2005), other databases and reference lists of articles. Randomised controlled trials and quasi-randomised trials testing exercise programmes designed to rehabilitate adults with isolated ACL injuries. Trials where participants were randomised to receive any combination of the following: no care, usual care, a single-exercise intervention, and multiple-exercise interventions, were included. The primary outcome measures of interest were returning to work and return to pre-injury level of activity post treatment, at six months and one year. Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials. Nine trials involving 391 participants were included. Only two trials, involving 76 participants, reported conservative rehabilitation and seven trials, involving 315 participants, evaluated rehabilitation following ACL reconstruction. Methodological quality scores varied considerably across the trials, with the nature of participant and assessor blinding poorly reported. Trial comparisons fell into six categories. Pooling of data was rarely possible due to lack of appropriate

  6. STRATEGY OF VISUAL PROPRIOCEPTIVE CONTROL IN PATIENTS WITH INJURY TO THE ANTERIOR CRUCIATE LIGAMENT OF THE KNEE AND HEALTHY INDIVIDUALS (SOCCER PLAYERS

    Directory of Open Access Journals (Sweden)

    Tomasz Piontek

    2012-01-01

    Full Text Available Objective: Knee joint dysfunction resulting from injury to the anterior crucial ligament (ACL is associated not only with mechanical joint instability but also with damage of ligamentous receptors responsible for the joint proprioception. It was found that disturbances of signals from the damaged joint produce disorders in movement perception and position of the analogous joint in the normal limb. This study is aimed at evaluating the control strategy in patients with an injury to the anterior crucial ligament.Design: Cohort study; Level of evidence, 3. Subjects/Patients- 84 men, aged 15 to 55 years (mean age 27 years were included in this study. Methods- Patients were divided into two groups: those with unilateral injury to the ACL (33 patients and a control group of healthy volunteers (soccer players; 51 men. Anterior crucial ligament damage was confirmed with arthroscopic knee joint examination in every patient. The way of visual proprioceptive control was assessed with both dynamic (DRT and static (SRT Riva tests standing on one leg. Tests were performed with the Delos Postural Proprioceptive System (Delos s.r.l., Corso Lecce, Torino, Italy in the biomechanical evaluation laboratory at Rehasport Clinic in Poznań. Results: A statistically significant difference for deviations from the averaged axis in SRT (static Riva test with closed eyes was found between the limb with a damaged ACL and the normal limb in the group of patients with injury to the ACL (p=0.006 and between the limb with a damaged ACL and normal limbs in healthy volunteers (p=0.022. A statistically significant difference for deviations from the averaged axis in SRT with closed eyes was also found between the dominant and non-dominant limb in healthy volunteers (p=0.013. No significant differences in the results of tests with open eyes were noted. Conclusions: The results of systems and their contribution to the visual proprioceptive control suggest an important role of the

  7. Effect of Fatigue Protocols on Lower Limb Neuromuscular Function and Implications for Anterior Cruciate Ligament Injury Prevention Training: A Systematic Review.

    Science.gov (United States)

    Barber-Westin, Sue D; Noyes, Frank R

    2017-12-01

    Approximately two-thirds of anterior cruciate ligament (ACL) tears are sustained during noncontact situations when an athlete is cutting, pivoting, decelerating, or landing from a jump. Some investigators have postulated that fatigue may result in deleterious alterations in lower limb biomechanics during these activities that could increase the risk of noncontact ACL injuries. However, prior studies have noted a wide variation in fatigue protocols, athletic tasks studied, and effects of fatigue on lower limb kinetics and kinematics. First, to determine if fatigue uniformly alters lower limb biomechanics during athletic tasks that are associated with noncontact ACL injuries. Second, to determine if changes should be made in ACL injury prevention training programs to alter the deleterious effects of fatigue on lower limb kinetics and kinematics. Systematic review; Level of evidence, 4. A systematic review of the literature using MEDLINE was performed. Key terms were fatigue, neuromuscular, exercise, hop test, and single-legged function tests. Inclusion criteria were original research studies involving healthy participants, use of a fatigue protocol, study of at least 1 lower limb task that involved landing from a hop or jump or cutting, and analysis of at least 1 biomechanical variable. Thirty-seven studies involving 806 athletes (485 female, 321 male; mean age, 22.7 years) met the inclusion criteria. General fatigue protocols were used in 20 investigations, peripheral protocols were used in 17 studies, and 21 different athletic tasks were studied (13 single-legged, 8 double-legged). There was no consistency among investigations regarding the effects of fatigue on hip, knee, or ankle joint angles and moments or surface electromyography muscle activation patterns. The fatigue protocols typically did not produce statistically significant changes in ground-reaction forces. Published fatigue protocols did not uniformly produce alterations in lower limb neuromuscular

  8. Anterior cruciate ligament injury/reinjury in alpine ski racing: a narrative review

    OpenAIRE

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

    2017-01-01

    Matthew J Jordan,1 Per Aagaard,2 Walter Herzog1 1Human Performance Laboratory, The University of Calgary, Calgary, AB, Canada; 2Department of Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC), University of Southern Denmark, Odense M, Denmark Abstract: The purpose of the present review was to: 1) provide an overview of the current understanding on the epidemiology, etiology, risk factors, and prevention methods for anterior cruciate ligament (ACL) injury in alpine ...

  9. Postural stability does not differ among female sports with high risk of anterior cruciate ligament injury.

    Science.gov (United States)

    Cortes, Nelson; Porter, Larissa D; Ambegaonkar, Jatin P; Caswell, Shane V

    2014-12-01

    Dancers have a lower incidence of anterior cruciate ligament (ACL) injury compared to athletes in sports that involve cutting and landing motions. Balance can impact ACL injury risk and is related to neuromuscular control during movement. The purpose of this study was to investigate whether balance differences exist among female dancers and female soccer and basketball athletes. Fifty-eight female dancers, soccer, and basketball athletes (16.5 ± 1.6 yrs, 1.6 ± 0.2 m, 60.2 ± 14.1 kg) completed the Stability Evaluation Test (SET) on the NeuroCom VSR Sport (NeuroCom International, Clackamas, OR) to measure sway velocity. Video records of the SET test were used for Balance Error Scoring System (BESS) test scoring. A oneway ANCOVA compared composite sway velocity and BESS scores among sports. There was no statistically significant difference for sway velocity or BESS among sports (sway velocity soccer 2.3 ± 0.4, dance 2.2 ± 0.4, and basketball 2.4 ± 0.4; BESS soccer 13.6 ± 5.0, dance 11.9 ± 5.5, and basketball 14.9 ± 5.1, p>0.05). Balance was similar among athletes participating in different sports (dance, basketball, and soccer). Quasi-static balance may not play a significant role in neuromuscular control during movement and not be a significant risk factor to explain the disparity in ACL injury incidence among sports. Future research should examine the effects of dynamic balance and limb asymmetries among sports to elucidate on the existing differences on ACL injury incidence rates.

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

    Science.gov (United States)

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

    2017-10-27

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

  11. Which screening tools can predict injury to the lower extremities in team sports?: a systematic review.

    Science.gov (United States)

    Dallinga, Joan M; Benjaminse, Anne; Lemmink, Koen A P M

    2012-09-01

    Injuries to lower extremities are common in team sports such as soccer, basketball, volleyball, football and field hockey. Considering personal grief, disabling consequences and high costs caused by injuries to lower extremities, the importance for the prevention of these injuries is evident. From this point of view it is important to know which screening tools can identify athletes who are at risk of injury to their lower extremities. The aim of this article is to determine the predictive values of anthropometric and/or physical screening tests for injuries to the leg, anterior cruciate ligament (ACL), knee, hamstring, groin and ankle in team sports. A systematic review was conducted in MEDLINE (1966 to September 2011), EMBASE (1989 to September 2011) and CINAHL (1982 to September 2011). Based on inclusion criteria defined a priori, titles, abstracts and full texts were analysed to find relevant studies. The analysis showed that different screening tools can be predictive for injuries to the knee, ACL, hamstring, groin and ankle. For injuries in general there is some support in the literature to suggest that general joint laxity is a predictive measure for leg injuries. The anterior right/left reach distance >4 cm and the composite reach distance injuries. Furthermore, an increasing age, a lower hamstring/quadriceps (H : Q) ratio and a decreased range of motion (ROM) of hip abduction may predict the occurrence of leg injuries. Hyperextension of the knee, side-to-side differences in anterior-posterior knee laxity and differences in knee abduction moment between both legs are suggested to be predictive tests for sustaining an ACL injury and height was a predictive screening tool for knee ligament injuries. There is some evidence that when age increases, the probability of sustaining a hamstring injury increases. Debate exists in the analysed literature regarding measurement of the flexibility of the hamstring as a predictive screening tool, as well as using the H

  12. Can MR appearance performed a few days after injury predict the morphological recovery of the anterior cruciate ligament treated by early protective motion?

    International Nuclear Information System (INIS)

    Ihara, Hidetoshi; Kawano, Tsutomu

    2011-01-01

    The aim of this study was to determine whether early MRI after anterior cruciate ligament (ACL) injury can predict the morphological recovery of the torn ACL treated by early protective motion. Consecutive acute ruptures of the ACL in 35 patients (mean age; 27.2 years) who were allowed to be healed without surgery were evaluated by repeated MRI. MR images were compared for a few days after injury (initial MRI), approximately one month after treatment (second MRI), and at an average follow-up of 8.5 months (follow-up MRI). The average time from injury to the initial MRI was 7.3 days. The initial MR appearance of the torn ligament was classified into five types of visualized ligament contours. The emergence of restoration signs such as straight band and/or verticalization was examined in the second MRI. The follow-up MR appearance of the treated ACL was categorized into four grades depending on homogeneity, straight band, and size. Relationships between the initial MRI and the follow-up MRI, the restoration signs on the second MRI and the follow-up MRI were analyzed using the Spearman rank correlation coefficient. As a result, the contour of the initial MRI was found to correlate with morphological recovery on the follow-up MRI (r s =0.565, p<0.001). There was no correlation between the emergence of restoration signs on the second MRI and morphological recovery on the follow-up MRI. (author)

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

    Science.gov (United States)

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

    2017-07-01

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

  14. Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes

    DEFF Research Database (Denmark)

    Zebis, Mette K.; Andersen, Lars L.; Brandt, Mikkel

    2016-01-01

    training 3 times weekly for 12 weeks. The CON group completed their regular warm-up exercise programme before training. Players were tested while performing a side cutting movement at baseline and 12-week follow-up, using surface electromyography (EMG) and three-dimensional movement analysis. We calculated...

  15. Blocking landing techniques in volleyball and the possible association with anterior cruciate ligament injury.

    Science.gov (United States)

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

    2018-04-01

    The number and type of landings performed after blocking during volleyball matches has been related to the potential risk of ACL injury. The aim of the present study was to determine whether gender affects the frequency of specific blocking landing techniques with potential risk of ACL injury from the perspective of foot contact and subsequent movement after the block used by volleyball players during competitive matches. Three matches involving four female volleyball teams (fourteen sets) and three matches involving four male volleyball teams (thirteen sets) in the Czech Republic were analyzed for this study. A Pearson chi-square test of independence was used to detect the relationship between gender and different blocking techniques. The results of the present study showed that gender affected single-leg landings with subsequent movement in lateral direction and double-leg landings. Although the total number of landings was lower for male athletes than for female athletes, a larger portion of male athletes demonstrated single leg landings with a subsequent movement than female athletes. Single leg landings with a subsequent movement have a higher potential risk of ACL injury.

  16. Change in KOOS and WOMAC Scores in a Young Athletic Population With and Without Anterior Cruciate Ligament Injury.

    Science.gov (United States)

    Antosh, Ivan J; Svoboda, Steven J; Peck, Karen Y; Garcia, E'Stephan J; Cameron, Kenneth L

    2018-06-01

    Several studies have examined changes in patient-reported outcome measures (PROMs) after anterior cruciate ligament (ACL) injury, but no studies to date have prospectively evaluated changes from preinjury baseline through injury and follow-up among ACL-injured patients compared to the baseline and follow-up changes of uninjured patients. To examine changes in PROMs over time from preinjury baseline to at least 2 years after ACL reconstruction and to compare these changes with those of an uninjured control group having similar physical activity requirements. Cohort study; Level of evidence, 2. The authors conducted a prospective cohort study with a nested case-control analysis at a US service academy. All incoming first year students were recruited to participate in this study. Consenting participants completed a baseline questionnaire that included the KOOS (Knee injury and Osteoarthritis Outcome Score), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and MARS (Marx Activity Rating Scale). Participants who sustained a subsequent ACL injury completed assessments at the time of surgery and at 6, 12, and 24 months after surgery. Healthy participants were recruited to repeat the baseline assessments within 1 year of graduation. Inter- and intragroup differences at these time points were evaluated with dependent and independent t tests, respectively. We also compared these results with established minimum clinically important difference (MCID) values. Of 1268 first year students entering the academy, 1005 with no previous injuries consented to participate in this study (82% male, mean ± SD age 19 ± 1 years). Of those enrolled, 30 suffered an ACL injury and met the inclusion criteria for this study. Ninety uninjured control students who met the inclusion criteria completed follow-up assessments. There were statistically significant differences across all KOOS and WOMAC subscales between ACL-injured group and uninjured group at the time of the

  17. Comparison of traditional advanced cardiac life support (ACLS) course instruction vs. a scenario-based, performance oriented team instruction (SPOTI) method for Korean paramedic students.

    Science.gov (United States)

    Lee, Christopher C; Im, Mark; Kim, Tae Min; Stapleton, Edward R; Kim, Kyuseok; Suh, Gil Joon; Singer, Adam J; Henry, Mark C

    2010-01-01

    Current Advanced Cardiac Life Support (ACLS) course instruction involves a 2-day course with traditional lectures and limited team interaction. We wish to explore the advantages of a scenario-based performance-oriented team instruction (SPOTI) method to implement core ACLS skills for non-English-speaking international paramedic students. The objective of this study was to determine if scenario-based, performance-oriented team instruction (SPOTI) improves educational outcomes for the ACLS instruction of Korean paramedic students. Thirty Korean paramedic students were randomly selected into two groups. One group of 15 students was taught the traditional ACLS course. The other 15 students were instructed using a SPOTI method. Each group was tested using ACLS megacode examinations endorsed by the American Heart Association. All 30 students passed the ACLS megacode examination. In the traditional ACLS study group an average of 85% of the core skills were met. In the SPOTI study group an average of 93% of the core skills were met. In particular, the SPOTI study group excelled at physical examination skills such as airway opening, assessment of breathing, signs of circulation, and compression rates. In addition, the SPOTI group performed with higher marks on rhythm recognition compared to the traditional group. The traditional group performed with higher marks at providing proper drug dosages compared to the SPOTI students. However, the students enrolled in the SPOTI method resulted in higher megacode core compliance scores compared to students trained in traditional ACLS course instruction. These differences did not achieve statistical significance due to the small sample size. Copyright 2010 Elsevier Inc. All rights reserved.

  18. Assessment of the diagnostic value of dual-energy CT and MRI in the detection of iatrogenically induced injuries of anterior cruciate ligament in a porcine model

    Energy Technology Data Exchange (ETDEWEB)

    Fickert, S.; Niks, M.; Lehmann, L. [University Medical Center Mannheim, Center of Orthopaedics and Traumatology, Mannheim (Germany); Dinter, D.J.; Hammer, M.; Weckbach, S.; Schoenberg, S.O.; Jochum, S. [University Medical Center Mannheim, Department of Clinical Radiology and Nuclear Medicine, Mannheim (Germany)

    2013-03-15

    Magnetic resonance imaging (MRI) is the standard of reference for the non-invasive evaluation of ligament injuries of the knee. The development of dual-energy CT (DE-CT) made it possible to differentiate between tissues of different density by two simultaneous CT measurements with different tube voltages. This approach enables DE-CT to discriminate ligament structures without intra-articular contrast media injection. The aims of this study were on the one hand to determine the delineation of the anterior cruciate ligament (ACL) and on the other hand to assess the diagnostic value of DE-CT and MRI in the detection of iatrogenically induced injury of the ACL in a porcine knee joint model. Twenty porcine hind legs, which were placed in a preformed cast in order to achieve a standardized position, were scanned using DE-CT. Thereafter, a 1.5-T MRI using a standard protocol was performed. The imaging procedures were repeated with the same parameters after inducing defined lesions (total or partial incision) on the ACL arthroscopically. After post-processing, two radiologists and two orthopedic surgeons first analyzed the delineation of the ACL and then, using a consensus approach, the iatrogenically induced lesions. The result of the arthrotomy was defined as the standard of reference. The ACL could be visualized both on DE-CT and MRI in 100% of the cases. As for the MRI, the sensitivity and specificity of detecting the cruciate ligament lesion respectively compared with the defined arthrotomy was 66.7% and 78.6% for intact cruciate ligaments, 100% and 75% in the case of a complete lesion, 33.3% and 78.6% for lesions of the anteromedial bundle, and 0% and 100% for lesions of the posterolateral bundle. In comparison, DE-CT demonstrated a sensitivity and specificity of 66.7% and 71.4% in the case of intact cruciate ligaments, 75% and 68.8% in the case of completely discontinued ACLs, 0% and 92.9% in the case of lesions of the anteromedial bundle, and 25% and 87.5% in the

  19. Musculoskeletal injuries and pain in dancers: a systematic review update.

    Science.gov (United States)

    Jacobs, Craig L; Hincapié, Cesar A; Cassidy, J David

    2012-01-01

    The objective of this study was to assemble and synthesize the best available literature from 2004 to 2008 on musculoskeletal injury and pain in dancers. MEDLINE and CINAHL were the primary sources of data. Indexed terms such as dance, dancer, dancing, athletic injuries, occupational injuries, sprains and strains, musculoskeletal diseases, bone density, menstruation disturbances, and eating disorders were used to search the databases. Citations were screened for relevance using a priori criteria, and relevant studies were critically reviewed for scientific merit by the best-evidence synthesis method. After screening, 19 articles were found to be scientifically admissible. Data from accepted studies were abstracted into evidence tables relating to: prevalence and associated factors; incidence and risk factors; intervention; and injury characteristics and prognosis of musculoskeletal injury and pain in dancers. Principal findings included: a high prevalence and incidence of lower extremity, hip and back injuries; preliminary evidence that psychosocial and psychological issues such as stress and coping strategies affect injury frequency and duration; history of a previous lateral ankle sprain is associated with an increased risk of ankle sprain in the contralateral ankle in dance students; fatigue may play a role in ACL injury in dancers; acute hamstring strains in dancers affect tendon more than muscle tissue, often resulting in prolonged absence from dance. It is concluded that, while there are positive developments in the literature on the epidemiology, diagnosis, prognosis, treatment, and prevention of MSK injuries and pain in dancers, much room for improvement remains. Suggestions for future research are offered.

  20. Magnetic resonance imaging in evaluation of tunnel diameters prior to revision ACL reconstruction: a comparison to computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Drews, Bjoern Holger; Gulkin, Daniel; Guelke, Joachim; Gebhard, Florian [University of Ulm, Center of Surgery, Department for Orthopedic Trauma, Hand and Reconstructive Surgery, Ulm (Germany); Merz, Cornelia; Huth, Jochen; Mauch, Frieder [Sportklinik Stuttgart GmbH, Stuttgart (Germany)

    2017-10-15

    Revision ACL reconstruction is becoming more frequent because of a 10% rate of re-ruptures and insufficiencies. Currently, computed tomography (CT) represents the gold standard in detecting and measuring the tunnels of the initial ACL reconstruction. The purpose of this study was to compare measurement results of CT and thin-sliced MRI sequences, which were modified to a high soft tissue-bone contrast. Prior to an ACL revision surgery, 16 consecutive patients had an MRI in addition to the standard CT scan. A dedicated 0.25-T Esaote G-Scan (Esaote Biomedica, Cologne, Germany) with a Turbo 3D T1 sequence was used for MRI. Tunnel diameters were measured at 11 defined points of interest. For the statistical evaluation, the Mann-Whitney U test for connected samples was used. Inter- and intraobserver reliability was additionally calculated. All measured diameters showed significant to highly significant correlations between both diagnostic tools (r = 0.7-0.98). In addition, there was no significant difference (p > 0.5) between the two techniques. Almost all diameters showed nearly perfect intraobserver reliability (ICC 0.8-0.97). Interobserver reliability showed an ICC of 0.91/0.92 for only one diameter in MRI and CT. Prior to ACL revision surgery, bone tunnel measurements can be done using a 3D T1-MRI sequence in low-field MRI. MRI measurements show the same accuracy as CT scans. Preoperative radiation exposure in mainly young patients could be reduced. Also the costs of an additional CT scan could be saved. (orig.)

  1. Single Wake Meandering, Advection and Expansion - An analysis using an adapted Pulsed Lidar and CFD LES-ACL simulations

    DEFF Research Database (Denmark)

    In this paper, single wake characteristics have been studied both experimentally and numerically. Firstly, the wake is studied experimentally using full-scale measurements from an adapted focused pulsed lidar system, which potentially gives more insight into the wake dynamics as compared to class...... using the EllipSys3D flow solver using Large Eddy Simulation (LES) and Actuator Line Technique (ACL) to model the rotor. Discrepancies due to the uncertainties on the wake advection velocity are observed and discussed....

  2. Single Wake Meandering, Advection and Expansion - An analysis using an adapted Pulsed Lidar and CFD LES-ACL simulations

    DEFF Research Database (Denmark)

    Machefaux, Ewan; Larsen, Gunner Chr.; Troldborg, Niels

    2013-01-01

    In this paper, single wake characteristics have been studied both experimentally and numerically. Firstly, the wake is studied experimentally using full-scale measurements from an adapted focused pulsed lidar system, which potentially gives more insight into the wake dynamics as compared to class...... using the EllipSys3D flow solver using Large Eddy Simulation (LES) and Actuator Line Technique (ACL) to model the rotor. Discrepancies due to the uncertainties on the wake advection velocity are observed and discussed....

  3. Evaluation of an intact, an ACL-deficient, and a reconstructed human knee joint finite element model.

    Science.gov (United States)

    Vairis, Achilles; Stefanoudakis, George; Petousis, Markos; Vidakis, Nectarios; Tsainis, Andreas-Marios; Kandyla, Betina

    2016-02-01

    The human knee joint has a three-dimensional geometry with multiple body articulations that produce complex mechanical responses under loads that occur in everyday life and sports activities. Understanding the complex mechanical interactions of these load-bearing structures is of use when the treatment of relevant diseases is evaluated and assisting devices are designed. The anterior cruciate ligament (ACL) in the knee is one of four main ligaments that connects the femur to the tibia and is often torn during sudden twisting motions, resulting in knee instability. The objective of this work is to study the mechanical behavior of the human knee joint and evaluate the differences in its response for three different states, i.e., intact, ACL-deficient, and surgically treated (reconstructed) knee. The finite element models corresponding to these states were developed. For the reconstructed model, a novel repair device was developed and patented by the author in previous work. Static load cases were applied, as have already been presented in a previous work, in order to compare the calculated results produced by the two models the ACL-deficient and the surgically reconstructed knee joint, under the exact same loading conditions. Displacements were calculated in different directions for the load cases studied and were found to be very close to those from previous modeling work and were in good agreement with experimental data presented in literature. The developed finite element model for both the intact and the ACL-deficient human knee joint is a reliable tool to study the kinematics of the human knee, as results of this study show. In addition, the reconstructed human knee joint model had kinematic behavior similar to the intact knee joint, showing that such reconstruction devices can restore human knee stability to an adequate extent.

  4. Sports Injuries

    Science.gov (United States)

    ... sometimes you can injure yourself when you play sports or exercise. Accidents, poor training practices, or improper ... can also lead to injuries. The most common sports injuries are Sprains and strains Knee injuries Swollen ...

  5. Golf Injuries

    Science.gov (United States)

    ... Our Newsletter Donate Blog Skip breadcrumb navigation Preventing Golf Injuries Golf looks like an easy game to ... WHAT TYPES OF INJURIES ARE MOST COMMON IN GOLF? Acute injuries are usually the result of a ...

  6. The Effects of Injury Prevention Programs on the Biomechanics of Landing Tasks: A Systematic Review With Meta-analysis.

    Science.gov (United States)

    Lopes, Thiago Jambo Alves; Simic, Milena; Myer, Gregory D; Ford, Kevin R; Hewett, Timothy E; Pappas, Evangelos

    2018-05-01

    Anterior cruciate ligament (ACL) tear is a common injury in sports and often occurs during landing from a jump. To synthesize the evidence on the effects of injury prevention programs (IPPs) on landing biomechanics as they relate to the ligament, quadriceps, trunk, and leg dominance theories associated with ACL injury risk. Meta-analysis. Six electronic databases were searched for studies that investigated the effect of IPPs on landing task biomechanics. Prospective studies that reported landing biomechanics at baseline and post-IPP were included. Results from trunk, hip, and knee kinematics and kinetics related to the ACL injury theories were extracted, and meta-analyses were performed when possible. The criteria were met by 28 studies with a total of 466 participants. Most studies evaluated young females, bilateral landing tasks, and recreational athletes, while most variables were related to the ligament and quadriceps dominance theories. An important predictor of ACL injury, peak knee abduction moment, decreased ( P = .01) after the IPPs while other variables related to the ligament dominance theory did not change. Regarding the quadriceps dominance theory, after the IPPs, angles of hip flexion at initial contact ( P = .009), peak hip flexion ( P = .002), and peak knee flexion ( P = .007) increased, while knee flexion at initial contact did not change ( P = .18). Moreover, peak knee flexion moment decreased ( P = .005) and peak vertical ground-reaction force did not change ( P = .10). The exercises used in IPPs might have the potential to improve landing task biomechanics related to the quadriceps dominance theory, especially increasing peak knee and hip flexion angles. Importantly, peak knee abduction moment decreased, which indicates that IPPs influence a desired movement strategy to help athletes overcome dangerous ligament dominance loads arising from lack of frontal plane control during dynamic tasks. The lack of findings for some biomechanical variables

  7. Weaker lower extremity muscle strength predicts traumatic knee injury in youth female but not male athletes.

    Science.gov (United States)

    Ryman Augustsson, Sofia; Ageberg, Eva

    2017-01-01

    The role of lower extremity (LE) muscle strength for predicting traumatic knee injury in youth athletes is largely unknown. The aim was to investigate the influence of LE muscle strength on traumatic knee injury in youth female and male athletes. 225 athletes (40% females) from sport senior high schools in Sweden were included in this case-control study. The athletes recorded any traumatic knee injury that had occurred during their high-school period in a web-based injury form. A one repetition maximum (1RM) barbell squat test was used to measure LE muscle strength. The 1RM was dichotomised to analyse 'weak' versus 'strong' athletes according to the median (weak median vs strong median ). 63 traumatic knee injuries, including 18 ACL injuries, were registered. The majority of injured female athletes were in the weak group compared with the strong group (p=0.0001). The odds of sustaining a traumatic knee injury and an ACL injury was 9.5 times higher and 7 times higher, respectively, in the weak median group compared with the strong median group in females (p ≤0.011). A relative 1RM squat ≤1.05 kg (105% of bodyweight) was established as the best cut-off value to distinguish high versus low risk of injury in female athletes. No strength-injury relationships were observed for the male athletes (p ≥0.348). Weaker LE muscle strength predicted traumatic knee injury in youth female athletes, but not in males. This suggests that LE muscle strength should be included in injury screening in youth female athletes.

  8. Hydrogel fibers for ACL prosthesis: design and mechanical evaluation of PVA and PVA/UHMWPE fiber constructs.

    Science.gov (United States)

    Bach, Jason S; Detrez, Fabrice; Cherkaoui, Mohammed; Cantournet, Sabine; Ku, David N; Corté, Laurent

    2013-05-31

    Prosthetic devices for anterior cruciate ligament (ACL) reconstruction have been unsuccessful due to mechanical failure or chronic inflammation. Polymer hydrogels combine biocompatibility and unique low friction properties; however, their prior use for ligament reconstruction has been restricted to coatings due to insufficient tensile mechanics. Here, we investigate new constructs of polyvinyl alcohol (PVA) hydrogel fibers. In water, these fibers swell to an equilibrium water content of 50% by weight, retaining a tensile modulus greater than 40 MPa along the fiber axis at low strain. Rope constructs were assembled for ACL replacement and mechanical properties were compared with data from the literature. Pure PVA hydrogel constructs closely reproduce the non-linear tensile stiffness of the native ACL with an ultimate strength of about 2000 N. An additional safety factor in tensile strength was achieved with composite braids by adding ultrahigh molecular weight polyethylene (UHMWPE) fibers around a core of PVA cords. Composition and braiding angle are adjusted to produce a non-linear tensile behavior within the range of the native ligament that can be predicted by a simple rope model. This design was found to sustain over one million cycles between 50 and 450 N with limited damage and less than 20% creep. The promising mechanical performances of these systems provide justification for more extensive in vivo evaluation. Copyright © 2013. Published by Elsevier Ltd.

  9. Modification of Knee Flexion Angle Has Patient-Specific Effects on Anterior Cruciate Ligament Injury Risk Factors During Jump Landing.

    Science.gov (United States)

    Favre, Julien; Clancy, Caitlin; Dowling, Ariel V; Andriacchi, Thomas P

    2016-06-01

    The incidence of anterior cruciate ligament (ACL) injuries may be decreased through the use of intervention programs that focus on increasing the knee flexion angle during jump landing, which decreases strain on the ACL. To investigate whether intervention training designed to change the knee flexion angle during landing causes secondary changes in other known measures associated with the risk of ACL injuries and to examine the time points when these secondary measures change. Controlled laboratory study. A total of 39 healthy recreational athletes performed a volleyball block jump task in an instrumented gait laboratory. The participants first completed the jumps without any modification to their normal landing technique. They were then given oral instruction to land softly and to increase their knee flexion angle during landing. Lower body kinematics and kinetics were measured before and after the modification using an optoelectronic motion capture system. The knee flexion angle after the modification significantly increased from 11.2° to 15.2° at initial contact and from 67.8° to 100.7° at maximum flexion, and the time between initial contact and maximum flexion increased from 177.4 to 399.4 milliseconds. The flexion modification produced a substantial reduction in vertical ground-reaction force (243.1 to 187.8 %BW) with a concomitant reduction in the maximum flexion moment. Interestingly, the flexion modification only affected the abduction angle and abduction moment for the group of participants that landed in an initial adducted position before the modification and had no significant effect on the group that landed in an abducted position. Increasing the knee flexion angle during jump landing may be an effective intervention to improve knee biomechanical risk factors associated with an ACL injury. However, the fact that the flexion modification only influenced critical risk factors (the abduction angle and abduction moment) in participants who initially

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-09-15

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

  11. The difference in centre position in the ACL femoral footprint inclusive and exclusive of the fan-like extension fibres.

    Science.gov (United States)

    Iriuchishima, Takanori; Ryu, Keinosuke; Aizawa, Shin; Fu, Freddie H

    2016-01-01

    The purpose of this study was to compare the centre position of each anterior cruciate ligament bundle in its femoral footprint in measurements including and excluding the fan-like extension fibres. Fourteen non-paired human cadaver knees were used. All soft tissues around the knee were resected except the ligaments. The ACL was divided into antero-medial (AM) and postero-lateral (PL) bundles according to the difference in tension patterns. The ACL was carefully dissected, and two outlines were made of the periphery of each bundle insertion site: those which included and those which excluded the fan-like extension fibres. An accurate lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The centre position of each bundle, including and excluding the fan-like extension fibres, was measured with ImageJ software (National Institution of Health). Evaluation of the centre position was performed using the modified quadrant method. The centre of the femoral AM bundle including the fan-like extension was located at 28.8% in a shallow-deep direction and 37.2% in a high-low direction. When the AM bundle was evaluated without the fan-like extension, the centre was significantly different at 34.6% in a shallow-deep direction (p = 0.000) and 36% in a high-low direction. The centre of the PL bundle including the fan-like extension was found at 37.1% in a shallow-deep direction and 73.4% in a high-low direction. When the PL bundle was evaluated without the fan-like extension, the centre was significantly different at 42.7% in a shallow-deep direction (p = 0.000) and 69.3% in a high-low direction (p = 0.000). The centre position of the AM and PL bundles in the femoral ACL footprint was significantly different depending on the inclusion or exclusion of the fan-like extension fibres. For the clinical relevance, to reproduce the direct femoral insertion in the anatomical ACL reconstruction, tunnels should be

  12. Chondral Injuries and Irreparable Meniscal Tears Among Adolescents With Anterior Cruciate Ligament or Meniscal Tears Are More Common in Patients With Public Insurance.

    Science.gov (United States)

    Williams, Ariel A; Mancini, Nickolas S; Solomito, Matthew J; Nissen, Carl W; Milewski, Matthew D

    2017-07-01

    Access to health care services is a critical component of health care reform and may differ among patients with different types of insurance. Hypothesis/Purpose: The purpose was to compare adolescents with private and public insurance undergoing surgery for anterior cruciate ligament (ACL) and/or meniscal tears. We hypothesized that patients with public insurance would have a delayed presentation from the time of injury and therefore would have a higher incidence of chondral injuries and irreparable meniscal tears and lower preoperative International Knee Documentation Committee (IKDC) scores than patients with private insurance. Cross-sectional study; Level of evidence, 3. This was a retrospective study of patients under 21 years of age undergoing ACL reconstruction and/or meniscal repair or debridement from January 2013 to March 2016 at a single pediatric sports medicine center. Patients were identified by a search of Current Procedural Terminology (CPT) codes. A chart review was performed for insurance type; preoperative diagnosis; date of injury, initial office visit, and surgery; preoperative IKDC score; intraoperative findings; and procedures. The study group consisted of 119 patients (mean age, 15.0 ± 1.7 years). Forty-one percent of patients had private insurance, while 59% had public insurance. There were 27 patients with isolated meniscal tears, 59 with combined meniscal and ACL tears, and 33 with isolated ACL tears. The mean time from injury to presentation was 56 days (range, 0-457 days) in patients with private insurance and 136 days (range, 0-1120 days) in patients with public insurance ( P = .02). Surgery occurred, on average, 35 days after the initial office visit in both groups. The mean preoperative IKDC score was 53 in both groups. Patients with meniscal tears with public insurance were more likely to require meniscal debridement than patients with private insurance (risk ratio [RR], 2.3; 95% CI, 1.7-3.1; P = .02). Patients with public insurance

  13. DIAGNOSTIC ACCURACY OF CLINICAL AND MAGNETIC RESONANCE IN KNEE MENISCI AND LIGAMENTOUS INJURIES

    Directory of Open Access Journals (Sweden)

    Nilesh

    2016-03-01

    Full Text Available OBJECTIVE The purpose of this study was to evaluate the reliability of clinical diagnosis compared to MRI findings in ligamentous and meniscal injuries with respect to arthroscopic confirmation as a gold standard. METHODS 485 patients with knee injuries were prospectively assessed by clinical evaluation and magnetic resonance imaging and correlated after therapeutic arthroscopy. The overall accuracy, clinically productive values of sensitivity and specificity was derived. The actual value of the test with respect to positive predictive and negative predictive value was also derived, taking arthroscopic findings as confirmatory. The overall partial and total agreement among the clinical, MRI and arthroscopy was documented. RESULTS The overall accuracy for clinical examination was 85, 92, 100 and 100 and accuracy for MRI was 90, 97, 97 and 97 for detecting medial meniscus, lateral meniscus, ACL and PCL tears respectively. Clinically lateral meniscus tears are difficult to diagnose clinically with negative predictive value (90 whereas ACL injuries do not need MRI for diagnosis as evident by a high negative predictive value (100 of clinical examination. Total agreement with the clinical findings confirmed by arthroscopy was 64.40% which was relatively high as compared to total agreement of MRI findings which was only 31.50%. We found similar total agreement versus total disagreement of both clinical and MRI to be only 2.74% indicating very high accuracy in clinical diagnosis of meniscal and ligamentous injuries combined. CONCLUSION The clinical evaluation alone is sufficient to diagnose meniscal and ACL/PCL pathologies and MRI should be considered only as a powerful negative diagnostic tool. The arthroscopy decision should not be heavily dependent on MRI for ligamentous injuries but reverse is true for meniscal lesions. MR evaluation functions as a powerful negative diagnostic tool to rule out doubtful and complex knee injuries.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-10-15

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

  15. Relationships of Functional Tests Following ACL Reconstruction: Exploratory Factor Analyses of the Lower Extremity Assessment Protocol.

    Science.gov (United States)

    DiFabio, Melissa; Slater, Lindsay V; Norte, Grant; Goetschius, John; Hart, Joseph M; Hertel, Jay

    2018-03-01

    After ACL reconstruction (ACLR), deficits are often assessed using a variety of functional tests, which can be time consuming. It is unknown whether these tests provide redundant or unique information. To explore relationships between components of a battery of functional tests, the Lower Extremity Assessment Protocol (LEAP) was created to aid in developing the most informative, concise battery of tests for evaluating ACLR patients. Descriptive, cross-sectional. Laboratory. 76 ACLR patients (6.86±3.07 months postoperative) and 54 healthy participants. Isokinetic knee flexion and extension at 90 and 180 degrees/second, maximal voluntary isometric contraction for knee extension and flexion, single leg balance, 4 hopping tasks (single, triple, crossover, and 6-meter timed hop), and a bilateral drop vertical jump that was scored with the Landing Error Scoring System (LESS). Peak torque, average torque, average power, total work, fatigue indices, center of pressure area and velocity, hop distance and time, and LESS score. A series of factor analyses were conducted to assess grouping of functional tests on the LEAP for each limb in the ACLR and healthy groups and limb symmetry indices (LSI) for both groups. Correlations were run between measures that loaded on retained factors. Isokinetic and isometric strength tests for knee flexion and extension, hopping, balance, and fatigue index were identified as unique factors for all limbs. The LESS score loaded with various factors across the different limbs. The healthy group LSI analysis produced more factors than the ACLR LSI analysis. Individual measures within each factor had moderate to strong correlations. Isokinetic and isometric strength, hopping, balance, and fatigue index provided unique information. Within each category of measures, not all tests may need to be included for a comprehensive functional assessment of ACLR patients due to the high amount of shared variance between them.

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

    Science.gov (United States)

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

    2015-11-01

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

  17. Stereoscopic filming for investigating evasive side-stepping and anterior cruciate ligament injury risk

    Science.gov (United States)

    Lee, Marcus J. C.; Bourke, Paul; Alderson, Jacqueline A.; Lloyd, David G.; Lay, Brendan

    2010-02-01

    Non-contact anterior cruciate ligament (ACL) injuries are serious and debilitating, often resulting from the performance of evasive sides-stepping (Ssg) by team sport athletes. Previous laboratory based investigations of evasive Ssg have used generic visual stimuli to simulate realistic time and space constraints that athletes experience in the preparation and execution of the manoeuvre. However, the use of unrealistic visual stimuli to impose these constraints may not be accurately identifying the relationship between the perceptual demands and ACL loading during Ssg in actual game environments. We propose that stereoscopically filmed footage featuring sport specific opposing defender/s simulating a tackle on the viewer, when used as visual stimuli, could improve the ecological validity of laboratory based investigations of evasive Ssg. Due to the need for precision and not just the experience of viewing depth in these scenarios, a rigorous filming process built on key geometric considerations and equipment development to enable a separation of 6.5 cm between two commodity cameras had to be undertaken. Within safety limits, this could be an invaluable tool in enabling more accurate investigations of the associations between evasive Ssg and ACL injury risk.

  18. Comparison of injury incidences between football teams playing in different climatic regions

    Science.gov (United States)

    Orchard, John W; Waldén, Markus; Hägglund, Martin; Orchard, Jessica J; Chivers, Ian; Seward, Hugh; Ekstrand, Jan

    2013-01-01

    Australian Football League (AFL) teams in northern (warmer) areas generally have higher rates of injury than those in southern (cooler) areas. Conversely, in soccer (football) in Europe, teams in northern (cooler) areas have higher rates of injury than those in southern (warmer) areas, with an exception being knee anterior cruciate ligament (ACL) injuries, which are more common in the southern (warmer) parts of Europe. This study examined relative injury incidence in the AFL comparing 9,477 injuries over 229,827 player-weeks from 1999–2012. There was a slightly higher injury incidence for teams from warmer parts of Australia (relative risk [RR] 1.05, 95% confidence interval [CI] 1.01–1.10) with quadriceps strains (RR 1.32, 95% CI 1.10–1.58), knee cartilage injuries (RR 1.42, 95% CI 1.16–1.74), and ankle sprains (RR 1.17, 95% CI 1.00–1.37) all being more likely in warmer region teams. Achilles injuries followed a reverse pattern, tending to be more common in cooler region teams (RR 0.70, 95% CI 0.47–1.03). In conclusion, common findings from the AFL and European soccer are that ankle sprains and ACL injuries are generally more likely in teams playing in warmer climate zones, whereas Achilles tendinopathy may be more likely in teams playing in cooler zones. These injuries may have climate or surface risk factors (possibly related to types and structure of grass and shoe-surface traction) that are universal across different football codes. PMID:24379731

  19. Does Donor Age of Nonirradiated Achilles Tendon Allograft Influence Mid-Term Results of Revision ACL Reconstruction?

    Science.gov (United States)

    Zaffagnini, Stefano; Roberti di Sarsina, Tommaso; Bonanzinga, Tommaso; Nitri, Marco; Macchiarola, Luca; Stefanelli, Federico; Lucidi, Gianandrea; Grassi, Alberto

    2018-01-01

    Purpose  The purpose of the present study was to investigate if the donor age of nonirradiated Achilles tendon allograft could influence the clinical results of revision anterior cruciate ligament (ACL) reconstruction. Methods  All patients that underwent ACL revision between 2004 and 2008 with at least 4 years of follow-up were included. For all the patients that met the inclusion criteria, the age of the graft donor was obtained from the tissue bank. Lysholm score was administered to patients that met inclusion criteria. In addition, patients were divided in two groups based on the donor age (<45 years vs. ≥45 years), and the baseline characteristics and outcomes were compared. Results  Fifty-two patients were evaluated at a mean 4.8 ± 0.8 years follow-up with Lysholm score. The Lysholm significantly improved from 62.3 ± 6.6 at preoperative status to 84.4 ± 12.3 at final follow-up. The mean donor age was 48.7 ± 8.4 years; a significant difference in Lysholm score was noted between patients that received an allograft with a donor age <45 years (14 patients; 27%) and those receiving an allograft with a donor age ≥45 years (38; 73%) (89.5 ± 3.2 vs. 80.1 ± 11.1, respectively; p  = 0.0469). The multiple regression model showed the donor age, the final follow-up, and the preoperative Lysholm score as significant predictors of postoperative Lysholm score ( p  < 0.0002). Conclusion  Donor age of nonirradiated Achilles tendon allograft influenced the mid-term results of revision ACL reconstruction, thus advising the use of grafts from young donors. Level of Evidence  Level III, retrospective comparative study. PMID:29675501

  20. Accidental perforation of the lateral femoral cortex in ACL reconstruction: an investigation of mechanical properties of different fixation techniques.

    Science.gov (United States)

    Herbort, Mirco; Heletta, Sebastian; Raschke, Michael J; Schliemann, Benedikt; Osada, Nani; Petersen, Wolf; Zantop, Thore

    2012-03-01

    The aim of this study was to evaluate the mechanical properties of anterior cruciate ligament (ACL) reconstruction using the medial portal technique with cortical fixation and hybrid fixation after penetration of the lateral cortex by use of different drill sizes. In this biomechanical study a porcine in vitro model was used. The testing protocol consisted of a cyclic loading protocol (1,000 cycles, 50 and 250 N) and subsequent ultimate failure testing. Number of cyclic loadings survived, stiffness, yield load, maximum load, and graft elongation, as well as failure mode, were analyzed after ACL reconstruction with 5- to 9-mm soft-tissue grafts. In the control group, conventional penetration of the lateral cortex with a 4.5-mm drill and cortical fixation were performed. In the tested groups, the lateral cortex was penetrated with a drill matching the graft size. In the first part of the study, we used cortical fixation. In the second part, we used hybrid fixation with an interference screw. In the first part of the study, ACL reconstruction with 5- to 6-mm perforation of the lateral cortex showed no significant differences in ultimate failure load after cyclic loading compared with the control group (P > .05). Specimens with reconstruction with 7- to 9-mm perforation of the lateral cortex and cortical fixation did not survive the cyclic loading protocol. In the second part of the study, with a hybrid fixation technique, ultimate failure testing after cyclic loading of specimens with 7- to 9-mm penetration showed no significant differences in tested parameters compared with the control group (P > .05). After penetration of the lateral cortex with a drill size of more than 6 mm, cortical ACL fixation results in poor mechanical properties. Hybrid fixation increases the mechanical properties significantly after penetration with a 7- to 9-mm drill. We advise caution to avoid penetration of the lateral femoral cortex when using cortical flip-button fixation. In case of

  1. When celebrations go wrong: a case series of injuries after celebrating in sports.

    Science.gov (United States)

    Momaya, Amit; Read, Connor; Estes, Reed

    2017-03-01

    Athletes often engage in various celebration maneuvers during sports events. These celebrations can result in acute injuries. Our objective was to document publicized injuries in collegiate and professional athletes resulting from celebrations and examine associated variables. A retrospective case series study was performed based on internet searches performed using the following major sporting news websites: espn.com, SI.com, bleacherreport.com, totalprosports.com, cbssports.com, larrybrownspots.com, nfl.com, and mlb.com and PubMed. Keywords used during these searches included "celebration injury", "score celebration", and "surgery after celebration". These same sources were used to document the sport, athlete's age at time of injury, celebration action, type of injury, previous play, and whether surgery was required. A total of 62 athletes sustained 62 injuries resulting from various types of celebrations. All but two athletes were males, and the average age was 26.5 years old. The injuries occurred between 1993 and 2015. Sixteen (25.8%) of these injuries required surgery. Professional soccer players accounted for the greatest number of these injuries with a total of 22 injuries. One celebration in a professional soccer player resulted in a cervical spinal cord injury and subsequent death. Common celebration maneuvers included leaping into the air, pile ups, sliding, and somersaults. Serious injuries occur in a diversity of sports after celebrations. The most prevalent celebration maneuvers resulting in injuries included sliding and pile ups. The most common injuries were ACL ruptures and ankle sprains. The most serious injuries were a spinal cord injury and ankle fractures. Sixteen (25.8%) of the injuries required surgery. By encouraging athletes to temper excessive celebrations and prohibiting certain types of celebrations, many injuries may be prevented.

  2. EPIDEMIOLOGY OF KNEE INJURIES AMONG US HIGH SCHOOL ATHLETES, 2005/06–2010/11

    Science.gov (United States)

    Swenson, David M.; Collins, Christy L.; Best, Thomas M.; Flanigan, David C.; Fields, Sarah K.; Comstock, R. Dawn

    2012-01-01

    Purpose US high school athletes sustain millions of injuries annually. Detailed patterns of knee injuries, among the most costly sports injuries, remain largely unknown. We hypothesize that patterns of knee injuries in US high school sports differ by sport and gender. Methods US High school sports-related injury data were collected for 20 sports using the National High School Sports-Related Injury Surveillance System, High School RIO™. Knee injury rates, rate ratios, and injury proportion ratios were calculated. Results From 2005/06–2010/11, 5,116 knee injuries occurred during 17,172,376 athlete exposures (AEs) for an overall rate of 2.98 knee injuries per 10,000 AEs. Knee injuries were more common in competition than practice (RR 3.53, 95% CI 3.34–3.73). Football had the highest knee injury rate (6.29 per 10,000 AEs) followed by girls’ soccer (4.53) and girls’ gymnastics (4.23). Girls had significantly higher knee injury rates than boys in gender-comparable sports (soccer, volleyball, basketball, baseball/softball, lacrosse, swimming and diving, and track and field) (RR 1.52, 95% CI 1.39–1.65). The most commonly involved structure was the MCL (reported in 36.1% of knee injuries), followed by the patella/patellar tendon (29.5%), ACL (25.4%), meniscus (23.0%), LCL (7.9%), and PCL (2.4%). Girls were significantly more likely to sustain ACL injuries in gender-comparable sports (RR 2.38, 95% CI 1.91–2.95). Overall, 21.2% of knee injuries were treated with surgery; girls were more often treated with surgery than boys in gender-comparable sports (IPR 1.30, 95% CI 1.11–1.53). Conclusions Knee injury patterns differ by sport and gender. Continuing efforts to develop preventive interventions could reduce the burden of these injuries. PMID:23059869

  3. Knee ligament injuries associated with long bone fractures

    Directory of Open Access Journals (Sweden)

    Kaseb M.H

    2007-06-01

    Full Text Available Background: Tibial and femoral fractures, commonly seen in emergency departments, may be associated with various knee ligament injuries. The aim of this study was to determine the prevalence of such fracture-associated knee ligament problems, with especial attention to rapid diagnosis. Methods: This study was carried out in patients with femoral or tibial fractures who were operated on in Imam Khomeini Medical Center from March 2003 to March 2005. All patients underwent surgical repair immediately after acute fracture, followed by a thorough knee examination. Patients with positive clinical findings were further evaluated using the stress view and arthroscopy. Results: We enrolled 470 cases in this study, of which 266 were tibial and 204 were femoral fractures. There were 404 men and 67 women, with an average age of tibial fracture patients was 34.5 and 44.6 years for those with femoral fractures. Of all fractures, 66% were due to car accidents, 16% to industrial accidents and 8% due to falling. The overall prevalence of ligament injuries in tibial fractures was as follows: 6.58% ACL tearing, 2.5% PCL, 21.95% MCL and 14.63% LCL. The overall prevalence of ligament injuries in femoral fractures was as follows: 6% ACL tearing, 3% PCL, 14% MCL and 8% LCL. Conclusion: The prevalence of ligament injuries of the knee was highest in distal femoral and tibial plateau fractures. It is prudent to perform a thorough knee examination once the fracture is stabilized in the operating room for the early detection of ligament injuries and prevention of further complications.

  4. Three-dimensional kinematic and kinetic analysis of knee rotational stability in ACL-deficient patients during walking, running and pivoting

    DEFF Research Database (Denmark)

    Bohn, Marie Bagger; Petersen, Annemette Krintel; Nielsen, Dennis Brandborg

    2016-01-01

    BACKGROUND: Anterior cruciate ligament (ACL) deficiency leads to altered stability of the knee. The purpose of this study was to compare the dynamic, rotational stability of the knee, expressed as rotational stiffness, between anterior cruciate ligament-deficient (ACLD) knees, their contralateral......: The tibial internal rotation of the ACLD knee was not significantly different from the ACLI knee during all three tasks. During walking and running, the tibial rotation of the control group was significantly different from both legs of the ACL-injured patient. For pivoting, no difference in tibial rotation...... group. During running, the ACLI knee displayed a higher external moment than the ACLD and the healthy control group. This could indicate some type of protective strategy or muscular adaptation in the ACL-injured patients....

  5. Eye Injuries

    Science.gov (United States)

    ... that you could lose your vision. Most eye injuries are preventable. If you play sports or work in certain jobs, you may need protection. The most common type of injury happens when something irritates the ...

  6. Ocular Injuries

    African Journals Online (AJOL)

    GB

    2015-04-02

    Apr 2, 2015 ... KEYWORDS: Bangers, eye injuries, holidays, Nigeria ... antibiotic and cycloplegic eye drops, antibiotic ointment at night and .... Adeoti C. O, Bello T. O., Ashaye A. O. Blinding ... Can fireworks-related injuries to children during ...

  7. Knee Injuries

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Knee Injuries KidsHealth / For Teens / Knee Injuries What's in ... can do to protect them. What's in a Knee? The knee is a joint , actually the largest ...

  8. Attenuated synovial fluid ghrelin levels are linked with cartilage damage, meniscus injury, and clinical symptoms in patients with knee anterior cruciate ligament deficiency.

    Science.gov (United States)

    Zou, Yu-Cong; Chen, Liang-Hua; Ye, Yong-Liang; Yang, Guang-Gang; Mao, Zheng; Liu, Dan-Dan; Chen, Jun-Qi; Chen, Jing-Jie; Liu, Gang

    2016-12-01

    The meniscus injury and post-traumatic knee osteoarthritis (PTOA) following anterior cruciate ligament (ACL) lesions often cause great burdens to patients. Ghrelin, a recently identified 28-amino-acid peptide, has been shown to inhibit inflammation and perform as a growth factor for chondrocyte. This study was aimed at investigating ghrelin concentration in synovial fluid and its association with the degree of meniscus injury, articular degeneration, and clinical severity in patients suffering from anterior cruciate ligament (ACL) deficiency. 61 ACL deficiency patients admitted to our hospital were drafted in the current study. The Noyes scale and Mankin scores were used to assess articular cartilage damage arthroscopically and histopathologically, respectively. The Lysholm scores and International Knee Documentation Committee (IKDC) subjective scores were utilized to evaluate the clinical severity. The radiological severity of meniscus injury was assessed by MR imaging. Serum and synovial fluid ghrelin levels were determined using enzyme linked immunosorbent assay (ELISA). The cartilage degradation markers collagen type II C-telopeptide (CTX-II) and cartilage oligomeric matrix protein (COMP) in addition to inflammatory markers interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) were also examined. Receiver operating characteristic (ROC) curve was performed and the area under curve (AUC) was calculated to assess the diagnostic value of ghrelin levels for the prediction of the MRI grading for meniscus injury by comparing with other biomarkers. SF ghrelin levels were positively related to Lysholm and IKDC scores. PTOA patients with grade 3 showed significantly decreased levels of ghrelin in SF compared with those with grade 2. The ghrelin levels in SF were negatively related to MRI signal grades for meniscus injury. SF ghrelin levels were also inversely associated with Noyes scale and Mankin scores, and levels of inflammation markers IL-6, TNF-α, and

  9. Relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL) and morphologic change of the intercondylar notch: MRI and arthroscopy correlation

    International Nuclear Information System (INIS)

    Cha, Ji Hyeon; Shin, Myung Jin; Choi, Byeong Kyoo; Lee, Sang Hoon; Bin, Sung Il

    2008-01-01

    The purpose of this study was to evaluate the relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL) and morphologic change of the intercondylar notch. We retrospectively reviewed the 105 patients with knee magnetic resonance imaging (MRI) with or without knee arthroscopy [group 1: patients with arthroscopic notchplasty (N = 47), group 2: knee arthroscopy demonstrating intact ACL (N = 33), and group 3: patients with normal knee MRI but no arthroscopy (N = 25)]. Groups 2 and 3 served as an arthroscopic and MR control group, respectively. Two musculoskeletal radiologists reviewed all MR examinations. The intercondylar notch width, notch index (width of intercondylar notch/width of femoral condyle), transverse notch angle (TNA), sagittal notch angle (SNA), and notch area were recorded on axial and sagittal MR images at the midpoint of Blumensaat's line which was identified on sagittal images. The diameter of the ACL was recorded on coronal MR images at the posterior end of Blumensaat's line. The mean values of the intercondylar notch width, notch index, TNA, SNA, notch area, and ACL diameter for the three groups were 16.0 mm/0.2/50.3 /36.5 /249.0 mm 2 /7.7 mm (group 1); 19.3 mm/0.3/52.9 /40.2 /323.4 mm 2 /4.8 mm (group 2); and 20.3 mm/0.3/51.4 /39.1 /350.8 mm 2 /4.5 mm (group 3). The intercondylar notch width, notch index, SNA, and notch area were smaller, and ACL diameter was thicker in group 1 compared with the other groups (p < 0.05). Patients with mucoid ACL hypertrophy show a narrower notch, a steeper notch angle, and a smaller notch area than control groups. (orig.)

  10. Hamstring Injury

    Science.gov (United States)

    Hamstring injury Overview A hamstring injury occurs when you strain or pull one of your hamstring muscles — the group of three muscles that run along ... You may be more likely to get a hamstring injury if you play soccer, basketball, football, tennis ...

  11. Orienteering injuries

    OpenAIRE

    Folan, Jean M.

    1982-01-01

    At the Irish National Orienteering Championships in 1981 a survey of the injuries occurring over the two days of competition was carried out. Of 285 individual competitors there was a percentage injury rate of 5.26%. The article discusses the injuries and aspects of safety in orienteering.

  12. [Effect of equipment on current ski injuries, their development in the last 20 years and their prevention].

    Science.gov (United States)

    Zucco, P

    1994-01-01

    Ski injuries depend from many factors which involve the skier and his behavior, the environment, especially the weather and slopes conditions, but first of all, the typical equipment, skis, boots and bindings. These materials have undergone a great technical improvement in recent years which allowed a significant decrease of ski injuries, first of all of the typical lower leg fracture, the so called "boot fracture". Nevertheless alpine skiers are exposed to conditions not encountered in other sports. The ski and the stiff plastic ski boot combine to form an extension to the human anatomy, which subjects the lower extremities to loads not normally encountered in other activities. The velocity of the skier combine with the equipment used to expose to a risk of injury that by type, severity and incidence is unusual. The more frequent ski injury in the last 15 years involve the knee and his ligaments. These lesions often involve the medial and lateral compartment and the anterior cruciate ligament (ACL, more than 65% of all knee lesions) and the etiology is related to both the boot and bindings characteristics. Many studies have shown the direct relationship between injuries of the lower extremity and equipment (the so called LEER-injuries, near 46% of all lesions in US studies) and also the importance of a proper binding setting for a lower risk. Ski boots are indicated as the primary cause of the ACL tears but, at this moment, for this lesion 4 mechanisms are described.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Technical evaluation of the novel preanalytical module on instrumentation laboratory ACL TOP: advancing automation in hemostasis testing.

    Science.gov (United States)

    Lippi, Giuseppe; Ippolito, Luigi; Favaloro, Emmanuel J

    2013-10-01

    Automation in hemostasis testing is entering an exciting and unprecedented phase. This study was planned to assess the performance of the new preanalytical module on the hemostasis testing system Instrumentation Laboratory ACL TOP. The evaluation included interference studies to define reliable thresholds for rejecting samples with significant concentrations of interfering substances; within-run imprecision studies of plasma indices on four different interference degrees for each index; comparison studies with reference measures of hemolysis index, bilirubin, and triglycerides on clinical chemistry analyzers; and calculation of turnaround time with and without automatic performance of preanalytical check. The upper limits for sample rejection according to our interference studies were 3.6 g/L for hemoglobin, 13.6 mg/dL for bilirubin, and 1454 mg/dL for triglycerides. We found optimal precision for all indices (0.6% to 3.1% at clinically relevant thresholds) and highly significant correlations with reference measures on clinical chemistry analyzers (from 0.985 to 0.998). The limited increase of turnaround time (i.e., +3% and +5% with or without cap-piercing), coupled with no adjunctive costs over performance of normal coagulation assays, contribute to make the automatic check of plasma indices on ACL TOP a reliable and practical approach for improving testing quality and safeguarding patient safety.

  14. Double incision iso-anatomical ACL reconstruction: the freedom to place the femoral tunnel within the anatomical attachment site without exception.

    Science.gov (United States)

    Arnold, Markus P; Duthon, Victoria; Neyret, Philippe; Hirschmann, Michael T

    2013-02-01

    The present paper describes the rationale behind the surgical technique and the clinical results of the iso-anatomical, single bundle bone patellar-tendon bone anterior cruciate ligament (ACL) reconstruction. Using a second incision on the distal lateral femur an outside-in femoral tunnel is drilled. Guided by a special aiming device it is possible to place the femoral tunnel in the centre of the ACL footprint in every single case. Since every crucial step of the procedure is under visual control, the technique is safe and reliable, which is mirrored by good clinical results.

  15. Alpine ski bindings and injuries. Current findings.

    Science.gov (United States)

    Natri, A; Beynnon, B D; Ettlinger, C F; Johnson, R J; Shealy, J E

    1999-07-01

    In spite of the fact that the overall incidence of alpine ski injuries has decreased during the last 25 years, the incidence of serious knee sprains usually involving the anterior cruciate ligament (ACL) has risen dramatically since the late 1970s. This trend runs counter to a dramatic reduction in lower leg injuries that began in the early 1970s and to date has lowered the risk of injury below the knee by almost 90%. One of the primary design objectives of modern ski boots and bindings has been to protect the skier from tibia and ankle fractures. So, in that sense, they have done an excellent job. However, despite advances in equipment design, modern ski bindings have not protected the knee from serious ligament trauma. At the present time, we are unaware of any binding design, settings or function that can protect both the knee and lower extremities from serious ligament sprains. No innovative change in binding design appears to be on the horizon that has the potential to reduce the risk of these severe knee injuries. Indeed, only 1 study has demonstrated a means to help reduce this risk of serious knee sprains, and this study involved education of skiers, not ski equipment. Despite the inability of bindings to reduce the risk of severe knee injuries there can be no doubt that improvement in ski bindings has been the most important factor in the marked reduction in incidence of lower leg and ankle injuries during the last 25 years. The authors strongly endorse the application of present International Standards Organisation (ISO) and American Society for Testing and Materials (ASTM) standards concerning mounting, setting and maintaining modern 'state of the art' bindings.

  16. Injury rate and socioeconomic costs resulting from sports injuries in Flanders: data derived from sports insurance statistics 2003.

    Science.gov (United States)

    Cumps, E; Verhagen, E; Annemans, L; Meeusen, R

    2008-09-01

    This study determines the injury rate (%) and the associated direct medical and indirect costs of sports injuries in Flanders. Epidemiological cohort designs and a human capital method were set up to measure respectively the medical direct and indirect cost of sports injuries. 72 out of 82 Flemish sports federations participated. Insurance statistics from 2003 were used to determine the overall rate of injury and injury localisations. Using these data, the medical direct cost and the impact sports injuries have on indirect costs were estimated. The indirect costs were determined by multiplying the days of absence from work with the daily cost resulting from a loss of production, being 200 euros. The total direct medical cost extrapolated for the Flemish sports participants was 15,027,423 euros, which amounted to 0.07% to 0.08% of the total budget spent on healthcare. The indirect cost extrapolated for the Flemish sports participants was 111,420,813 euros, which is about 3.4% of the costs arising from absenteeism from work. Of the 14 in-depth analysed sports, the rate of injury was highest in European team handball (8.96%; 95% confidence interval (CI) 8.95-8.96) and lowest in swimming (0.62%; 95% CI 0.62-0.62). The highest direct medical cost was found for anterior cruciate ligament (ACL) injuries (1358 euros per injury) and the lowest for foot injuries (52 euros per injury). The costs calculated in this study could become critical statistics in medical care debates. Data obtained here will enable a cost-benefit analysis of the impact of preventive measures to be made.

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

    Science.gov (United States)

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

    2018-03-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    study was to characterise correlations between this novel test set, called the Test for Substitution Patterns (TSP) and commonly used tests of knee function. METHODS: In a blinded set-up, 53 subjects (mean age 30 years, range 20-39, with 2-5 years since ACL injury) were assessed using the TSP, the Knee...... Injury and Osteoarthritis Outcome Score subscale sport/recreation (KOOS sport/rec), 3 hop tests and 3 muscle power tests. Correlations between the scores of the TSP and the other tests were determined. RESULTS: Moderate correlations were found between TSP scores and KOOS sport/rec (rs = -0.43; p = 0...

  19. WITHDRAWN: Exercise for treating anterior cruciate ligament injuries in combination with collateral ligament and meniscal damage of the knee in adults.

    Science.gov (United States)

    Trees, Amanda H; Howe, Tracey E; Grant, Margaret; Gray, Heather G

    2011-05-11

    The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. The ACL may be damaged in isolation but often other ligaments and menisci are implicated. The injury may be managed surgically or conservatively. Injury causes pain, effusion and inflammation leading to alteration in muscle function. Regaining muscular control is essential if the individual wishes to return to pre-injury level of function and patients will invariably be referred for rehabilitation. To present the best evidence for effectiveness of exercise used in the treatment of ACL injuries in combination with collateral ligament and meniscal damage to the knee in adults, on return to work and pre-injury levels of activity. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (October 2006), Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 3), MEDLINE (1996 to October 2006), EMBASE (1980 to October 2006), other databases and reference lists of articles. We included randomised controlled trials and quasi-randomised trials testing exercise programmes designed to treat adults with ACL injuries in combination with collateral ligament and meniscal damage. Included trials randomised participants to receive any combination of the following: no care, usual care, a single-exercise intervention, and multiple-exercise interventions. The primary outcome measures of interest were returning to work and return to pre-injury level of activity post treatment, at six months and one year. Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials. Five trials (243 participants) evaluated different exercise programmes following ACL reconstruction and one trial (100 participants) compared supervised with self-monitored exercises as part of conservative treatment. No study compared the effect of exercise versus

  20. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Cord Injury What is a Spinal Cord Injury Levels of Injury and What They Mean Animated Spinal ... Cord Injury What is a Spinal Cord Injury Levels of Injury and What They Mean Animated Spinal ...

  1. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Injury Chart Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal Cord Injury Rehabilitation ... Injury Chart Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal Cord Injury Rehabilitation ...

  2. Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study

    Directory of Open Access Journals (Sweden)

    Satish Shervegar

    2015-10-01

    Full Text Available Background: No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstruction. Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. Study design: Retrospective observational study. Methods: A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. Results: C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively.Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26 .Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test P Conclusions: Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation

  3. Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study

    Directory of Open Access Journals (Sweden)

    Satish Shervegar

    2015-09-01

    Full Text Available Background: No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstruction. Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. Study design: Retrospective observational study. Methods: A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. Results: C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively.Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26 .Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test P Conclusions: Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation

  4. Decreased Knee Joint Loading Associated With Early Knee Osteoarthritis After Anterior Cruciate Ligament Injury.

    Science.gov (United States)

    Wellsandt, Elizabeth; Gardinier, Emily S; Manal, Kurt; Axe, Michael J; Buchanan, Thomas S; Snyder-Mackler, Lynn

    2016-01-01

    Anterior cruciate ligament (ACL) injury predisposes individuals to early-onset knee joint osteoarthritis (OA). Abnormal joint loading is apparent after ACL injury and reconstruction. The relationship between altered joint biomechanics and the development of knee OA is unknown. Altered knee joint kinetics and medial compartment contact forces initially after injury and reconstruction are associated with radiographic knee OA 5 years after reconstruction. Case-control study; Level of evidence, 3. Individuals with acute, unilateral ACL injury completed gait analysis before (baseline) and after (posttraining) preoperative rehabilitation and at 6 months, 1 year, and 2 years after reconstruction. Surface electromyographic and knee biomechanical data served as inputs to an electromyographically driven musculoskeletal model to estimate knee joint contact forces. Patients completed radiographic testing 5 years after reconstruction. Differences in knee joint kinetics and contact forces were compared between patients with and those without radiographic knee OA. Patients with OA walked with greater frontal plane interlimb differences than those without OA (nonOA) at baseline (peak knee adduction moment difference: 0.00 ± 0.08 N·m/kg·m [nonOA] vs -0.15 ± 0.09 N·m/kg·m [OA], P = .014; peak knee adduction moment impulse difference: -0.001 ± 0.032 N·m·s/kg·m [nonOA] vs -0.048 ± 0.031 N·m·s/kg·m [OA], P = .042). The involved limb knee adduction moment impulse of the group with osteoarthritis was also lower than that of the group without osteoarthritis at baseline (0.087 ± 0.023 N·m·s/kg·m [nonOA] vs 0.049 ± 0.018 N·m·s/kg·m [OA], P = .023). Significant group differences were absent at posttraining but reemerged 6 months after reconstruction (peak knee adduction moment difference: 0.02 ± 0.04 N·m/kg·m [nonOA] vs -0.06 ± 0.11 N·m/kg·m [OA], P = .043). In addition, the OA group walked with lower peak medial compartment contact forces of the involved limb

  5. Computer-assisted anatomical placement of a double-bundle ACL through 3D-fitting of a statistically generated femoral template into individual knee geometry

    NARCIS (Netherlands)

    Luites, J. W. H.; Wymenga, A. B.; Sati, M.; Bourquin, Y.; Blankevoort, L.; van der Venne, R.; Kooloos, J. G. M.; Staubli, H. U.

    2000-01-01

    Femoral graft placement is an important factor in the success of ACL-reconstruction. Besides improving the accuracy of femoral tunnel placement, Computer Assisted Surgery (CAS) can be used to determine the anatomical Location. This requires a 3D femoral template with the position of the anatomical

  6. Anterior-Posterior Instability of the Knee Following ACL Reconstruction with Bone-Patellar Tendon-Bone Ligament in Comparison with Four-Strand Hamstrings Autograft

    Directory of Open Access Journals (Sweden)

    A. G. Angoules

    2013-01-01

    Full Text Available Purpose. To evaluate anterior-posterior knee laxity using two different autografts. Material-Methods. 40 patients, (34 males and 6 women, 17–54 years old (mean: 31, were included in the present study. Group A (4SHS = 20 underwent reconstruction using four-strand hamstrings, and group B (BPBT = 20 underwent reconstruction using bone-patellar tendon-bone autograft. Using the KT-1000 arthrometer, knee instability was calculated in both knees of all patients preoperatively and 3, 6, and 12 months after surgery at the ACL-operated knee. The contralateral healthy knee was used as an internal control group. Results. Anterior-posterior instability using the KT1000 Arthrometer was found to be increased after ACL insufficiency. The recorded laxity improved after arthroscopic ACL reconstruction in both groups. However, statistically significant greater values were detected in the bone-patellar tendon-bone group, which revealed reduction of anteroposterior stability values to an extent, where no statistical significance with the normal values even after 3 months after surgery was observed. Conclusions. Anterior-Posterior instability of the knee improved significantly after arthroscopic ACL reconstruction. The bone-patellar tendon-bone graft provided an obvious greater stability.

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    OBJECTIVES: To investigate changes in the knee during the first year after acute rupture of the anterior cruciate ligament (ACL) of volumes of joint fluid (JF), bone marrow lesions (BMLs), and cartilage volume (VC), and cartilage thickness (ThCcAB) and cartilage surface area (AC). To identify fac...

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

    Directory of Open Access Journals (Sweden)

    Theresa Bieler

    2014-01-01

    Full Text Available Objective. Persistent weakness is a common problem after anterior cruciate ligament- (ACL- reconstruction. This study investigated the effects of high-intensity (HRT versus low-intensity (LRT resistance training on leg extensor power and recovery of knee function after ACL-reconstruction. Methods. 31 males and 19 females were randomized to HRT (n=24 or LRT (n=26 from week 8–20 after ACL-reconstruction. Leg extensor power, joint laxity, and self-reported knee function were measured before and 7, 14, and 20 weeks after surgery. Hop tests were assessed before and after 20 weeks. Results. Power in the injured leg was 90% (95% CI 86–94% of the noninjured leg, decreasing to 64% (95% CI 60–69% 7 weeks after surgery. During the resistance training phase there was a significant group by time interaction for power (P=0.020. Power was regained more with HRT compared to LRT at week 14 (84% versus 73% of noninjured leg, resp.; P=0.027 and at week 20 (98% versus 83% of noninjured leg, resp.; P=0.006 without adverse effects on joint laxity. No other between-group differences were found. Conclusion. High-intensity resistance training during rehabilitation after ACL-reconstruction can improve muscle power without adverse effects on joint laxity.

  9. Superior perioperative analgesia with combined femoral-obturator-sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery.

    Science.gov (United States)

    Bareka, Metaxia; Hantes, Michael; Arnaoutoglou, Eleni; Vretzakis, George

    2018-02-01

    The purpose of this randomized controlled study is to compare and evaluate the intraoperative and post-operative outcome of PLPS nerve block and that of femoral, obturator and sciatic (FOS) nerve block as a method of anaesthesia, in performing ACL reconstruction. Patients referred for elective arthroscopic ACL reconstruction using hamstring autograft were divided in two groups. The first group received combined femoral-obturator-sciatic nerve block (FOS Group) under dual guidance, whereas the second group received posterior lumbar plexus block under neurostimulation and sciatic nerve block (PLPS Group) under dual guidance. The two groups were comparable in terms of age, sex, BMI and athletic activity. The time needed to perform the nerve blocks was significantly shorter for the FOS group (p block under dual guidance for arthroscopic ACL reconstructive surgery is a safe and tempting anaesthetic choice. The success rate of this technique is higher in comparison with PLPS and results in less peri- and post-operative pain with less opioid consumption. This study provides support for the use of peripheral nerve blocks as an exclusive method for ACL reconstructive surgery in an ambulatory setting with almost no complications. I.

  10. A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes.

    Science.gov (United States)

    Yoo, Jae Ho; Lim, Bee Oh; Ha, Mina; Lee, Soo Won; Oh, Soo Jin; Lee, Yong Seuk; Kim, Jin Goo

    2010-06-01

    Female athletes are more prone to anterior cruciate ligament (ACL) injury than their male counterparts, presumably because of anatomical, hormonal, and neuromuscular differences. Of these three, only the neuromuscular component can be modified by preventive exercise. We aimed to evaluate the effect of a neuromuscular protocol on the prevention of ACL injury by performing meta-analysis, and to identify essential factors by subgroup analysis. An extensive literature review was conducted to identify relevant studies, and eventually, only seven randomized controlled trials or prospective cohort studies were included in the analysis. The odds ratios (OR) and the confidence interval (CI) for the overall effects of training and of potentially contributory factors were estimated. The OR and the 95% CI for the overall effect of the preventive training were 0.40 and [0.27, 0.60], respectively. Subgroup analysis revealed that an age under 18, soccer rather than handball, pre- and in-season training rather than either pre- or in-season training, and the plyometrics and strengthening components rather than balancing were significant. Meta-analysis showed that pre- and in-season neuromuscular training with an emphasis on plyometrics and strengthening exercises was effective at preventing ACL injury in female athletes, especially in those under 18 years of age. Further study is required to develop a relevant training program protocol of appropriate intensity.

  11. Anterolateral ligament injuries in knees with an anterior cruciate ligament tear. Contribution of ultrasonography and MRI

    International Nuclear Information System (INIS)

    Faruch Bilfeld, Marie; Constans, Olivia; Lapegue, Franck; Chiavassa Gandois, Helene; Sans, Nicolas; Cavaignac, Etienne; Wytrykowski, Karine; Larbi, Ahmed

    2018-01-01

    To describe the pathological appearance of the anterolateral ligament (ALL) on US and MRI in knees with an anterior cruciate ligament (ACL) tear. This prospective study included 30 patients who had a suspected acute ACL tear. Their injured and contralateral knees were evaluated with radiography, US and MRI. Two radiologists evaluated the ALL on the MRI and US examinations. Agreement between these examiners' findings was evaluated with Cohen's kappa. On US examination, the ALL was found to be injured in 63% of cases (19/30; k = 0.93). The enthesis was found to be torn in 50% of cases (15/30; k = 1), with the tear located at the tibial attachment in all instances. On the MRI exam, the ALL was found to be injured in 53% of cases (16/30; k = 0.93). The enthesis was found to be torn in 13% of cases (4/30; k = 0.76), with the tear located at the tibial attachment in all instances (k = 0.93). ALL injuries that occur with ACL tears are located at the tibial enthesis. They are often associated with bone avulsion at the enthesis and are better viewed on US. (orig.)

  12. Anterolateral ligament injuries in knees with an anterior cruciate ligament tear. Contribution of ultrasonography and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Faruch Bilfeld, Marie; Constans, Olivia; Lapegue, Franck; Chiavassa Gandois, Helene; Sans, Nicolas [CHU Toulouse-Purpan, Service de Radiologie, Toulouse (France); Cavaignac, Etienne; Wytrykowski, Karine [CHU Toulouse-Purpan, Service d' Orthopedie, Toulouse (France); Larbi, Ahmed [Hopital Universitaire Caremeau, Service de Radiologie, Nimes (France)

    2018-01-15

    To describe the pathological appearance of the anterolateral ligament (ALL) on US and MRI in knees with an anterior cruciate ligament (ACL) tear. This prospective study included 30 patients who had a suspected acute ACL tear. Their injured and contralateral knees were evaluated with radiography, US and MRI. Two radiologists evaluated the ALL on the MRI and US examinations. Agreement between these examiners' findings was evaluated with Cohen's kappa. On US examination, the ALL was found to be injured in 63% of cases (19/30; k = 0.93). The enthesis was found to be torn in 50% of cases (15/30; k = 1), with the tear located at the tibial attachment in all instances. On the MRI exam, the ALL was found to be injured in 53% of cases (16/30; k = 0.93). The enthesis was found to be torn in 13% of cases (4/30; k = 0.76), with the tear located at the tibial attachment in all instances (k = 0.93). ALL injuries that occur with ACL tears are located at the tibial enthesis. They are often associated with bone avulsion at the enthesis and are better viewed on US. (orig.)

  13. Magnetic resonance imaging of meniscal and anterior cruciate ligament injuries of the knee

    International Nuclear Information System (INIS)

    Kreitner, K.F.; Herrig, A.; Grebe, P.; Runkel, M.; Regentrop, H.J.

    1998-01-01

    To categorise discrepancies in findings of the menisci and anterior cruciate ligament (ACL) between arthroscopy and MRI. Materials and methods: The MRIs of 236 patients were retrospectively analysed by an experienced radiologist without knowledge of clinical and/for operative findings. Discrepancies in arthroscopic findings were reevaluated together with the arthroscopist to determine their cause of error. Results: The diagnostic accuracies for injuries of the medial and lateral meniscus and the ACL were 92.4%, 92.4%, and 94.1%. respectively. For the menisci, causes for discrepancies in findings (n=31) were: overinterpretation of central signal intensities with contact to the meniscal surface but without disturbance of the meniscal contour as a tear (n=12), insufficient arthroscopie evaluation of the knee joint (n=11), overlooked tears on MR imaging (n=6), misinterpretation of normal anatomic structures (n=1), ''magic angle'' phenomenon (n=1), and missed tears at MRI (n=1). Causes for discrepancies for the ACL (n=18) were: nearly complete versus complete rupture either at MRI or arthroscopy and vice versa (n=9), insufficient arthroscopic evaluation (n=6), insufficient MRI technique (n=2), and overlooked tear on MR imaging (n=1). Conclusions: Discrepant findings between MRI and arthroscopy may be also due to an insufficient arthroscopic evaluation in clinical routine. The close cooperation between surgeons and radiologists improves the understanding of the methods of each other. (orig.) [de

  14. Paragliding injuries.

    OpenAIRE

    Krüger-Franke, M; Siebert, C H; Pförringer, W

    1991-01-01

    Regulations controlling the sport of paragliding were issued in April 1987 by the German Department of Transportation. The growing popularity of this sport has led to a steady increase in the number of associated injuries. This study presents the incidence, localization and degree of injuries associated with paragliding documented in Germany, Austria and Switzerland. The 283 injuries suffered by 218 paragliders were documented in the period 1987-1989: 181 occurred during landing, 28 during st...

  15. Post-operative 3D CT feedback improves accuracy and precision in the learning curve of anatomic ACL femoral tunnel placement.

    Science.gov (United States)

    Sirleo, Luigi; Innocenti, Massimo; Innocenti, Matteo; Civinini, Roberto; Carulli, Christian; Matassi, Fabrizio

    2018-02-01

    To evaluate the feedback from post-operative three-dimensional computed tomography (3D-CT) on femoral tunnel placement in the learning process, to obtain an anatomic anterior cruciate ligament (ACL) reconstruction. A series of 60 consecutive patients undergoing primary ACL reconstruction using autologous hamstrings single-bundle outside-in technique were prospectively included in the study. ACL reconstructions were performed by the same trainee-surgeon during his learning phase of anatomic ACL femoral tunnel placement. A CT scan with dedicated tunnel study was performed in all patients within 48 h after surgery. The data obtained from the CT scan were processed into a three-dimensional surface model, and a true medial view of the lateral femoral condyle was used for the femoral tunnel placement analysis. Two independent examiners analysed the tunnel placements. The centre of femoral tunnel was measured using a quadrant method as described by Bernard and Hertel. The coordinates measured were compared with anatomic coordinates values described in the literature [deep-to-shallow distance (X-axis) 28.5%; high-to-low distance (Y-axis) 35.2%]. Tunnel placement was evaluated in terms of accuracy and precision. After each ACL reconstruction, results were shown to the surgeon to receive an instant feedback in order to achieve accurate correction and improve tunnel placement for the next surgery. Complications and arthroscopic time were also recorded. Results were divided into three consecutive series (1, 2, 3) of 20 patients each. A trend to placing femoral tunnel slightly shallow in deep-to-shallow distance and slightly high in high-to-low distance was observed in the first and the second series. A progressive improvement in tunnel position was recorded from the first to second series and from the second to the third series. Both accuracy (+52.4%) and precision (+55.7%) increased from the first to the third series (p process to improve accuracy and precision of femoral

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

    DEFF Research Database (Denmark)

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

    2018-01-01

    BACKGROUND: Meaningful change scores in the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients undergoing anterior cruciate ligament (ACL) reconstruction have not yet been established. PURPOSE: To define the minimal important change (MIC) for the KOOS after ACL reconstruction. STUDY...... data for at least one of the KOOS subscales were obtained from 542 (45.3%) participants. Predictive modeling MIC values were 12.1 for the KOOS subscales of Sport and Recreational Function and 18.3 for Knee-Related Quality of Life. These values aid in interpreting within-group improvement over time...... and can be used as responder criteria when comparing groups. The corresponding and much lower values for the subscales of Pain (2.5), Symptoms (-1.2), and Activities of Daily Living (2.4) are the results from patients reporting, on average, only mild problems with these domains preoperatively. Although 4...

  17. Evaluation using MRI T2 mapping of the articular cartilage after anterior cruciate ligament injury in young athletes

    International Nuclear Information System (INIS)

    Ishihara, Kohei; Ohdera, Toshihiro; Matsuda, Shusaku

    2011-01-01

    Articular cartilage damage coexisting in the anterior cruciate ligament (ACL) injury in young athletes is not rare. We evaluated the conditions of the articular cartilage using MRI T2 mapping method and compared the vesults with the findings of arthroscopy. From June to August in 2010, we performed ACL reconstruction in 31 patients. We selected 17 cases (eleven men and six women, mean age 19.1 years old), all of whom were athletes and the under 29 years old. Articular cartilage damage was observed in six out of 10 cases, and their T2 values were high on MRI T2 mapping. On the other hand, damage was observed only in one out of seven cases, and T2 values were in the normal level of the mapping. Using MRI T2 mapping, we can evaluate the articular cartilage at an early phase noninvasively. MRI T2 mapping is useful and effective for athletes. (author)

  18. Paragliding injuries.

    Science.gov (United States)

    Krüger-Franke, M; Siebert, C H; Pförringer, W

    1991-06-01

    Regulations controlling the sport of paragliding were issued in April 1987 by the German Department of Transportation. The growing popularity of this sport has led to a steady increase in the number of associated injuries. This study presents the incidence, localization and degree of injuries associated with paragliding documented in Germany, Austria and Switzerland. The 283 injuries suffered by 218 paragliders were documented in the period 1987-1989: 181 occurred during landing, 28 during starting procedures and nine during flight. The mean patient age was 29.6 years. There were 34.9% spinal injuries, 13.4% upper extremity injuries and 41.3% lower limb injuries. Over half of these injuries were treated surgically and in 54 instances permanent disability remained. In paragliding the lower extremities are at greatest risk of injury during landing. Proper equipment, especially sturdy footwear, exact training in landing techniques as well as improved instruction in procedures during aborted or crash landings is required to reduce the frequency of these injuries.

  19. Study of correlation between clinical, magnetic resonance imaging, and arthroscopic findings in meniscal and anterior cruciate ligament injuries

    Directory of Open Access Journals (Sweden)

    Subhash R Puri

    2013-01-01

    Full Text Available Background: Approx. 28% of patients presents to orthopedic OPD with complaints of knee pain. Common medical complications include an unstable knee, chronic knee pain, and post traumatic arthritis. Aim: To study the correlation between clinical, magnetic resonance imaging (MRI, and arthroscopic findings in knee injuries. Materials and Methods: About 30 cases with history of rotational injury having knee pain and recurrent swelling were subjected to study. Results: MRI had better sensitivity (0.95 vs. 0.85 and specificity (1.0 vs. 0.5 in comparison with clinical examination for medial meniscus. In lateral meniscus injury (sensitivity 0.65 vs. 0.61 and specificity 0.95 vs. 0.92 and in ACL injury (Sensitivity 0.77 vs. 0.8 and specificity 1.0 vs. 0.96 the sensitivity and specificity of MRI versus clinical examination showed minimal difference. Conclusion: Our conclusion is that carefully performed clinical examination can give equal or better diagnosis of meniscal and ACL injuries in comparison with MRI scan. MRI may be used as an additional tool for diagnosis.

  20. All-Epiphyseal Anterior Cruciate Ligament Femoral Tunnel Drilling: Avoiding Injury to the Physis, Lateral Collateral Ligament, Anterolateral Ligament, and Popliteus-A 3-Dimensional Computed Tomography Study.

    Science.gov (United States)

    Shea, Kevin G; Cannamela, Peter C; Fabricant, Peter D; Terhune, Elizabeth B; Polousky, John D; Milewski, Matthew D; Anderson, Allen F; Ganley, Theodore J

    2018-01-25

    To investigate the relation of the at-risk structures (distal femoral physis, lateral collateral ligament, anterolateral ligament, popliteus, and articular cartilage) during all-epiphyseal femoral tunnel drilling. A second purpose was 2-fold: (1) to develop recommendations for tunnel placement and orientation that anatomically reconstruct the anterior cruciate ligament (ACL) while minimizing the risk of injury to these at-risk structures, and (2) to allow for maximal tunnel length to increase the amount of graft in the socket to facilitate healing. Three-dimensional models of 6 skeletally immature knees (aged 7-11 years) were reconstructed from computed tomography and used to simulate all-epiphyseal femoral tunnels. Tunnels began within the ACL footprint and were directed laterally or anterolaterally, with the goal of avoiding injury to at-risk structures. The spatial relation between the ideal tunnel and these structures was evaluated. Full-length tunnels and partial length condyle sockets were simulated in the models using the same trajectories. An anterolateral tunnel could be placed to avoid direct injury to lateral structures. The safe zone on the anterolateral aspect of the femur was larger than that of a tunnel with a direct lateral trajectory (median 127 mm 2 vs 83 mm 2 , P = .028). Anterolateral tunnels were longer than direct lateral tunnels (median 30 mm vs 24 mm, P = .041). Safe angles for anterolateral tunnels were 34° to 40° from the posterior condylar axis; direct lateral tunnels were drilled 4° to 9° from the posterior condylar axis. Sockets could be placed without direct injury to structures at risk with either orientation. An all-epiphyseal ACL femoral tunnel can be placed without causing direct injury to at-risk structures. A tunnel angled anterolaterally from the ACL origin is longer and has a larger safe zone compared with the direct lateral tunnel. The largest safe zone for femoral all-epiphyseal ACL drilling was (1) anterior to

  1. Comparison of femoral tunnel widening between outside-in and trans-tibial double-bundle ACL reconstruction.

    Science.gov (United States)

    Lee, Yong Seuk; Lee, Beom Koo; Oh, Won Seok; Cho, Yong Kyun

    2014-09-01

    The objectives of this study were to compare (1) the degree of widening by comparing the diameter at the most widened area and the site of widening by measuring the distance from the tunnel entrance to the most widened area in two femoral tunnels (anteromedial and posterolateral), and (2) the morphologic change at the tunnel entrance between outside-in and trans-tibial double-bundle anterior cruciate ligament (ACL) reconstruction. A retrospective study that included 17 trans-tibial and 19 outside-in double-bundle ACL reconstructed patients was conducted for evaluation of serial computed tomography (CT) scan (immediate post-operation and post-operative 1 year). Digital image communication in medicine (DICOM) data was extracted from the PiViewSTAR and imported into OsiriX, which was installed on a Macbook Pro laptop computer. Diameter of the most widened area and distance from the entrance to this point were measured from each of two perpendicular (sagittal and coronal) planes that were accurately realigned parallel to the tunnel direction. Change in the morphology of the tunnel entrance between immediate post-operation and 1-year post-operation was evaluated. Widening was observed in both planes of both tunnels in the two techniques. However, no statistical significances in the diameter of most widened area and distance from the tunnel entrance to the most widened point were observed between the both techniques (n.s.). Distances from the centre point to each four sections showed an increase in all four sections of all both tunnels in both techniques. However, no statistical significance was observed between the two techniques (n.s.). Widening was observed in all tunnels using both techniques and degrees, and sites of the widening did not differ between groups. Morphologic change at the tunnel entrance was not limited to the specific direction and occurred in all directions without significant difference between groups. Retrospective comparative study, Level III.

  2. Whiplash injuries.

    Science.gov (United States)

    Malanga, Gerard; Peter, Jason

    2005-10-01

    Whiplash injuries are very common and usually are associated with rear-end collisions. However, a whiplash injury can be caused by any event that results in hyperextension and flexion of the cervical spine. These injuries are of serious concern to all consumers due to escalating cost of diagnosis, treatment, insurance, and litigation. Most acute whiplash injury cases respond well to conservative treatments, which result in resolution of symptoms usually within weeks to a few months after the injury occurred. Chronic whiplash injuries often are harder to diagnose and treat and often result in poor outcomes. Current research shows that various structures in the cervical spine receive nociceptive innervation and potentially may be the cause of chronic pain symptoms. One potential pain generator showing promise is the facet or zygapophyseal joints. Various researchers have proven that these joints are injured during whiplash injuries and that diagnosis and temporary pain relief can be obtained with facet joint injections. The initial evaluation of any patient should follow an organized and stepwise approach, and more serious causes of neck pain must first be ruled out through the history, physical examination, and diagnostic testing. Treatment regimens should be evidence-based, focusing on treatments that have proven to be effective in treating acute and chronic whiplash injuries.

  3. Ocular Injury

    Science.gov (United States)

    ... trauma can happen at home, school, play or sports. Most common injuries are scratches to the cornea or blunt trauma. Approved and tested eye and face protection is essential to prevent injuries. Sports such as hockey, baseball, racquet ball, squash, and ...

  4. Rowing Injuries

    DEFF Research Database (Denmark)

    Thornton, Jane S; Vinther, Anders; Wilson, Fiona

    2017-01-01

    understanding in pre-participation screening, training load, emerging concepts surrounding back and rib injury, and relative energy deficiency in sport. Through a better understanding of the nature of the sport and mechanisms of injury, physicians and other healthcare providers will be better equipped to treat...

  5. Trampoline injuries.

    Science.gov (United States)

    Nysted, M; Drogset, J O

    2006-12-01

    To describe the mechanism, location and types of injury for all patients treated for trampoline-associated injuries at St Olav's University Hospital, Trondheim, Norway, from March 2001to October 2004. Patients were identified from a National Injury Surveillance System. All patients were asked to complete a standard questionnaire at their first visit at the hospital. Most data were recorded prospectively, but data on the mechanism of injury, the number of participants on the trampoline at the time of injury, adult supervision and whether the activity occurred at school or in another organised setting were collected retrospectively. A total of 556 patients, 56% male and 44% female, were included. The mean age of patients was 11 (range 1-62) years. 77% of the injuries occurred on the body of the trampoline, including falls on to the mat, collisions with another jumper, falls on to the frame or the springs, and performing a somersault, whereas 22% of the people fell off the trampoline. In 74% of the cases, more than two people were on the trampoline, with as many as nine trampolinists noted at the time of injury. For children Trampolining can cause serious injuries, especially in the neck and elbow areas of young children. The use of a trampoline is a high-risk activity. However, a ban is not supported. The importance of having safety guidelines for the use of trampolines is emphasised.

  6. Posterior Cruciate Ligament Injuries Associated With Military Survival Swim Training.

    Science.gov (United States)

    Crowell, Michael S; Mason, John S; Posner, Matthew A; Haley, Chad A

    2017-07-01

    Posterior cruciate ligament (PCL) injuries are relatively common injuries associated with athletic activities and high-energy trauma. Posterolateral corner (PLC) injuries frequently accompany injury to the PCL. Diagnosis can be challenging and requires a comprehensive history and physical examination. Patients frequently report vague, nonspecific symptoms and the mechanism of injury is often useful in localizing injured structures. Two of the more common mechanisms for PCL injury include a direct blow to the proximal anterior tibia with the knee flexed, as well as a significant knee hyperextension injury. With a PCL tear, patients rarely describe an audible "pop" that is commonly reported in ACL injuries. On physical exam, a frequent finding in PCL tears is a loss of 10 to 20° of knee flexion. Although the most common clinical tests for PCL tears include the posterior drawer test, the posterior sag sign, and the quadriceps active test, there is a lack of high-quality diagnostic accuracy studies. Two cases of U.S. Military Academy Cadets who sustained PCL injuries while removing combat boots during military survival swim training are presented. The results of the clinical examination are accompanied by magnetic resonance imaging results and intraoperative arthroscopic images to highlight key findings. Both patients were evaluated and diagnosed with PCL injures within 10 days of their injuries. Each reported feeling/hearing a "pop," which is atypical in PCL tears. Both patients demonstrated a lack of active and passive knee flexion, which is a commonly reported impairment. One patient was managed nonsurgically with physical therapy and eventually returned to full duty without limitations 9 months after his injury. The other patient, who sustained a combined PCL-PLC injury, underwent a PCL reconstruction and PLC repair and reconstruction 8 weeks after his injury. He returned all training, with the exception of contact/collision sports, 9 months after surgery. Both

  7. Mechanisms of anterior cruciate ligament injuries in elite women's netball: a systematic video analysis.

    Science.gov (United States)

    Stuelcken, Max C; Mellifont, Daniel B; Gorman, Adam D; Sayers, Mark G L

    2016-08-01

    This study involved a systematic video analysis of 16 anterior cruciate ligament (ACL) injuries sustained by elite-level netball players during televised games in order to describe the game situation, the movement patterns involved, the player's behaviour, and a potential injury mechanism. Eight of the ACL injuries were classified as "indirect contact" and eight as "non-contact". Two common scenarios were identified. In Scenario A the player was jumping to receive or intercept a pass and whilst competing for the ball experienced a perturbation in the air. As a result the player's landing was unbalanced with loading occurring predominantly on the knee of the injured side. In Scenario B the player was generally in a good position at ground contact, but then noticeably altered the alignment of the trunk before the landing was completed. This involved rotating and laterally flexing the trunk without altering the alignment of the feet. Apparent knee valgus collapse on the knee of the injured side was observed in 3/6 Scenario A cases and 5/6 Scenario B cases. Players may benefit from landing training programmes that incorporate tasks that use a ball and include decision-making components or require players to learn to cope with being unbalanced.

  8. Injury - kidney and ureter

    Science.gov (United States)

    ... kidney; Ureteral injury; Pre-renal failure - injury, Post-renal failure - injury; Kidney obstruction - injury Images Kidney anatomy Kidney - blood and urine flow References Molitoris BA. Acute kidney injury. In: Goldman ...

  9. Spinal Cord Injury 101

    Medline Plus

    Full Text Available menu Understanding Spinal Cord Injury What is a Spinal Cord Injury Levels of Injury and What They Mean Animated Spinal Cord Injury Chart Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal ...

  10. Repetitive Stress Injuries

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Repetitive Stress Injuries KidsHealth / For Teens / Repetitive Stress Injuries What's ... t had any problems since. What Are Repetitive Stress Injuries? Repetitive stress injuries (RSIs) are injuries that ...

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    BACKGROUND AND PURPOSE: In clinical practice, visual observation is often used to determine functional impairment and to evaluate treatment following a knee injury. The aim of this study was to evaluate the reliability and validity of observational assessments of knee movement pattern quality......, crossover hop on one leg and one-leg hop. The videos were observed by four physiotherapists, and the knee movement pattern quality, a feature of the loading strategy of the lower extremity, was scored on an 11-point rating scale. To assess the criterion validity, the observational rating was correlated...... obtained between the observers' assessment and knee flexion angle, r = 0.37-0.61. The crossover hop test or one-leg hop test was ranked as the most useful test in 172 of 192 occasions (90%) when assessing knee function. CONCLUSION: The moderate to good inter-observer reliability and the moderate criterion...

  12. Badminton injuries.

    Science.gov (United States)

    Krøner, K; Schmidt, S A; Nielsen, A B; Yde, J; Jakobsen, B W; Møller-Madsen, B; Jensen, J

    1990-01-01

    In a one year period, from 1 January 1986 to 31 December 1986, 4303 patients with sports injuries were treated at Aarhus Amtssygehus and Aarhus Kommunehospital. The mean age was 21.6 years (range 7-72 years) and 2830 were men. Two hundred and seventeen badminton injuries occurred in 208 patients (136 men) with a mean age of 29.6 years (range 7-57 years), constituting 4.1 percent of all sport injuries in Aarhus. Joints and ligaments were injured in 58.5 percent of the patients, most frequently located in the lower limb and significantly more often among patients younger than 30 years of age. Muscle injury occurred in 19.8 percent of the patients. This type of injury was significantly more frequent among patients older than 30 years of age. Most injuries were minor. However, 6.8 percent of the patients were hospitalized and 30.9 percent received additional treatment by a physician. As the risk of injury varies with age, attempts to plan training individually and to institute prophylactic measures should be made. PMID:2078802

  13. Biomarkers for equine joint injury and osteoarthritis.

    Science.gov (United States)

    McIlwraith, C Wayne; Kawcak, Christopher E; Frisbie, David D; Little, Christopher B; Clegg, Peter D; Peffers, Mandy J; Karsdal, Morten A; Ekman, Stina; Laverty, Sheila; Slayden, Richard A; Sandell, Linda J; Lohmander, L S; Kraus, Virginia B

    2018-03-01

    We report the results of a symposium aimed at identifying validated biomarkers that can be used to complement clinical observations for diagnosis and prognosis of joint injury leading to equine osteoarthritis (OA). Biomarkers might also predict pre-fracture change that could lead to catastrophic bone failure in equine athletes. The workshop was attended by leading scientists in the fields of equine and human musculoskeletal biomarkers to enable cross-disciplinary exchange and improve knowledge in both. Detailed proceedings with strategic planning was written, added to, edited and referenced to develop this manuscript. The most recent information from work in equine and human osteoarthritic biomarkers was accumulated, including the use of personalized healthcare to stratify OA phenotypes, transcriptome analysis of anterior cruciate ligament (ACL) and meniscal injuries in the human knee. The spectrum of "wet" biomarker assays that are antibody based that have achieved usefulness in both humans and horses, imaging biomarkers and the role they can play in equine and human OA was discussed. Prediction of musculoskeletal injury in the horse remains a challenge, and the potential usefulness of spectroscopy, metabolomics, proteomics, and development of biobanks to classify biomarkers in different stages of equine and human OA were reviewed. The participants concluded that new information and studies in equine musculoskeletal biomarkers have potential translational value for humans and vice versa. OA is equally important in humans and horses, and the welfare issues associated with catastrophic musculoskeletal injury in horses add further emphasis to the need for good validated biomarkers in the horse. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:823-831, 2018. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  14. Morphological size evaluation of the mid-substance insertion areas and the fan-like extension fibers in the femoral ACL footprint.

    Science.gov (United States)

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

    2017-08-01

    The purpose of this study was to evaluate the detailed anatomy of the femoral anterior cruciate ligament (ACL) insertion site, with special attention given to the morphology of the mid-substance insertion areas and the fan-like extension fibers. Twenty-three non-paired human cadaver knees were used (7 Males, 16 Females, median age 83, range 69-96). All soft tissues around the knee were resected except the ligaments. The ACL was divided into antero-medial (AM) and postero-lateral (PL) bundles according to the difference in macroscopic tension patterns. The ACL was carefully dissected and two outlines were made of the periphery of each bundle insertion site: those which included and those which excluded the fan-like extension fibers. An accurate lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The area of each bundle, including and excluding the fan-like extension fibers, was measured with Image J software (National Institution of Health). The width and length of the mid-substance insertion sites were also evaluated using same image. The femoral ACL footprint was divided into four regions (mid-substance insertion sites of the AM and PL bundles, and fan-like extensions of the AM and PL bundles). The measured areas of the mid-substance insertion sites of the AM and PL bundles were 35.5 ± 12.5, and 32.4 ± 13.8 mm 2 , respectively. Whole width and length of the mid-substance insertion sites were 5.3 ± 1.4, and 15.5 ± 2.9 mm, respectively. The measured areas of the fan-like extensions of the AM and PL bundles were 27 ± 11.5, and 29.5 ± 12.4 mm 2 , respectively. The femoral ACL footprint was divided into quarters of approximately equal size (mid-substance insertion sites of the AM and PL bundles, and fan-like extensions of the AM and PL bundles). For clinical relevance, to perform highly reproducible anatomical ACL reconstruction, the presence of the fan-like extension

  15. Non-operative management of a complete anterior cruciate ligament injury in an English Premier League football player with return to play in less than 8 weeks: applying common sense in the absence of evidence

    Science.gov (United States)

    Weiler, Richard; Monte-Colombo, Mathew; Mitchell, Adam; Haddad, Fares

    2015-01-01

    This case report illustrates and discusses the non-operative management of a complete anterior cruciate ligament (ACL) injury in an English Premier League football player, his return to play within 8 weeks and problem-free follow-up at 18 months post injury. When non-operative verses surgical ACL reconstruction is considered there are many fundamental gaps in our knowledge and currently, at elite level, there are no cases in cutting sports within the literature to guide these decisions. When the norm is for all professional footballers to be recommended surgery, it will be very challenging when circumstances and patient autonomy dictate a conservative approach, where prognosis, end points and risk are unclear and assumed to be high. This case challenges current dogma and provides a starting point for much needed debate about best practice, treatment options, research direction and not just at the elite level of sport. PMID:25917066

  16. Preventing knee injuries in adolescent female football players – design of a cluster randomized controlled trial [NCT00894595

    Directory of Open Access Journals (Sweden)

    Waldén Markus

    2009-06-01

    Full Text Available Abstract Background Knee injuries in football are common regardless of age, gender or playing level, but adolescent females seem to have the highest risk. The consequences after severe knee injury, for example anterior cruciate ligament (ACL injury, are well-known, but less is known about knee injury prevention. We have designed a cluster randomized controlled trial (RCT to evaluate the effect of a warm-up program aimed at preventing acute knee injury in adolescent female football. Methods In this cluster randomized trial 516 teams (309 clusters in eight regional football districts in Sweden with female players aged 13–17 years were randomized into an intervention group (260 teams or a control group (256 teams. The teams in the intervention group were instructed to do a structured warm-up program at two training sessions per week throughout the 2009 competitive season (April to October and those in the control group were informed to train and play as usual. Sixty-eight sports physical therapists are assigned to the clubs to assist both groups in data collection and to examine the players' acute knee injuries during the study period. Three different forms are used in the trial: (1 baseline player data form collected at the start of the trial, (2 computer-based registration form collected every month, on which one of the coaches/team leaders documents individual player exposure, and (3 injury report form on which the study therapists report acute knee injuries resulting in time loss from training or match play. The primary outcome is the incidence of ACL injury and the secondary outcomes are the incidence of any acute knee injury (except contusion and incidence of severe knee injury (defined as injury resulting in absence of more than 4 weeks. Outcome measures are assessed after the end of the 2009 season. Discussion Prevention of knee injury is beneficial for players, clubs, insurance companies, and society. If the warm-up program is proven to

  17. Preventing knee injuries in adolescent female football players - design of a cluster randomized controlled trial [NCT00894595].

    Science.gov (United States)

    Hägglund, Martin; Waldén, Markus; Atroshi, Isam

    2009-06-23

    Knee injuries in football are common regardless of age, gender or playing level, but adolescent females seem to have the highest risk. The consequences after severe knee injury, for example anterior cruciate ligament (ACL) injury, are well-known, but less is known about knee injury prevention. We have designed a cluster randomized controlled trial (RCT) to evaluate the effect of a warm-up program aimed at preventing acute knee injury in adolescent female football. In this cluster randomized trial 516 teams (309 clusters) in eight regional football districts in Sweden with female players aged 13-17 years were randomized into an intervention group (260 teams) or a control group (256 teams). The teams in the intervention group were instructed to do a structured warm-up program at two training sessions per week throughout the 2009 competitive season (April to October) and those in the control group were informed to train and play as usual. Sixty-eight sports physical therapists are assigned to the clubs to assist both groups in data collection and to examine the players' acute knee injuries during the study period. Three different forms are used in the trial: (1) baseline player data form collected at the start of the trial, (2) computer-based registration form collected every month, on which one of the coaches/team leaders documents individual player exposure, and (3) injury report form on which the study therapists report acute knee injuries resulting in time loss from training or match play. The primary outcome is the incidence of ACL injury and the secondary outcomes are the incidence of any acute knee injury (except contusion) and incidence of severe knee injury (defined as injury resulting in absence of more than 4 weeks). Outcome measures are assessed after the end of the 2009 season. Prevention of knee injury is beneficial for players, clubs, insurance companies, and society. If the warm-up program is proven to be effective in reducing the incidence of knee

  18. Spinal injury

    Science.gov (United States)

    ... Dallas, TX: American Red Cross; 2016. Kaji AH, Newton EJ, Hockberger RS. Spinal injuries. In: Marx JA, ... member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www. ...

  19. Chilling injury

    African Journals Online (AJOL)

    ahar

    2013-12-18

    Dec 18, 2013 ... ROS avoidance genes play pivotal role in defense mechanism against chilling injury derived oxidative stress. ... Low temperature storage is a postharvest technology ..... crops is highly dependent on ethylene production and.

  20. Injury Statistics

    Science.gov (United States)

    ... Power Saws for 2001 05/15/2002 Nail Gun Related Injuries and Deaths Home Maintenance & Construction 05/ ... Information (FOIA) Inspector General No Fear Act Data USA.gov Report an Unsafe Product Contact Us: 800- ...

  1. Electrical injury

    Science.gov (United States)

    ... RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 134. Price LA, Loiacono LA. Electrical and lightning injury. In: Cameron JL, Cameron AM, eds. Current Surgical ...

  2. Ear Injury

    Science.gov (United States)

    ... of different injuries can affect the outer ear. Cauliflower ear (subperichondrial hematoma) A blunt blow to the ... to a deformed ear. This deformity, called a cauliflower ear, is common among wrestlers, boxers, and rugby ...

  3. The effect of short-duration sub-maximal cycling on balance in single-limb stance in patients with anterior cruciate ligament injury: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Roberts David

    2004-11-01

    Full Text Available Abstract Background It has previously been shown that an anterior cruciate ligament (ACL injury may lead to impaired postural control, and that the ability to maintain postural control is decreased by fatigue in healthy subjects. To our knowledge, no studies have reported the effect of fatigue on postural control in subjects with ACL injury. This study was aimed at examining the effect of fatigue on balance in single-limb stance in subjects with ACL injury, and to compare the effects, and the ability to maintain balance, with that of a control group of uninjured subjects. Methods Thirty-six patients with unilateral, non-operated, non-acute ACL injury, and 24 uninjured subjects were examined with stabilometry before (pre-exercise and immediately after (post-exercise short-duration, sub-maximal cycling. In addition, the post-exercise measurements were compared, to evaluate the instantaneous ability to maintain balance and any possible recovery. The amplitude and average speed of center of pressure movements were registered in the frontal and sagittal planes. The paired t-test was used for the intra-group comparisons, and the independent t-test for the inter-group comparisons, with Bonferroni correction for multiple comparisons. Results No differences were found in the effects of exercise between the patients and the controls. Analysis of the post-exercise measurements revealed greater effects or a tendency towards greater effects on the injured leg than in the control group. The average speed was lower among the patients than in the control group. Conclusions The results of the present study showed no differences in the effects of exercise between the patients and the controls. However, the patients seemed to react differently regarding ability to maintain balance in single-limb stance directly after exercise than the control group. The lower average speed among the patients may be an expression of different neuromuscular adaptive strategies than

  4. Cold injuries.

    Science.gov (United States)

    Kruse, R J

    1995-01-01

    There are two categories of cold injury. The first is hypothermia, which is a systemic injury to cold, and the second is frostbite, which is a local injury. Throughout history, entire armies, from George Washington to the Germans on the Russian Front in World War II, have fallen prey to prolonged cold exposure. Cold injury is common and can occur in all seasons if ambient temperature is lower than the core body temperature. In the 1985 Boston Marathon, even though it was 76 degrees and sunny, there were 75 runners treated for hypothermia. In general, humans adapt poorly to cold exposure. Children are at particular risk because of their relatively greater surface area/body mass ratio, causing them to cool even more rapidly than adults. Because of this, the human's best defense against cold injury is to limit his/her exposure to cold and to dress appropriately. If cold injury has occurred and is mild, often simple passive rewarming such as dry blankets and a warm room are sufficient treatment.

  5. Predictors and effects of patellofemoral pain following hamstring-tendon ACL reconstruction.

    Science.gov (United States)

    Culvenor, Adam G; Collins, Natalie J; Vicenzino, Bill; Cook, Jill L; Whitehead, Timothy S; Morris, Hayden G; Crossley, Kay M

    2016-07-01

    Patellofemoral pain is a frequent and troublesome complication following anterior cruciate ligament reconstruction (ACLR), irrespective of graft source. Yet, little is known about the factors associated with patellofemoral pain following hamstring-tendon ACLR. Retrospective analysis of potential patellofemoral pain predictors, and cross-sectional analysis of possible patellofemoral pain consequences. Potential predictors (pre-injury patellofemoral pain and activity level, concomitant patellofemoral cartilage damage and meniscectomy, age, sex, and surgical delay) and consequences (hopping performance, quality of life, kinesiophobia, and return to sport rates and attitudes) of patellofemoral pain 12 months following hamstring-tendon ACLR were assessed in 110 participants using univariate and multivariate analyses. Thirty-three participants (30%) had patellofemoral pain at 12 months post-ACLR. Older age at the time of ACLR was the only predictor of post-operative patellofemoral pain. Following ACLR, those with patellofemoral pain had a higher body mass index, and worse physical performance, quality of life, kinesiophobia and return to sport attitudes. Patellofemoral pain has a significant burden on individuals 12 months following hamstring-tendon ACLR. Clinicians need to be cognisant of patellofemoral pain, particularly in older individuals and those with a higher body mass index. The importance of considering psychological factors that are not typically addressed during ACLR rehabilitation, such as kinesiophobia, quality of life and return to sport attitudes is emphasised. Copyright © 2016. Published by Elsevier Ltd.

  6. A protocol of rehabilitation after ACL reconstruction using a hamstring autograft in the first month after surgery--a preliminary report.

    Science.gov (United States)

    Biernat, Ryszard; Wołosewicz, Mariusz; Tomaszewski, Wiesław

    2007-01-01

    The purpose of this paper is to present a protocol of rehabilitation after ACL reconstruction using a hamstring autograft in the first month after surgery. The program enables the patient to return early to everyday activities (school, sedentary work) without crutches or a stabilizer. The program has been developed in accordance with rehabilitation protocols employed at Karolinska Institute in Sweden and Prof. Shelbourne's Clinic in the USA. The study group included 31 patients (18 men and 13 women). Patients rehabilitated in the Department according to our program achieved stable gait patterns and were able to step up and down within four to seven weeks. Early patient mobilization after ACL reconstruction is possible and does not cause any negative effects provided that the patient, doctor and physiotherapist cooperate very closely.

  7. Transphyseal ACL Reconstruction in Skeletally Immature Patients: Does Independent Femoral Tunnel Drilling Place the Physis at Greater Risk Compared With Transtibial Drilling?

    Science.gov (United States)

    Cruz, Aristides I; Lakomkin, Nikita; Fabricant, Peter D; Lawrence, J Todd R

    2016-06-01

    Most studies examining the safety and efficacy of transphyseal anterior cruciate ligament (ACL) reconstruction for skeletally immature patients utilize transtibial drilling. Independent femoral tunnel drilling may impart a different pattern of distal femoral physeal involvement. To radiographically assess differences in distal femoral physeal disruption between transtibial and independent femoral tunnel drilling. We hypothesized that more oblique tunnels associated with independent drilling involve a significantly larger area of physeal disruption compared with vertically oriented tunnels. Cross-sectional study; Level of evidence, 3. We analyzed skeletally immature patients aged between 10 and 15 years who underwent transphyseal ACL reconstruction utilizing an independent femoral tunnel drilling technique between January 1, 2008, and March 31, 2011. These patients were matched with a transtibial technique cohort based on age and sex. Radiographic measurements were recorded from preoperative magnetic resonance imaging and postoperative radiographs. Ten patients in each group were analyzed. There were significant differences between independent drilling and transtibial drilling cohorts in the estimated area of physeal disruption (1.64 vs 0.74 cm(2); P drilling technique disrupt a larger area of the distal femoral physis and create more eccentric tunnels compared with a transtibial technique. As most studies noting the safety of transphyseal ACL reconstruction have utilized a central, vertical femoral tunnel, surgeons should be aware that if an independent femoral tunnel technique is utilized during transphyseal ACL reconstruction, more physeal tissue is at risk and tunnels are more eccentrically placed across the physis when drilling at more horizontal angles. Prior studies have shown that greater physeal involvement and eccentric tunnels may increase the risk of growth disturbance.

  8. Impact differences in ground reaction force and center of mass between the first and second landing phases of a drop vertical jump and their implications for injury risk assessment.

    Science.gov (United States)

    Bates, Nathaniel A; Ford, Kevin R; Myer, Gregory D; Hewett, Timothy E

    2013-04-26

    The drop vertical jump (DVJ) task is commonly used to assess biomechanical performance measures that are associated with ACL injury risk in athletes. Previous investigations have solely assessed the first landing phase. We examined the first and second landings of a DVJ for differences in the magnitude of vertical ground reaction force (vGRF) and position of center of mass (CoM). A cohort of 239 adolescent female basketball athletes completed a series of DVJ tasks from an initial box height of 31 cm. Dual force platforms and a three dimensional motion capture system recorded force and positional data for each trial. There was no difference in peak vGRF between landings (p=0.445), but side-to-side differences increased from the first to second landing (p=0.007). Participants demonstrated a lower minimum CoM during stance in the first landing than the second landing (p<0.001). The results have important implications for the future assessment of ACL injury risk behaviors in adolescent female athletes. Greater side-to-side asymmetry in vGRF and higher CoM during impact indicate the second landing of a DVJ may exhibit greater perturbation and better represent in-game mechanics associated with ACL injury risk. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Evidence for differential control of tibial position in perturbed unilateral stance after acute ACL rupture.

    Science.gov (United States)

    Chmielewski, T L; Ramsey, D K; Snyder-Mackler, L

    2005-01-01

    Functional outcomes in anterior cruciate ligament-deficient "potential copers" and "non-copers" may be related to their knee stabilization strategies. Therefore, the purpose of this study was to differentiate dynamic knee stabilization strategies of potential copers and non-copers through analysis of sagittal plane knee angle and tibia position during disturbed and undisturbed unilateral standing. Ten uninjured potential coper and non-coper subjects stood in unilateral stance on a platform that translated anteriorly, posteriorly and laterally. Knee angle and tibia position with reference to the femur were calculated before and after platform movement. During perturbation trials, potential copers maintained kinematics that were similar to uninjured subjects across conditions. Conversely, non-copers stood with greater knee flexion than uninjured subjects and a tibia position that was more posterior than the other groups. Both non-copers and potential copers demonstrated small changes in tibia position following platform movement, but direction of movement was not similar. The similarities between the knee kinematics of potential copers and uninjured subjects suggest that potential copers compensated well from their injury by utilizing analogous dynamic knee stabilization strategies. In comparison to the other groups, by keeping the knee in greater flexion and the tibia in a more posterior position, non-copers appear to constrain the tibia in response to a challenging task, which is consistent with a "stiffening strategy". Based on the poor functional outcomes of non-copers, a stiffening strategy does not lead to dynamic knee stability, and the strategy may increase compressive forces which could contribute to or exacerbate articular cartilage degeneration.

  10. Comparison of landing biomechanics between male and female dancers and athletes, part 1: Influence of sex on risk of anterior cruciate ligament injury.

    Science.gov (United States)

    Orishimo, Karl F; Liederbach, Marijeanne; Kremenic, Ian J; Hagins, Marshall; Pappas, Evangelos

    2014-05-01

    The incidence of anterior cruciate ligament (ACL) injuries among dancers is much lower than among team sport athletes, and no clear disparity between sexes has been reported in the dance population. Although numerous studies have observed differences in landing biomechanics of the lower extremity between male and female team sport athletes, there is currently little research examining the landing biomechanics of male and female dancers and none comparing athletes to dancers. Comparing the landing biomechanics within these populations may help explain the lower overall ACL injury rates and lack of sex disparity. The purpose was to compare the effects of sex and group (dancer vs team sport athlete) on single-legged drop-landing biomechanics. The primary hypothesis was that female dancers would perform a drop-landing task without demonstrating typical sex-related risk factors associated with ACL injuries. A secondary hypothesis was that female team sport athletes would display typical ACL risk factors during the same task. Controlled laboratory study. Kinematics and kinetics were recorded as 40 elite modern and ballet dancers (20 men and 20 women) and 40 team sport athletes (20 men and 20 women) performed single-legged drop landings from a 30-cm platform. Joint kinematics and kinetics were compared between groups and sexes with a group-by-sex multivariate analysis of variance (MANOVA) followed by pairwise t tests. Dancers of both sexes and male team sport athletes landed similarly in terms of frontal-plane knee alignment, whereas female team sport athletes landed with a significantly greater peak knee valgus (P = .007). Female dancers were found to have a lower hip adduction torque than those of the other 3 groups (P = .003). Dancers (male and female) exhibited a lower trunk side flexion (P = .002) and lower trunk forward flexion (P = .032) compared with team sport athletes. In executing a 30-cm drop landing, female team sport athletes displayed a greater knee valgus

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-10-15

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

  12. Chest Injuries Associated with Head Injury

    African Journals Online (AJOL)

    Traumatic brain injury (TBI) is a common cause of mortality and severe morbidity. Although there have been significant advances in management, associated severe injuries, in particular chest injuries, remain a major challenge. Extracranial injuries, especially chest injuries increase mortality in patients with TBI in both short.

  13. Thermographic image analysis for classification of ACL rupture disease, bone cancer, and feline hyperthyroid, with Gabor filters

    Science.gov (United States)

    Alvandipour, Mehrdad; Umbaugh, Scott E.; Mishra, Deependra K.; Dahal, Rohini; Lama, Norsang; Marino, Dominic J.; Sackman, Joseph

    2017-05-01

    Thermography and pattern classification techniques are used to classify three different pathologies in veterinary images. Thermographic images of both normal and diseased animals were provided by the Long Island Veterinary Specialists (LIVS). The three pathologies are ACL rupture disease, bone cancer, and feline hyperthyroid. The diagnosis of these diseases usually involves radiology and laboratory tests while the method that we propose uses thermographic images and image analysis techniques and is intended for use as a prescreening tool. Images in each category of pathologies are first filtered by Gabor filters and then various features are extracted and used for classification into normal and abnormal classes. Gabor filters are linear filters that can be characterized by the two parameters wavelength λ and orientation θ. With two different wavelength and five different orientations, a total of ten different filters were studied. Different combinations of camera views, filters, feature vectors, normalization methods, and classification methods, produce different tests that were examined and the sensitivity, specificity and success rate for each test were produced. Using the Gabor features alone, sensitivity, specificity, and overall success rates of 85% for each of the pathologies was achieved.

  14. Artificial neural networks in knee injury risk evaluation among professional football players

    Science.gov (United States)

    Martyna, Michałowska; Tomasz, Walczak; Krzysztof, Grabski Jakub; Monika, Grygorowicz

    2018-01-01

    Lower limb injury risk assessment was proposed, based on isokinetic examination that is a part of standard athlete's biomechanical evaluation performed mainly twice a year. Information about non-contact knee injury (or lack of the injury) sustained within twelve months after isokinetic test, confirmed in USG were verified. Three the most common types of football injuries were taken into consideration: anterior cruciate ligament (ACL) rupture, hamstring and quadriceps muscles injuries. 22 parameters, obtained from isokinetic tests were divided into 4 groups and used as input parameters of five feedforward artificial neural networks (ANNs). The 5th group consisted of all considered parameters. The networks were trained with the use of Levenberg-Marquardt backpropagation algorithm to return value close to 1 for the sets of parameters corresponding injury event and close to 0 for parameters with no injury recorded within 6 - 12 months after isokinetic test. Results of this study shows that ANN might be useful tools, which simplify process of simultaneous interpretation of many numerical parameters, but the most important factor that significantly influence the results is database used for ANN training.

  15. Relationships of Muscle Function and Subjective Knee Function in Patients After ACL Reconstruction.

    Science.gov (United States)

    Bodkin, Stephan; Goetschius, John; Hertel, Jay; Hart, Joe

    2017-07-01

    After anterior cruciate ligament reconstruction (ACLR), relationships between objective measures of muscle function and patient-reported outcomes may change over time. Examining these measures at different time frames after surgery may help develop individualized approaches to improve post-ALCR analysis. To examine the associations between subjective knee function and lower-extremity muscle function in individual patients at various time points after ACLR. Descriptive laboratory study. Fifty-one participants who underwent primary, unilateral ACLR (15 males, 36 females; mean age, 22.9 ± 4.5 years; mean height, 172.4 ± 10.1 cm; mean weight, 68.7 ± 13.1 kg) were separated into 3 groups depending on time since surgery (early, 5 years). Subjective knee function was quantified using the International Knee Documentation Committee (IKDC) subjective knee form and the Knee injury and Osteoarthritis Outcome Score (KOOS). Isometric knee extension and flexion strength were collected at 90 deg/s. Single-leg hop performance was measured using the single hop, triple hop, cross-over hop, and 6-m timed hop. Coefficient correlations were calculated between subjective knee function and objective measures of muscle function for each group. The early group demonstrated moderate correlations between the KOOS and unilateral measures of flexion peak torque ( r = 0.514, P = .035) and flexion power ( r = 0.54, P = .027). The middle group demonstrated the strongest correlations between the KOOS and symmetry measures of the single hop ( r = 0.69, P = .002) and extension work ( r = 0.71, P = .002) as well as unilateral measures of the triple hop ( r = 0.52, P = .034) and extension work ( r = 0.66, P = .004). The late group demonstrated strong correlations between the 6-m timed hop symmetry and the IKDC ( r = 0.716, P = .001) and KOOS ( r = 0.71, P = .001). Patients with a post-ACLR status of less than 2 years exhibited stronger relationships with unilateral strength measures to subjective

  16. Comparing the effects of mechanical perturbation training with a compliant surface and manual perturbation training on joints kinematics after ACL-rupture.

    Science.gov (United States)

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

    2018-05-23

    Performing physical activities on a compliant surface alters joint kinematics and increases joints stiffness. However, the effect of compliant surface on joint kinematics after ACL-rupture is yet unknown. To compare the effects of mechanical perturbation training with a compliant surface to manual perturbation training on joint kinematics after ACL-rupture. Sixteen level I/II athletes with ACL-rupture participated in this preliminary study. Eight patients received mechanical perturbation with compliant surface (Mechanical) and 8 patients received manual perturbation training (Manual). Patients completed standard gait analysis before (Pre) and after (Post) training. Significant group-by-time interactions were found for knee flexion angle at initial contact (IC) and peak knee flexion (PKF) (pMechanical:27.68+4.08°, p = 0.011), hip rotation angle at PKE (Manual:-3.40+4.78°, Mechanical:5.43+4.78°, p Mechanical:0.55+2.23°, p = 0.039). Main effects of time were found for hip adduction angle at PKE (Pre:6.98+4.48°, Post:8.41+4.91°, p = 0.04), knee adduction angle at IC (Pre:-2.90+3.50°, Post:-0.62+2.58°, p = 0.03), ankle adduction angle at IC (Pre:2.16+3.54, Post:3.8+3.68, p = 0.008), and ankle flexion angle at PKF (Pre:-4.55+2.77°, Post:-2.39+3.48°, p = 0.01). Training on a compliant surface induces different effects on joint kinematics compared to manual perturbation training after ACL-rupture. Manual perturbation improved hip alignment and increased knee flexion angles, while mechanical training decreased knee flexion angles throughout the stance phase. Administering training on a compliant surface after ACL-rupture may help improving dynamic knee stability, however, long-term effects on knee health needs to be determined. Copyright © 2018 Elsevier B.V. All rights reserved.

  17. THE ASSOCIATIONS BETWEEN HIP STRENGTH AND HIP KINEMATICS DURING A SINGLE LEG HOP IN RECREATIONAL ATHLETES POST ACL RECONSTRUCTION COMPARED TO HEALTHY CONTROLS.

    Science.gov (United States)

    Tate, Jeremiah; Suckut, Tell; Wages, Jensen; Lyles, Heather; Perrin, Benjamin

    2017-06-01

    Only a small amount of evidence exists linking hip abductor weakness to dynamic knee valgus during static and dynamic activities. The associations of hip extensor strength and hip kinematics during the landing of a single leg hop are not known. Purpose: To determine if relationships exist between hip extensor and abductor strength and hip kinematics in both involved and uninvolved limb during the landing phase of a single leg hop in recreational athletes post anterior cruciate ligament (ACL) reconstruction. The presence of similar associations was also evaluated in healthy recreational athletes. Controlled Laboratory Study; Cross-sectional. Twenty-four recreational college-aged athletes participated in the study (12 post ACL reconstruction; 12 healthy controls). Sagittal and frontal plane hip kinematic data were collected for five trials during the landing of a single leg hop. Hip extensor and abductor isometric force production was measured using a hand-held dynamometer and normalized to participants' height and weight. Dependent and independent t-tests were used to analyze for any potential differences in hip strength or kinematics within and between groups, respectively. Pearson's r was used to demonstrate potential associations between hip strength and hip kinematics for both limbs in the ACL group and the right limb in the healthy control group. Independent t-tests revealed that participants post ACL reconstruction exhibited less hip extensor strength (0.18 N/Ht*BW vs. 0.25 N/Ht*BW, p=hip adduction (9.0 º vs. 0.8 º, p=hip extensor strength and maximum hip abduction/adduction angle in the involved limb. A moderate and direct relationship between hip abductor strength and maximum hip flexion angle was demonstrated in the both the involved ( r =.62) and uninvolved limb ( r =.65, p=.02). No significant associations were demonstrated between hip extensor or abductor strength and hip flexion and/or abduction/adduction angles in the healthy group. The

  18. The effective of preventive training programme on the incidence of anterior cruciate ligament injuries in female soccer players

    Directory of Open Access Journals (Sweden)

    Atakan Çağlayan

    2015-12-01

    Full Text Available Aim: The aim of this study was to prevent non-contact Anterior Cruciate Ligament (ACL injuries that occur more frequently because of anatomic, hormonal and muscular differences in female athletes, with a training programme including neuromuscular, proprioceptive and flexilibity training drills and seeing the changes on physical and physiological parameters on female athletes. Material and Methods: Our study consists of 76 female soccer players (Experimental Group (EG: 20, age:17.2±3.38years and Control Group (CG: 56, age:17.5±3.14years whom participated in Turkish Female Soccer 1. League. EG were given a training programme for six weeks, three days a week, nearly 30 minutes. Retrospective questionnaire that enclosed six months was applied to both EG and CG. For the assesment of physical and physological affects of training programme; leg strength, speed, vertical jump, aerobic and anaerobic capacity, balance, flexibility, height, weight and skinfold thickness were measured. Results: As a result of statistical analysises there wasn’t seen any significant difference on the incidence of ACL injury between EG and CG (p>0.05. A significant difference was detected on vertical jump, aerobic-anaerobic power, balance, leg strength and body fat percentage at the level of (p<0.01, speed and flexibility at the level of p<0.05. Conclusion: After six-week recovery training program there was’t not seen any ACL injury until the end of the season. Furthermore, we observed significant differences after evaulation of biomotor properties of female athletes. We suggest that this kind of researchs must be made perennial with the participation of more athletes with multidisipliner workship.

  19. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal Cord Injury Rehabilitation Pediatric Spinal ... Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal Cord Injury Rehabilitation Pediatric Spinal ...

  20. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Cord Injury Rehabilitation Pediatric Spinal Cord Injuries Video Library SCI Medical Experts People Living with SCI Personal ... Cord Injury Rehabilitation Pediatric Spinal Cord Injuries Video Library SCI Medical Experts People Living with SCI Personal ...

  1. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Cord Injury Diane M. Rowles, MS, NP How Family Life Changes After Spinal Cord Injury Nancy Rosenberg, ... Children with Spinal Cord Injury Patricia Mucia, RN Family Life After Pediatric Spinal Injury Dawn Sheaffer, MSW ...

  2. Dealing with Sports Injuries

    Science.gov (United States)

    ... Videos for Educators Search English Español Dealing With Sports Injuries KidsHealth / For Teens / Dealing With Sports Injuries ... a long way toward preventing injuries. Types of Sports Injuries Common reasons why teens get injured playing ...

  3. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Animated Spinal Cord Injury Chart Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal ... Animated Spinal Cord Injury Chart Spinal Cord Injury Facts and Figures Care and Treatment After SCI Spinal ...

  4. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Topic Resources Peer Counseling Blog About Media Donate Spinal Cord Injury Medical Expert Videos Topics menu Topics Spinal Cord Injury 101 Adult Injuries Spinal Cord Injury 101 David ...

  5. Spinal Cord Injury 101

    Medline Plus

    Full Text Available ... Topic Resources Peer Counseling Blog About Media Donate Spinal Cord Injury Medical Expert Videos Topics menu Topics Spinal Cord Injury 101 Adult Injuries Spinal Cord Injury 101 ...

  6. Drop-Jump Landing Varies With Baseline Neurocognition: Implications for Anterior Cruciate Ligament Injury Risk and Prevention.

    Science.gov (United States)

    Herman, Daniel C; Barth, Jeffrey T

    2016-09-01

    Neurocognitive status may be a risk factor for anterior cruciate ligament (ACL) injury. Neurocognitive domains such as visual attention, processing speed/reaction time, and dual-tasking may influence ACL injury risk via alterations to neuromuscular performance during athletic tasks. However, the relationship between neurocognition and performance during athletic tasks is not yet established. Athletes with low baseline neurocognitive scores will demonstrate poorer jump landing performance compared with athletes with high baseline neurocognitive score. Controlled laboratory study. Neurocognitive performance was measured using the Concussion Resolution Index (CRI). Three-dimensional kinematic and kinetic data of the dominant limb were collected for 37 recreational athletes while performing an unanticipated jump-landing task. Healthy, nonconcussed subjects were screened using a computer-based neurocognitive test into a high performers (HP; n = 20; average CRI percentile, 78th) and a low performers (LP; n = 17; average CRI percentile, 41st) group. The task consisted of a forward jump onto a force plate with an immediate rebound to a second target that was assigned 250 milliseconds before landing on the force plate. Kinematic and kinetic data were obtained during the first jump landing. The LP group demonstrated significantly altered neuromuscular performance during the landing phase while completing the jump-landing task, including significantly increased peak vertical ground-reaction force (mean ± SD of LP vs HP: 1.81 ± 0.53 vs 1.38 ± 0.37 body weight [BW]; P knee abduction moment (0.47 ± 0.56 vs 0.03 ± 0.64 BW × body height; P = .03), and knee abduction angle (6.1° ± 4.7° vs 1.3° ± 5.6°; P = .03), as well as decreased trunk flexion angle (9.6° ± 9.6° vs 16.4° ± 11.2°; P knee kinematic and kinetic patterns that are linked to ACL injury. Neurocognitive testing using the CRI may be useful for identification of athletes at elevated risk for future ACL

  7. Comparison of injury incidences between football teams playing in different climatic regions

    Directory of Open Access Journals (Sweden)

    Orchard JW

    2013-12-01

    Full Text Available John W Orchard,1 Markus Waldén,2 Martin Hägglund,3 Jessica J Orchard,1 Ian Chivers,4 Hugh Seward,5 Jan Ekstrand21School of Public Health, University of Sydney, Sydney, NSW, Australia; 2Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden; 3Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden; 4Native Seeds, Cheltenham, VIC, Australia; 5Australian Football League Medical Officers Association, Melbourne, VIC, AustraliaAbstract: Australian Football League (AFL teams in northern (warmer areas generally have higher rates of injury than those in southern (cooler areas. Conversely, in soccer (football in Europe, teams in northern (cooler areas have higher rates of injury than those in southern (warmer areas, with an exception being knee anterior cruciate ligament (ACL injuries, which are more common in the southern (warmer parts of Europe. This study examined relative injury incidence in the AFL comparing 9,477 injuries over 229,827 player-weeks from 1999–2012. There was a slightly higher injury incidence for teams from warmer parts of Australia (relative risk [RR] 1.05, 95% confidence interval [CI] 1.01–1.10 with quadriceps strains (RR 1.32, 95% CI 1.10–1.58, knee cartilage injuries (RR 1.42, 95% CI 1.16–1.74, and ankle sprains (RR 1.17, 95% CI 1.00–1.37 all being more likely in warmer region teams. Achilles injuries followed a reverse pattern, tending to be more common in cooler region teams (RR 0.70, 95% CI 0.47–1.03. In conclusion, common findings from the AFL and European soccer are that ankle sprains and ACL injuries are generally more likely in teams playing in warmer climate zones, whereas Achilles tendinopathy may be more likely in teams playing in cooler zones. These injuries may have climate or surface risk factors (possibly related to types and structure of grass and shoe-surface traction that are

  8. Fingertip Injuries

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Fingertip Injury Email to a friend * required fields ...

  9. Musculoskeletal injuries

    International Nuclear Information System (INIS)

    Gigirey, V

    2012-01-01

    This presentation is about musculoskeletal injuries and the diagnosis of osseous tumors. The use of the radiology, bone scintigraphy, computed tomography and magnetic resonance contribute to detect the localization of the osseous lesions as well as the density (lytic, sclerotic, mixed) and the benign and malignant tumors.

  10. Evaluating different closed loop graft preparation technique for tibial suspensory fixation in ACL reconstruction using TightRope™

    Directory of Open Access Journals (Sweden)

    Takahisa Sasho

    2018-04-01

    Full Text Available In most anterior cruciate ligament (ACL reconstructions, grafts are fixed to the femoral side first followed by the tibial side. Various techniques have been reported to achieve optimal tension on the grafts, but once the grafts are fixed it is difficult to adjust graft tension further. To enable post fixation tension control we have invented a new graft configuration using an adjustable loop-device (TightRopeTM, Arthrex, FL, USA on the tibial side. In this paper, biomechanical properties of this configuration using soft tissue were examined in terms of graft diameter and various suture techniques (referred to as base suture to make a closed circle to support TightRopeTM.Two experiments were conducted under different conditions. In each experiment, cyclic load, followed by a pull-to-failure load, was applied to the grafts and elongation and failure mode were recorded. (1 To evaluate the effects of diameter, 5.0 or 6.0 mm grafts were prepared by a single locking loop stitch as the base suture (SLL5, SLL6. (2 To evaluate different base sutures, 5.0 mm tendons were used, and grafts were prepared using five kinds of base sutures (SLL, ZLL: zigzag locking loop, DZLL: double zigzag locking loop, DK: double Krackow, DK w/o TR: double Krackow without TightRopeTM. In the first experiment, tearing was observed in 2 of 6 cases in the SLL5 test group, whereas no tearing was observed with SLL6. In the second experiment, no tearing was observed with DZLL or DK. Elongation was smaller in these two groups compared to the other groups. Mechanical strength decreases with a smaller graft diameter. Biomechanical properties differed with different base sutures and, among them, the double-zigzag-suture stitch and double Krackow provided less elongation and higher ultimate load in this graft configuration.

  11. Return to Play and Patient Satisfaction After ACL Reconstruction: Study with Minimum 2-Year Follow-up.

    Science.gov (United States)

    Nwachukwu, Benedict U; Voleti, Pramod B; Berkanish, Patricia; Chang, Brenda; Cohn, Matthew R; Williams, Riley J; Allen, Answorth A

    2017-05-03

    Return to play and patient satisfaction after anterior cruciate ligament reconstruction (ACLR) have been inconsistently studied. The purposes of this study were to (1) investigate rates and predictors of return to play after ACLR, (2) evaluate patient satisfaction after ACLR, and (3) analyze the relationship between return to play and satisfaction with the result of ACLR. Eligible patients were active athletes included in an institutional ACL registry who had undergone ACLR and had been followed for a minimum of 2 years. A questionnaire was administered to elicit information regarding factors associated with return to play, sports performance, reinjury, and overall patient satisfaction. The Wilcoxon-Mann-Whitney U test was used to compare return to play with patient satisfaction. Multivariable logistic regression was used to identify demographic, sports, and clinical factors associated with return to play. Two hundred and thirty-two patients with a mean age of 26.7 years (standard deviation [SD] = 12.5 years) who had been followed for a mean of 3.7 years were enrolled. Of 231 patients who responded to the return-to-play question, 201 (87.0%) had returned to play, at a mean of 10.1 months; of 175 athletes eligible to return to their prior level of competition, 89.1% had done so. Overall satisfaction was high: 85.4% were very satisfied with the outcome and 98.1% stated that they would have surgery again. Patients were more likely to respond "very satisfied" if they had returned to play (p patient satisfaction are high after ACLR in active athletes. The use of patellar tendon autograft increased the likelihood of returning to play whereas preinjury participation in soccer and lacrosse decreased these odds. Additionally, patients who returned to play were more likely to be very satisfied with the result of the ACLR. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  12. Diffusion chamber system for testing of collagen-based cell migration barriers for separation of ligament enthesis zones in tissue-engineered ACL constructs.

    Science.gov (United States)

    Hahner, J; Hoyer, M; Hillig, S; Schulze-Tanzil, G; Meyer, M; Schröpfer, M; Lohan, A; Garbe, L-A; Heinrich, G; Breier, A

    2015-01-01

    A temporary barrier separating scaffold zones seeded with different cell types prevents faster growing cells from overgrowing co-cultured cells within the same construct. This barrier should allow sufficient nutrient diffusion through the scaffold. The aim of this study was to test the effect of two variants of collagen-based barriers on macromolecule diffusion, viability, and the spreading efficiency of primary ligament cells on embroidered scaffolds. Two collagen barriers, a thread consisting of a twisted film tape and a sponge, were integrated into embroidered poly(lactic-co-caprolactone) and polypropylene scaffolds, which had the dimension of lapine anterior cruciate ligaments (ACL). A diffusion chamber system was designed and established to monitor nutrient diffusion using fluorescein isothiocyanate-labeled dextran of different molecular weights (20, 40, 150, 500 kDa). Vitality of primary lapine ACL cells was tested at days 7 and 14 after seeding using fluorescein diacetate and ethidium bromide staining. Cell spreading on the scaffold surface was measured using histomorphometry. Nuclei staining of the cross-sectioned scaffolds revealed the penetration of ligament cells through both barrier types. The diffusion chamber was suitable to characterize the diffusivity of dextran molecules through embroidered scaffolds with or without integrated collagen barriers. The diffusion coefficients were generally significantly lower in scaffolds with barriers compared to those without barriers. No significant differences between diffusion coefficients of both barrier types were detected. Both barriers were cyto-compatible and prevented most of the ACL cells from crossing the barrier, whereby the collagen thread was easier to handle and allowed a higher rate of cell spreading.

  13. Return to sport after ACL reconstruction: a survey between the Italian Society of Knee, Arthroscopy, Sport, Cartilage and Orthopaedic Technologies (SIGASCOT) members.

    Science.gov (United States)

    Grassi, Alberto; Vascellari, Alberto; Combi, Alberto; Tomaello, Luca; Canata, Gian Luigi; Zaffagnini, Stefano

    2016-07-01

    A worldwide consensus for timing and criteria for return to sport after anterior cruciate ligament (ACL) reconstruction is lacking. The aim of the study was to survey among the Italian Society of Knee, Arthroscopy, Sport, Cartilage and Orthopaedic Technologies (SIGASCOT) members in order to evaluate their approaches to the return to sport after ACL reconstruction regarding timing and criteria. A web survey among the SIGASCOT members was performed, including 14 questions regarding technical and graft preferences, timing for return to training and competitive activity for contact and non-contact sports and criteria to allow return to sport. Totally, 123 members completed the questionnaire. Return to training sports was allowed within 6 month by 87 % for non-contact sports and by 53 % for contact sports. Return to competitive activity was allowed within 6 months by 48 % for non-contact sports and by 13 % for contact sports. Full ROM (77 %), Lachman test (65 %) and Pivot-Shift test (65 %) were the most used criteria to allow return to sport. The 90 % used at least one clinical score. The SIGASCOT members showed various approaches in the return to sport after ACL reconstruction, with differences between return to training or competitive activity, and between contact and non-contact sports. Six months was generally considered adequate by most of the members for the most demanding activities. The most used criteria to allow return to sport were manual testing. A clear definition of sport activities and more objective criteria for the return to sport are needed. Level V, expert opinion.

  14. Fixation strength of biocomposite wedge interference screw in ACL reconstruction: effect of screw length and tunnel/screw ratio. A controlled laboratory study

    Directory of Open Access Journals (Sweden)

    Herrera Antonio

    2010-06-01

    Full Text Available Abstract Background Primary stability of the graft is essential in anterior cruciate ligament surgery. An optimal method of fixation should be easy to insert and provide great resistance against pull-out forces. A controlled laboratory study was designed to test the primary stability of ACL tendinous grafts in the tibial tunnel. The correlation between resistance to traction forces and the cross-section and length of the screw was studied. Methods The tibial phase of ACL reconstruction was performed in forty porcine tibias using digital flexor tendons of the same animal. An 8 mm tunnel was drilled in each specimen and two looped tendons placed as graft. Specimens were divided in five groups according to the diameter and length of the screw used for fixation. Wedge interference screws were used. Longitudinal traction was applied to the graft with a Servohydraulic Fatigue System. Load and displacement were controlled and analyzed. Results The mean loads to failure for each group were 295,44 N (Group 1; 9 × 23 screw, 564,05 N (Group 2; 9 × 28, 614,95 N (Group 3; 9 × 35, 651,14 N (Group 4; 10 × 28 and 664,99 (Group 5; 10 × 35. No slippage of the graft was observed in groups 3, 4 and 5. There were significant differences in the load to failure among groups (ANOVA/P Conclusions Longer and wider interference screws provide better fixation in tibial ACL graft fixation. Short screws (23 mm do not achieve optimal fixation and should be implanted only with special requirements.

  15. Sequential MRI Study of Graft Integrity and Signal Following Pediatric All-epiphyseal ACL Reconstruction: Does the “Sharp Turn” at the Socket of the Distal Femoral Aperture Matter?

    Science.gov (United States)

    Tuca, Maria; Greditzer, Harry Gus; Gausden, Elizabeth Bishop; Uppstrom, Tyler J.; Potter, Hollis G.; Cordasco, Frank A.; Green, Daniel W.

    2017-01-01

    . Perigraft scarring tended to reduce with follow-up (p=0.057) though not significantly, while synovitis had a significant reduction over time (p=0.01). On average, normalized SI showed no significant differences between measurements taken in different regions of the graft (p=0.58). When comparing the graft SI from 1st to 2nd MRI, no significant differences were found in any of the locations: femoral tunnel (p=0.14), proximal turn (p=0.11), midsubstance (p=0,29), intra-articular distal (p=0.10), or tibial tunnel (p=0.15). All 16 athletes returned to their prior sport at the same level of performance without re-injury. Conclusion: ACL grafts in skeletally immature patients with all-epiphyseal reconstructions maintain a stable intensity signaling at long term MRI follow-up, with no significant signal reduction over time. Despite the sharp turn created at the distal femoral socket aperture in physeal-sparing reconstructions, no particular anatomic location of the graft presents significantly different signal intensity over others. This is the first sequential mri study in pediatric epiphyseal acl reconstructions demonstrating postoperative maintenance of graft integrity and graft signal.

  16. ORBITAL INJURIES

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    Andrej Kansky

    2002-12-01

    Full Text Available Background. Orbit is involved in 40% of all facial fractures. There is considerable variety in severity, ranging from simple nondisplaced to complex comminuted fractures. Complex comminuted fractures (up to 20% ar