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Sample records for ligament reconstruction surgical

  1. The anatomic coracoclavicular ligament reconstruction: surgical technique and indications.

    PubMed

    Carofino, Brad C; Mazzocca, Augustus D

    2010-03-01

    The anatomic coracoclavicular ligament reconstruction (ACCR) is a surgical procedure to address acriomioclavicular joint instability. The coracoclavicular ligaments are reconstructed using a semitendinosus allograft passed beneath the coracoid and through bone tunnels in the clavicle. The graft is secured with interference screw fixation, and the acromioclavicular joint is retained. Here we describe the authors' surgical technique, indications, and rehabilitation protocol. Also, a preliminary case series of seventeen patients is presented. Patients demonstrated significant improvement in pain levels and function. The mean ASES score increased from 52 preoperatively to 92. The Constant Murley rose from 66.6 to 94.7. There were three failures in this series, and two required revision surgery. PMID:20188267

  2. The anterior talo-fibular ligament reconstruction in surgical treatment of chronic lateral ankle instability

    PubMed Central

    Trč, Tomáš; Handl, Milan

    2010-01-01

    Chronic lateral ankle instability causes significant problems in physical activity and accelerates development of osteoarthritic changes. The results of treatment for chronic ankle instability are often meets controversial. A surgical reconstruction of ATFL as described in this paper was performed during the period 1997–2005 on 47 patients (26 male, 21 female), with a mean age of 29.3 years. The average follow-up period was 46.2 months. All patients had clinical examination, X-ray and MRI. The mean values of the Good score improved from an average 3.32 prior to surgery to 1.19 one year after the operation. Paired t-tests showed improvements of great significance (p < 10−28). The Good score prior to surgery ranged from 2–4, whereas the scores one year after surgery were either 1 or 2, with a score of 1 being recorded in 38 cases (81%). In the postoperative follow-up, MRI showed a newly-formed ligament structure in all cases. The authors describe their own technique for a reconstruction of lateral ankle instability using remnants of the former ATFL. The scar tissue seems to be sufficient to form a new duplicated structure providing good stability. MRI proved to be a sensitive and specific method for identifying the extent of talo-fibular ligament injury. PMID:20431880

  3. Reconstruction of medial patello-femoral ligament: Comparison of two surgical techniques.

    PubMed

    Criscenti, G; De Maria, C; Sebastiani, E; Tei, M; Placella, G; Speziali, A; Vozzi, G; Cerulli, G

    2016-06-01

    The medial patello-femoral ligament is considered the most important passive patellar stabilizer and its proper functionality is essential for the patello-femoral joint stability. In this work, 18 human knees were randomly divided into two groups and reconstructed through two different surgical techniques: the "Through tunnel tendon" and the "Double converging tunnel" reconstructions. Subsequently, the samples were mechanically tested to evaluate the structural properties of reconstructed femur-MPFL-Patella complex (rFMPC). Particular attention was given to maintain the anatomical orientation between the patella and the graft. Both procedures showed lower stiffness and higher ultimate strain and absorbed energy compared to the native MPFL, but the advantages of the double converging tunnel technique are related to the restoration of the native MPFL sail-shape, to a better stress distribution on the patella, to the use of a single interference screw as fixation device and to the simplicity, rapidity and cost-effectivity of the surgical procedure. The evaluation of the structural properties of rMPFL is fundamental to evaluate the adequacy of the different techniques to restore the physiological structural properties of the native MPFL. PMID:26894660

  4. Dynamic medial patellofemoral ligament reconstruction in recurrent patellar instability: A surgical technique

    PubMed Central

    Kiran, Kopuri Ravi; Srikanth, I Muni; Chinnusamy, Lenin; Deepti, K

    2015-01-01

    The medial patellofemoral ligament (MPFL) is the primary stabilizer of the patellofemoral joint; its reconstruction has been recommended in adults over the past decade after recurrent patellar instability. However, there has been no standardized technique for reconstruction, therefore, ideal graft and technique for reconstruction are yet undetermined. However, dynamic MPFL reconstruction studies claim to be superior to other procedures as it is more anatomical. This preliminary study aims at assessing the outcomes of MPFL reconstruction in a dynamic pattern using hamstring graft. We performed this procedure in four consecutive patients with chronic patellar instability following trauma. MPFL reconstruction was done with hamstring tendons detached distally and secured to patellar periosteum after being passed through a bony tunnel in the patella without an implant and using the medial collateral ligament as a pulley. In all 4 knees, the MPFL reconstruction was isolated and was not associated with any other realignment procedures. No recurrent episodes of dislocation or subluxation were reported at 24 months followup. PMID:26806970

  5. Comparison of Clinical and Radiological Parameters with Two Different Surgical Methods for Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Çiloğlu, Osman; Çiçek, Hakan; Yılmaz, Ahmet; Özalay, Metin; Söker, Gökhan; Leblebici, Berrin

    2014-01-01

    Objectives: We investigated the effects anatomic or nonanatomic femoral tunnel positions and tunnel fixation methods obtained using two different surgery methods on tunnel widening and clinical results in anterior cruciate ligament (ACL) reconstructions. Methods: Patients with isolated anterior cruciate ligament rupture are included to study who don’t have intra-and extra-articular additional pathology of the knee, without previously a history of operations of both knees. 2 groups were created. Group 1 Aperfix implant were used which can be able to perform non anatomical femoral tunnel and intra tunnel fixation with transtibial technique. In Group 2 Endobutton CL implant were used which can make fixation from outside the cortex with anatomic femoral tunnel in use of anteromedial portal techniques. 27 patients (average age 29,33, range 18 to 55 years) in group 1 and 27 patients (average age 27,51, range 16 to 45 years) in group 2 totally 54 patients were performed surgery. All patients were assessed using the IKDC (International knee documentation committee), Tegner Activity Scala and Lysholm II Functional Scores. Muscle strength measurements in both groups compared to intact knee was measured with an isokinetic dynamometer Biodex System 3 Pro. The location of the femoral tunnel aperture and tunnel widening were imaged with 3D reconstructive computed tomography. All measurements were performed using the same software application by the same radiologist. Results: The two groups were similar with respect to age and sex distribution, operated side, the size of the tunnel created, and follow-up period (p>0.05). After surgery in both groups, the clinical scores showed significant improvement compared to preoperative (p=0,0001). However, postoperative clinical outcomes in the two groups did not show a difference significantly (p>0,005). Isokinetic muscle strength study showed significant differences between the two groups (p=0,0001). Location of femoral tunnel aperture

  6. Effectiveness of surgical reconstruction to restore radiocarpal joint mechanics after scapholunate ligament injury: an in vivo modeling study.

    PubMed

    Johnson, Joshua E; Lee, Phil; McIff, Terence E; Toby, E Bruce; Fischer, Kenneth J

    2013-05-31

    Disruption of the scapholunate ligament can cause a loss of normal scapholunate mechanics and eventually lead to osteoarthritis. Surgical reconstruction attempts to restore scapholunate relationship show improvement in functional outcomes, but postoperative effectiveness in restoring normal radiocarpal mechanics still remains a question. The objective of this study was to investigate the benefits of surgical repair by observing changes in contact mechanics on the cartilage surface before and after surgical treatment. Six patients with unilateral scapholunate dissociation were enrolled in the study, and displacement driven magnetic resonance image-based surface contact modeling was used to investigate normal, injured and postoperative radiocarpal mechanics. Model geometry was acquired from images of wrists taken in a relaxed position. Kinematics were acquired from image registration between the relaxed images, and images taken during functional loading. Results showed a trend for increase in radiocarpal contact parameters with injury. Peak and mean contact pressures significantly decreased after surgery in the radiolunate articulation and there were no significant differences between normal and postoperative wrists. Results indicated that surgical repair improves contact mechanics after injury and that contact mechanics can be surgically restored to be similar to normal. This study provides novel contact mechanics data on the effects of surgical repair after scapholunate ligament injury. With further work, it may be possible to more effectively differentiate between treatments and degenerative changes based on in vivo contact mechanics data. PMID:23618131

  7. 3D Printing Surgical Implants at the clinic: A Experimental Study on Anterior Cruciate Ligament Reconstruction

    PubMed Central

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

    2016-01-01

    Desktop three-dimensional (3D) printers (D3DPs) have become a popular tool for fabricating personalized consumer products, favored for low cost, easy operation, and other advantageous qualities. This study focused on the potential for using D3DPs to successfully, rapidly, and economically print customized implants at medical clinics. An experiment was conducted on a D3DP-printed anterior cruciate ligament surgical implant using a rabbit model. A well-defined, orthogonal, porous PLA screw-like scaffold was printed, then coated with hydroxyapatite (HA) to improve its osteoconductivity. As an internal fixation as well as an ideal cell delivery system, the osteogenic scaffold loaded with mesenchymal stem cells (MSCs) were evaluated through both in vitro and in vivo tests to observe bone-ligament healing via cell therapy. The MSCs suspended in Pluronic F-127 hydrogel on PLA/HA screw-like scaffold showed the highest cell proliferation and osteogenesis in vitro. In vivo assessment of rabbit anterior cruciate ligament models for 4 and 12 weeks showed that the PLA/HA screw-like scaffold loaded with MSCs suspended in Pluronic F-127 hydrogel exhibited significant bone ingrowth and bone-graft interface formation within the bone tunnel. Overall, the results of this study demonstrate that fabricating surgical implants at the clinic (fab@clinic) with D3DPs can be feasible, effective, and economical. PMID:26875826

  8. 3D Printing Surgical Implants at the clinic: A Experimental Study on Anterior Cruciate Ligament Reconstruction.

    PubMed

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

    2016-01-01

    Desktop three-dimensional (3D) printers (D3DPs) have become a popular tool for fabricating personalized consumer products, favored for low cost, easy operation, and other advantageous qualities. This study focused on the potential for using D3DPs to successfully, rapidly, and economically print customized implants at medical clinics. An experiment was conducted on a D3DP-printed anterior cruciate ligament surgical implant using a rabbit model. A well-defined, orthogonal, porous PLA screw-like scaffold was printed, then coated with hydroxyapatite (HA) to improve its osteoconductivity. As an internal fixation as well as an ideal cell delivery system, the osteogenic scaffold loaded with mesenchymal stem cells (MSCs) were evaluated through both in vitro and in vivo tests to observe bone-ligament healing via cell therapy. The MSCs suspended in Pluronic F-127 hydrogel on PLA/HA screw-like scaffold showed the highest cell proliferation and osteogenesis in vitro. In vivo assessment of rabbit anterior cruciate ligament models for 4 and 12 weeks showed that the PLA/HA screw-like scaffold loaded with MSCs suspended in Pluronic F-127 hydrogel exhibited significant bone ingrowth and bone-graft interface formation within the bone tunnel. Overall, the results of this study demonstrate that fabricating surgical implants at the clinic (fab@clinic) with D3DPs can be feasible, effective, and economical. PMID:26875826

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

    PubMed

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

    2016-07-01

    OBJECTIVE To determine the effect of graft choice (allograft, bone-patellar tendon-bone autograft, or hamstring autograft) on deep tissue infections following anterior cruciate ligament (ACL) reconstructions. DESIGN Retrospective cohort study. SETTING AND POPULATION Patients from 6 US health plans who underwent ACL reconstruction from January 1, 2000, through December 31, 2008. METHODS We identified ACL reconstructions and potential postoperative infections using claims data. A hierarchical stratified sampling strategy was used to identify patients for medical record review to confirm ACL reconstructions and to determine allograft vs autograft tissue implanted, clinical characteristics, and infection status. We estimated infection rates overall and by graft type. We used logistic regression to assess the association between infections and patients' demographic characteristics, comorbidities, and choice of graft. RESULTS On review of 1,452 medical records, we found 55 deep wound infections. With correction for sampling weights, infection rates varied by graft type: 0.5% (95% CI, 0.3%-0.8%) with allografts, 0.6% (0.1%-1.5%) with bone-patellar tendon-bone autografts, and 2.5% (1.9%-3.1%) with hamstring autograft. After adjusting for potential confounders, we found an increased infection risk with hamstring autografts compared with allografts (odds ratio, 5.9; 95% CI, 2.8-12.8). However, there was no difference in infection risk among bone-patellar tendon-bone autografts vs allografts (odds ratio, 1.2; 95% CI, 0.3-4.8). CONCLUSIONS The overall risk for deep wound infections following ACL reconstruction is low but it does vary by graft type. Infection risk was highest in hamstring autograft recipients compared with allograft recipients and bone-patellar tendon-bone autograft recipients. Infect Control Hosp Epidemiol 2016;37:827-833. PMID:27340734

  10. Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

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

    2014-01-01

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

  11. Coracoclavicular Ligament Reconstruction

    PubMed Central

    Li, Qi; Hsueh, Pei-ling; Chen, Yun-feng

    2014-01-01

    Abstract Operative intervention is recommended for complete acromioclavicular (AC) joint dislocation to restore AC stability, but the best operative technique is still controversial. Twelve fresh-frozen male cadaveric shoulders (average age, 62.8 ± 7.8 years) were equally divided into endobutton versus the modified Weaver-Dunn groups. Each potted scapula and clavicle was fixed in a custom made jig to allow translation and load to failure testing using a Zwick BZ2.5/TS1S material testing machine (Zwick/Roell Co, Germany). A systematic review of 21 studies evaluating reconstructive methods for coracoclavicular or AC joints using a cadaveric model was also performed. From our biomechanical study, after ligament reconstruction, the triple endobutton technique demonstrated superior, anterior, and posterior displacements similar to that of the intact state (P > 0.05). In the modified Weaver-Dunn reconstruction group, however, there was significantly greater anterior (P < 0.001) and posterior (P = 0.003) translation after ligament reconstruction. In addition, there was no significant difference after reconstruction between failure load of the triple endobutton group and that of the intact state (686.88 vs 684.9 N, P > 0.05), whereas the failure load after the modified Weaver-Dunn reconstruction was decreased compared with the intact state (171.64 vs 640.86 N, P < 0.001). From our systematic review of 21 studies, which involved comparison of the modified Weaver-Dunn technique with other methods, the majority showed that the modified Weaver-Dunn procedure had significantly (P < .05) greater laxity than other methods including the endobutton technique. The triple endobutton reconstruction proved superior to the modified Weaver-Dunn technique in restoration of AC joint stability and strength. Triple endobutton reconstruction of the coracoclavicular ligament is superior to the modified Weaver-Dunn reconstruction in controlling both superior and

  12. Ulnar Collateral Ligament Reconstruction

    PubMed Central

    Erickson, Brandon J.; Bach, Bernard R.; Cohen, Mark S.; Bush-Joseph, Charles A.; Cole, Brian J.; Verma, Nikhil N.; Nicholson, Gregory P.; Romeo, Anthony A.

    2016-01-01

    Background: Ulnar collateral ligament reconstruction (UCLR) is a common surgery performed in professional, collegiate, and high school athletes. Purpose: To report patient demographics, surgical techniques, and outcomes of all UCLRs performed at a single institution from 2004 to 2014. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent UCLR from January 1, 2004, through December 31, 2014, at a single institution were identified. Charts were reviewed to determine patient age, sex, date of surgery, sport played, athletic level, surgical technique, graft type, and complications. Data were collected prospectively, and patients were contacted via phone calls to obtain the return-to-sport rate, Conway-Jobe score, Andrews-Timmerman score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score. Continuous variable data were reported as weighted means, and categorical variable data were reported as frequencies with percentages. Results: A total of 187 patients (188 elbows) underwent UCLR during the study period (92% male; mean age, 19.6 ± 4.7 years; 78.2% right elbows). There were 165 baseball players (87.8% of all patients), 155 of whom were pitchers (82.5% of all patients). Ninety-seven (51.6%) were college athletes, 68 (36.2%) high school athletes, and 7 (3.7%) professional athletes at the time of surgery. The docking technique was used in 110 (58.5%) patients while the double-docking technique was used in 78 (41.5%). An ipsilateral palmaris longus graft was used in 110 (58.5%) patients while a hamstring autograft was used in 48 (25.5%) patients. The ulnar nerve was subcutaneously transposed in 79 (42%) patients. Clinical follow-up data were available on 85 patients. Mean follow-up was 60 ± 30.8 months. Overall, 94.1% of patients were able to return to sport and had a Conway-Jobe score of good/excellent while 4.3% had a score of fair. The mean KJOC score was 90.4 ± 6.7 and mean Andrews-Timmerman score was 92.5 ± 7

  13. Ligament reconstruction tendon interposition with mersilene augmentation.

    PubMed

    Stein, Andrew J; Schofield, Jennifer L; Marsh, Mike; Paulo, Jerry

    2011-03-01

    Many surgical procedures have been described for the treatment of thumb basilar joint osteoarthritis. Augmentation of the standard ligament reconstruction tendon interposition procedure with the use of a Mersilene suture tape suspension-plasty, to recreate the stability provided by the anterior oblique ligament and increase pinch strength, will be described. Satisfaction with this procedure was evaluated through surveys completed by patients. In addition, independent physical assessments were performed to demonstrate stability, range of motion, and strength. PMID:21358518

  14. Knee imaging after anterior cruciate ligament reconstruction.

    PubMed

    Rodrigues, M B; Silva, J J; Homsi, C; Stump, X M; Lecouvet, F E

    2001-01-01

    An increasing number of reconstructions of the anterior cruciate ligament (ACL) are performed every year, due to both the increasing occurrence of sport related injuries and the development of diagnostic and surgical techniques. The most used surgical procedure for the torn ACL reconstruction is the use of autogenous material, most often the patellar and semitendinosus tendons. Magnetic resonance (MR) imaging and spiral-CT performed after arthrography with multiplanar reconstructions are the imaging methods of choice for post-operative evaluation of ACL ligamentoplasty. This paper provides a brief bibliographic and more extensive pictorial review of the normal evolution and possible complications after ACL repair. PMID:11817479

  15. Return to Play Following Ulnar Collateral Ligament Reconstruction.

    PubMed

    Cain, Edward Lyle; McGonigle, Owen

    2016-10-01

    Ulnar collateral ligament injury in the overhead athlete typically presents as activity-related pain with loss of velocity and control. Treatment options range from nonoperative rehabilitation to ligament reconstruction. Surgical reconstruction is frequently required to allow the athlete to return to competition and many surgical techniques have been described. The rehabilitation process to return back to overhead athletics, in particular pitching, is prolonged and requires progression through multiple phases. Despite this, surgical treatment has been shown by multiple investigators to be successful at returning athletes to their previous level of competition. PMID:27543400

  16. Medial Patellofemoral Ligament Reconstruction: A Comprehensive Review

    PubMed Central

    Kim, Hee-June

    2015-01-01

    It has been suggested that in the majority of patellar dislocation cases, the medial patellofemoral ligament (MPFL) is disrupted with a high recurrence rate especially in female patients. Although MPFL tear is not the primary cause of instability, MPFL reconstruction is effective for stabilizing the knee and may alone prevent lateral patellar dislocation. There is limited but growing evidence that MPFL reconstruction for patellofemoral instability leads to excellent functional outcomes. Growing awareness of the biomechanical contribution of the MPFL has led to an upsurge in the publication of techniques and trials dealing with reconstructive techniques, warranting a review that includes the most recent evidence. The aim of this article was to review and summarize the recent literatures concerning MPFL reconstruction and provide a comprehensive review of previous studies ranging from basic science to current surgical techniques and results. PMID:26389065

  17. Anatomic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Murawski, Christopher D.; Wolf, Megan R.; Araki, Daisuke; Muller, Bart; Tashman, Scott

    2013-01-01

    Anatomic anterior cruciate ligament (ACL) reconstruction is common procedure performed by orthopedic surgeons, particularly in association with sports-related injuries. Whereas traditional reconstruction techniques used a single bundle graft that was typically placed in a non-anatomic position, a renewed interest in anatomy has facilitated the popularization of anatomic reconstruction techniques. Recently, a focus has been placed on individualizing ACL surgery based on each patient’s native anatomical characteristics (e.g., insertion site size, notch size, and shape), thereby dictating the ultimate procedure of choice. As subjective outcome measurements have demonstrated varying outcomes with respect to single- versus double-bundle ACL reconstruction, investigators have turned to more objective techniques, such as in vivo kinematics, as a means of evaluating joint motion and cartilage contact mechanics. Further investigation in this area may yield important information with regard to the potential progression to osteoarthritis after ACL reconstruction, including factors affecting or preventing it. PMID:26069663

  18. Surgical Dissection of the Anterolateral Ligament.

    PubMed

    Daggett, Matthew; Busch, Kyle; Sonnery-Cottet, Bertrand

    2016-02-01

    Recent investigations into the structure and function of the anterolateral ligament (ALL) have resulted in renewed interest in the role of the lateral extra-articular structures in rotational control of the knee. With increased focus on the ALL, debate about the anatomic characteristics, the functional role in knee stability, and even the existence of this lateral structure has ensued. This article describes our dissection method for the ALL. Through careful dissection and precise elevation of the iliotibial band, the ALL can be clearly identified as a distinct structure with an attachment near the lateral epicondyle on the femur and an insertion in a fan-like fashion onto the tibia, between the Gerdy tubercle and the fibular head. This investigation provides the surgeon with anatomic landmarks to use during surgical reconstruction of the ALL. PMID:27274451

  19. [Capsular ligament lesions of the knee joint. Conservative and surgical treatment].

    PubMed

    Gradinger, R; Haller, W; Rodammer, G; Rechl, H

    1989-02-28

    On the basis of our experience with more than 600 reconstructed capsular ligament injuries of the knee joint, we conclude that conservative functional treatment should be preserved for patients with capsular ligament lesions with no loss of stability. On an individual basis, it must be decided whether, in the event of a more or less large degree of instability presenting, conservative mobilising treatment (patients older than 45 years), or surgical reconstructive treatment should be provided. Surgical procedures aim at achieving anatomical reconstruction, which is only approximately possible with secondary reconstruction in the presence of chronic instability. For the reconstruction of the anterior cruciate ligament, the use of the semitendinosus tendon for reinforcement with possible reattachment of the cruciate ligament can be recommended. Otherwise, the free patellar ligament transplant, as far as possible with additional synovialisation--which permits better revitalisation of the ligament--should be employed. PMID:2703203

  20. [Dorsal ligament reconstruction in scapholunate dissociation].

    PubMed

    Zilch, H

    1985-07-01

    After discussion of the importance of the palmar, dorsal and interosseous ligaments in cases of scapholunate subluxation, the radiologic signs of this carpal instability are described. Four cases with this instability were treated successfully by reconstruction of the dorsal ligaments. In three instances ligament reconstruction was performed with the split tendon of the extensor carpi radialis brevis passed through drill holes in the scaphoid and lunate similar to the method reported by Dobyns. PMID:4029764

  1. Bone tunnel enlargement on anterior cruciate ligament reconstruction

    PubMed Central

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

    2014-01-01

    Objective: To assess the presence of tibial bone tunnel enlargement after surgical reconstruction of the anterior cruciate ligament using quadruple graft of the flexor tendons and correlate the functional results in their presence. Methods: The studied lasted six months and included 25 patients, with ages ranging from 18 to 43 years old. Assessment was based on radiographs taken immediately postoperatively and at the third and sixth month of follow up in the anterior cruciate ligament reconstruction. Reconstruction of ligaments was performed with tendon grafts of the semitendinosus and gracilis muscle fixated in the femur with transverse metal screw and in the tibia with interference screws. Patients were evaluated objectively by tests ligament, graded from zero to four crosses and subjectively by the Lysholm method preoperative and after sixth month follow up. Results: Significant increase in the tunnels diameters were observed, 20.56% for radiographs in the anteroposterior view, 26.48% in profile view and 23.22% in computed tomography. Descriptive statistics showed significant improvement in subjective and objective clinical parameters. Conclusions: The bone tunnel enlargement is a phenomenon found in the first months after surgical reconstruction of the anterior cruciate ligament and it has no implications on clinical outcomes in the short term. Level of Evidence II, Prospective Study. PMID:25328430

  2. Anterior Cruciate Ligament Reconstruction Rehabilitation

    PubMed Central

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

    2015-01-01

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

  3. Medial patellofemoral ligament reconstruction in patellar instability

    PubMed Central

    Krishna Kumar, MS; Renganathan, Sankarram; Joseph, Clement J; Easwar, TR; Rajan, David V

    2014-01-01

    Background: Medial patellofemoral ligament (MPFL) is one of the major static medial stabilising structures of the patella. MPFL is most often damaged in patients with patellar instability. Reconstruction of MPFL is becoming a common surgical procedure in treating patellar instability. We hypothesised that MPFL reconstruction was adequate to treat patients with patellar instability if the tibial tubercle and the centre of the trochlear groove (TT-TG) value was less than 20 mm and without a dysplastic trochlea. Materials and Methods: 30 patients matching our inclusion criteria and operated between April 2009 and May 2011 were included in the study. MPFL reconstruction was performed using gracilis tendon fixed with endobutton on the patellar side and bio absorbable interference screw or staple on the femoral side. Patients were followed up with subjective criteria, Kujala score and Lysholm score. Results: The mean duration of followup was 25 months (range 14-38 months). The mean preoperative Kujala score was 47.5 and Lysholm score was 44.7. The mean postoperative Kujala score was 87 and Lysholm score was 88.06. None of the patients had redislocation. Conclusion: MPFL reconstruction using gracilis tendon gives excellent results in patients with patellar instability with no redislocations. Some patients may have persistence of apprehension. PMID:25298558

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

    PubMed

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

    2015-11-01

    Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomic, biomechanical and radiological characteristics of the native anterolateral ligament (ALL) of the knee have led to a resurgent interest in reconstruction of this structure as part of the management of knee instability. This technical note describes our readily reproducible combined minimally invasive technique to reconstruct both the ACL and ALL anatomically using autologous semitendinosus and gracilis grafts. This method of ALL reconstruction can be easily integrated with all-inside ACL reconstruction, requiring minimal additional operative time, equipment and expertise. Level of evidence V. PMID:26387120

  5. Reconstruction of the anterior cruciate ligament.

    PubMed

    Seedhom, B B

    1992-01-01

    Ligaments are strong collagenous structures that act as constraints on joint motion, thus confining the articular surfaces to more or less the same paths. In so doing they prevent arbitrary apposition of these surfaces from occurring and resulting in abnormal stresses which may damage the joint surfaces. Ligaments rupture due to excessive loads, particularly those resulting from trauma occurring during sporting events or motor vehicle accidents. Knee and ankle joints have the highest frequency of ligamentous injuries. This paper is a brief review of the current approaches to the reconstruction of the knee ligaments with specific reference to the anterior cruciate ligament (ACL) being the most frequently reconstructed. This is not only because it is frequently injured but also because of the debilitating consequences of such an injury. Approaches ranging from the conservative to those that advocate the use of frank prosthetic replacement have been adopted by surgeons at both ends of the spectrum. Following a discussion of the rationale for reconstruction of the ACL, the mechanical and biological considerations of the reconstructive procedure are discussed. The different methods of ACL reconstruction are reviewed. These include: (a) primary repair, (b) reconstruction with different tissues, including autogenous allografts and xenografts, (c) reconstruction employing different synthetic devices. A brief discussion of the procedures used for reconstruction with different types of tissue and of the surviving examples of the synthetic devices will follow. PMID:1418190

  6. [Increase in surgical treatment of anterior cruciate ligament injury].

    PubMed

    Meuffels, D E

    2009-01-01

    An anterior cruciate ligament (ACL) rupture is a very common musculoskeletal injury. The number of ACL reconstructions is increasing, both in the Netherlands and worldwide. Substantial progress has been made in surgical technique: from open to arthroscopic procedures. An ACL reconstruction will not diminish the chance of osteoarthritis, and the biomechanical properties of the knee will never be the same as before the trauma. An ACL reconstruction does, however, reduce the chance of instability, or 'giving way', which is the most important indication for surgical intervention. There are insufficient long-term results described in the literature to indicate either surgery or conservative measures as the treatment of choice. Treatment should be individually determined, taking into consideration factors such as: pattern of symptoms, degree of instability, desire to practise sport, age and willingness to commit to a 9-month rehabilitation programme. PMID:21401972

  7. Ulnar Collateral Ligament Reconstruction; the Rush Experience

    PubMed Central

    Erickson, Brandon J.; Bach, Bernard R.; Cohen, Mark S.; Bush-Joseph, Charles A.; Cole, Brian J.; Verma, Nikhil N.; Nicholson, Gregory P.; Romeo, Anthony A.

    2016-01-01

    Objectives: Background: Ulnar collateral ligament reconstruction (UCLR) is now a common surgery performed in both professional, as well as high level athletes Purpose: To report the patient demographics, surgical techniques, and outcomes of all UCLR performed at a single institution from 2004-2014 Hypothesis: UCLR will be performed mostly in male pitchers and will have a complication rate of less than 5%. Methods: Methods: The surgical database of one institution was searched from January 1st 2004-December 31st 2014 for the current procedural terminology (CPT) code 24346 “Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)”. Charts were reviewed to determine patient age, gender, date of surgery, sport played, athletic level, surgical technique, graft type, and complications were recorded. Patients were contacted via phone calls to obtain the return to sport rate, Conway-Jobe score, Timmerman & Andrews score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score. Results: Results: One hundred eighty-nine patients underwent UCLR during the study period (92% male, average age 19.6 +/- 4.9 years, 77.8% were right elbows). There were 166 baseball players (87.8% of all patients), 156 of which were pitchers (82.5% of all patients). Ninety-eight (51.6%) were college athletes, 62 (36%) were high school athletes, and 25 (13.2%) were professional athletes at the time of surgery. The docking technique was used in 111 (58.7%) patients while the double docking technique was used in 78 (41.3%). An ipsilateral palmaris longus graft was used in 111 (58.7%) of patients while a hamstring autograft was used in 48 (25.4%) patients. The ulnar nerve was subcutaneously transposed in 79 (41.8%) patients. Overall 95.7% of patients were able to return to sport and had a Conway-Jobe score of good/excellent while 4.3% had a score of fair. The average KJOC score was 94.7 +/- 5.7 and average Timmerman-Andrews score was 93.7 +/- 7

  8. Isokinetic and anterior cruciate ligament reconstruction with hamstrings or patella tendon graft: analysis of literature.

    PubMed

    Dauty, M; Tortellier, L; Rochcongar, P

    2005-09-01

    We report isokinetic results of anterior cruciate ligament reconstruction with patellar tendon or hamstring graft from the literature analysis. The literature was defined from two search "textwords": Isokinetic and Anterior cruciate ligament reconstruction, and from three databases: Medline, Pascal, and Herasmus. Two independent physicians (Physical Medicine and Rehabilitation) carried out an analysis according to the French National Accreditation and Health Evaluation Agency recommendations. Fifty-three studies were selected: 29 reported isokinetic results after anterior cruciate ligament reconstruction with patellar tendon graft, 15 reported isokinetic results after anterior cruciate ligament reconstruction with hamstring graft, and 9 studies compared the two surgical procedures. After discussing different bias and in reference to prospective randomised and comparative studies, the anterior cruciate ligament reconstruction with patellar tendon graft involves a knee extensors deficit during several months. The hamstring surgical procedure involves a less important knee extensor deficit (from 6 to 19 % against 8 to 21 %). Knee sprain and intra-articular surgery involve a long-lasting knee extensors deficit. Anterior cruciate ligament reconstruction with hamstrings graft involves a knee flexors deficit over several months. The patellar tendon surgical procedure involves a less important knee flexors deficit (from 1 to 15 % against 5 to 17 %). In reference to isokinetic parameters, no difference between the two surgical procedures (patellar tendon graft or hamstring graft) is shown after more than twenty-four post-surgical months. PMID:16195995

  9. A Finite Element Analysis of Medial Patellofemoral Ligament Reconstruction

    PubMed Central

    DeVries Watson, Nicole A.; Duchman, Kyle R.; Bollier, Matthew J.; Grosland, Nicole M.

    2015-01-01

    Background The medial patellofemoral ligament is the primary soft-tissue restraint to lateral patella translation. Medial patellofemoral ligament reconstruction has become a viable surgical option to provide patellar stability in patients with recurrent instability. The primary goal of this study was to determine the effect of medial patellofemoral ligament reconstruction on the lateral force-displacement behavior of the patella using finite element analyses. Methods A finite element model of the knee was created using cadaveric image data. Experimental testing was performed to validate the computational model. After validation, the model was modified to study the effect of various medial patellofemoral ligament reconstruction insertion sites, allowing comparison of patellofemoral contact force and pressure. Results For the intact anatomic model, the lateral restraining force was 80.0 N with a corresponding patellar contact area of 54.97 mm2. For the anatomic reconstructed medial patellofemoral ligament model, the lateral restraining force increased to 148.9 N with a contact area of 71.78 mm2. This compared favorably to the corresponding experimental study. The force required to laterally displace the patella increased when the femoral insertion site was moved anteriorly or distally. The lateral restraining force decreased when the femoral insertion site moved proximally and the patellar insertion site moved either proximal or distal by 5 mm. Conclusion The line of action was altered with insertion site position, which in turn changed the amount of force it took to displace the patella laterally. Considering the model constraints, an anterior femoral attachment may over constrain the patella and increase cartilage wear due to increase contact area and restraining force. Clinical Relevance A malpositioned femoral tunnel in MPFL reconstruction could increase restraining forces and PF contact pressure, thus it is suggested to use intra-operative fluoroscopy to confirm

  10. A historical perspective on ankle ligaments reconstructive surgery.

    PubMed

    Di Matteo, Berardo; Tarabella, Vittorio; Filardo, Giuseppe; Tomba, Patrizia; Viganò, Anna; Marcacci, Maurilio; Zaffagnini, Stefano

    2016-04-01

    Ankle sprains are by far the most common injuries treated by sport medicine physicians. Treatment is mainly conservative, but in some cases surgical intervention is required. The aim of the present manuscript is to give an insight into the origins and developments of ankle ligaments reconstructive surgery, underlining the fundamental steps that marked the transition from a mere conservative approach to surgical treatment options. In this historical note, the most illustrious figures who contributed to this particular field of orthopaedic practice are also acknowledged. Level of evidence V. PMID:26718639

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

    Gali, Julio Cesar

    2015-01-01

    We describe the surgical approach that we have used over the last years for anterior cruciate ligament (ACL) reconstruction, highlighting the importance of arthroscopic viewing through the anteromedial portal (AMP) and femoral tunnel drilling through an accessory anteromedial portal (AMP). The AMP allows direct view of the ACL femoral insertion site on the medial aspect of the lateral femoral condyle, does not require guides for anatomic femoral tunnel reaming, prevents an additional lateral incision in the distal third of the thigh (as would be unavoidable when the outside-in technique is used) and also can be used for double-bundle ACL reconstruction. PMID:26417571

  13. Posterior Wall Blowout in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Mitchell, Justin J.; Dean, Chase S.; Chahla, Jorge; Menge, Travis J.; Cram, Tyler R.; LaPrade, Robert F.

    2016-01-01

    Violation of the posterior femoral cortex, commonly referred to as posterior wall blowout, can be a devastating intraoperative complication in anterior cruciate ligament (ACL) reconstruction and lead to loss of graft fixation or early graft failure. If cortical blowout occurs despite careful planning and adherence to proper surgical technique, a thorough knowledge of the anatomy and alternative fixation techniques is imperative to ensure optimal patient outcomes. This article highlights anatomic considerations for femoral tunnel placement in ACL reconstruction and techniques for avoidance and salvage of a posterior wall blowout. PMID:27335885

  14. Novel technique for ulnar collateral ligament reconstruction of the elbow.

    PubMed

    Acevedo, Daniel C; Lee, Brian; Mirzayan, Raffy

    2012-11-01

    Ulnar collateral ligament (UCL) reconstruction of the elbow has been shown to restore function in overhead athletes with valgus instability. Since the initial description of using bone tunnels for reconstruction, many modifications to the surgical technique have been introduced, including the modified Jobe technique, the docking technique, fixation with interference screws, and button fixation. The authors introduce a technique that uses a button on each of the humeral and ulnar sides for fixation. This method allows proper tensioning of the graft and provides immediate secure fixation that relies on metal implants as opposed to sutures over bone bridges alone. PMID:23127439

  15. Ulnar Collateral Ligament Reconstruction of the Elbow

    PubMed Central

    Erickson, Brandon J.; Chalmers, Peter N.; Bush-Joseph, Charles A.; Verma, Nikhil N.; Romeo, Anthony A.

    2015-01-01

    Background: Ulnar collateral ligament reconstruction (UCLR) is a common procedure in both professional and high-level athletes. Purpose: To determine the effect of technique and level of play with UCLR on return to sport (RTS). Hypothesis: When comparing different surgical techniques or preoperative level of sports participation, there is no difference in rate of RTS after UCLR. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was registered with PROSPERO and performed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting UCLR outcomes with level of evidence 1 through 4 were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Descriptive statistics were calculated, and 2-proportion 2-sample z-test calculators with α = .05 were used to compare RTS between level of play and technique. Results: Twenty studies (2019 patients/elbows; mean age, 22.13 ± 4 years; 97% male; mean follow-up, 39.9 ± 16.2 months) were included. The majority of patients were baseball players (94.5%), specifically pitchers (80%). The most common level of play was collegiate (44.6%). Palmaris longus (71.2%) and the American Sports Medicine Institute (ASMI) technique (65.6%) were the most common graft choice and surgical technique, respectively. There was a pooled 86.2% RTS rate, and 90% of players scored excellent/good on the Conway-Jobe scale. RTS rates were higher among collegiate athletes (95.5%) than either high school (89.4%, P = .023) or professional athletes (86.4%, P < .0001). RTS rates were higher for the docking technique (97.0%, P = .001) and the ASMI technique (93.3%, P = .0034) than the Jobe technique (66.7%). Conclusion: UCLR is performed most commonly in collegiate athletes. Collegiate athletes have the highest RTS rate

  16. Spring ligament reconstruction using the autogenous flexor hallucis longus tendon.

    PubMed

    Lee, Woo-Chun; Yi, Young

    2014-07-01

    The calcaneonavicular (spring) ligament complex is the soft tissue most often seen to fail in flatfoot pathology and is associated with deformity of the talonavicular joint. The spring ligament complex supports the talar head, preventing it from displacing into excessive plantar flexion/adduction. An anatomical reconstruction of the spring ligament should replicate this function. A new method of spring ligament reconstruction using autogenous flexor hallucis longus tendon transfer is reported. PMID:24992052

  17. Compression of the Popliteal Artery after Posterior Cruciate Ligament Reconstruction Using the Tibial Inlay Technique

    PubMed Central

    Seo, Seung Suk; Kim, Do Hun; Park, Byung Yoon

    2015-01-01

    Popliteal artery compression rarely occurs after posterior cruciate ligament (PCL) reconstruction using the tibial inlay technique that allows for direct visualization of the surgical field. However, we experienced a popliteal artery compression after PCL reconstruction performed using the technique, which eventually required re-operation. Here, we report this rare case and discuss reasons of popliteal artery compression. PMID:26673356

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

    PubMed Central

    DELLA VILLA, FRANCESCO; RICCI, MARGHERITA; PERDISA, FRANCESCO; FILARDO, GIUSEPPE; GAMBERINI, JACOPO; CAMINATI, DANIELE; DELLA VILLA, STEFANO

    2015-01-01

    Surgical reconstruction of an injured anterior cruciate ligament (ACL) leads to full recovery of function and sports activity in a high percentage of cases. The aim of the present study was to analyze variables related to the patient, the surgical technique and the post-surgical rehabilitation methods, seeking to identify predictors of outcome and recovery time after ACL reconstruction. One hundred and four patients (81 M, 23 F) undergoing a step-based rehabilitation protocol after ACL reconstruction were evaluated. 43.2% of them had an isolated ACL lesion, whereas 56.8% had one or more concurrent injuries. Data relating to personal characteristics, surgery and post-operative management were collected and analyzed for correlation. Clinical outcome was evaluated with IKDC subjective score and the Tegner score, and the time to reach full recovery was noted as well. Young patients with a higher pre-injury Tegner activity level or who practice sport at professional level, no concurrent capsular lesions and no postoperative knee bracing had better clinical results and took shorter time to recover. Also, a higher percentage of on-the-field rehabilitation sessions, and absence of significant muscle strength deficits at the first knee isokinetic test emerged as rehabilitation-related factors leading to a better post-surgical outcome. Personal, surgical and rehabilitation factors should be considered in order to optimize patient management and maximize the expected results. Further studies are needed to find the strongest factors in different patients. Level of evidence Level IV, retrospective study. PMID:26904523

  19. Knee Bracing After Anterior Cruciate Ligament Reconstruction.

    PubMed

    Rodríguez-Merchán, E Carlos

    2016-07-01

    Although some articles in the literature are in favor of the use of a postoperative brace after anterior cruciate ligament (ACL) reconstruction, this review found that several systematic reviews and other reports on the topic do not support the use of a postoperative brace after ACL reconstruction. There is no scientific evidence so far to support the routine use of a functional knee brace following a successful ACL reconstruction in the postoperative course. Most authors believe that bracing is not necessary. There is insufficient evidence to inform current practice. Good-quality randomized trials are required to remedy this situation. Future studies should better define the role of a brace following ACL surgery. A search of MEDLINE for articles published between January 1, 1995, and September 30, 2013, was performed. Key search terms used were ACL reconstruction and knee brace. Ninety-one articles were found, but only 28 focused on the subject of bracing after ACL reconstruction and were selected for this review. Several systematic reviews and randomized, controlled trials on the topic do not recommend the use of postoperative brace after ACL reconstruction. Postoperative bracing after ACL reconstruction does not seem to help with pain, function, rehabilitation, and stability. The literature does not support the use of a postoperative brace following ACL reconstruction. [Orthopedics. 2016; 39(4):e602-e609.]. PMID:27203412

  20. Ankle Arthroscopic Reconstruction of Lateral Ligaments (Ankle Anti-ROLL)

    PubMed Central

    Takao, Masato; Glazebrook, Mark; Stone, James; Guillo, Stéphane

    2015-01-01

    Ankle instability is a condition that often requires surgery to stabilize the ankle joint that will improve pain and function if nonoperative treatments fail. Ankle stabilization surgery may be performed as a repair in which the native existing anterior talofibular ligament or calcaneofibular ligament (or both) is imbricated or reattached. Alternatively, when native ankle ligaments are insufficient for repair, a reconstruction of the ligaments may be performed in which an autologous or allograft tendon is used to reconstruct the anterior talofibular ligament or calcaneofibular ligament (or both). Currently, ankle stabilization surgery is most commonly performed through an open incision, but arthroscopic ankle stabilization using repair techniques has been described and is being used more often. We present our technique for anatomic ankle arthroscopic reconstruction of the lateral ligaments (anti-ROLL) performed in an all–inside-out manner that is likely safe for patients and minimally invasive. PMID:26900560

  1. Infections in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Stucken, Charlton; Garras, David N.; Shaner, Julie L.; Cohen, Steven B.

    2013-01-01

    Context: Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity, potentially resulting in a poor clinical outcome. Evidence Acquisition: Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters. Results: Treatment with culture-specific antibiotics and debridement with graft retention is recommended as initial treatment, but with persistent infection, consideration should be given to graft removal. Graft type likely has no effect on infection rates. Conclusion: The early diagnosis of infection and appropriate treatment are necessary to avoid the complications of articular cartilage damage and arthrofibrosis. PMID:24427432

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

    PubMed Central

    Marchie, Anthony; Kumar, Arun; Catre, Melanio

    2009-01-01

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

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

    PubMed Central

    Millett, Peter J; Braun, Sepp; Gobezie, Reuben; Pacheco, Iván H

    2009-01-01

    Background Symptomatic Acromioclavicular (AC) dislocations have historically been surgically treated with Coracoclavicular (CC) ligament reconstruction with transfer of the Coracoacromial (CA) ligament. Tensioning the CA ligament is the key to success. Methods Seventeen patients with chronic, symptomatic Type III AC joint or acute Type IV and V injuries were treated surgically. The distal clavicle was resected and stabilized with CC ligament reconstruction using the CA ligament. The CA ligament was passed into the medullary canal and tensioned, using a modified 'docking' technique. Average follow-up was 29 months (range 12–57). Results Postoperative ASES and pain significantly improved in all patients (p = 0.001). Radiographically, 16 (94%) maintained reduction, and only 1 (6%) had a recurrent dislocation when he returned to karate 3 months postoperatively. His ultimate clinical outcome was excellent. Conclusion The docking procedure allows for tensioning of the transferred CA ligament and healing of the ligament in an intramedullary bone tunnel. Excellent clinical results were achieved, decreasing the risk of recurrent distal clavicle instability. PMID:19144190

  4. Anatomic Tunnel Placement in Anterior Cruciate Ligament Reconstruction.

    PubMed

    Dhawan, Aman; Gallo, Robert A; Lynch, Scott A

    2016-07-01

    The anatomic anterior cruciate ligament (ACL) reconstruction concept has developed in part from renewed interest in the insertional anatomy of the ACL, using surgical techniques that can reproduce this anatomy reliably and accurately during surgical reconstruction. Several technical tools are available to help identify and place the tibial and femoral grafts anatomically, including arthroscopic anatomic landmarks, a malleable ruler device, and intraoperative fluoroscopy. The changes in technique for anatomic tunnel placement in ACL reconstruction follow recent biomechanical and kinematic data that demonstrate improved time zero characteristics. A better re-creation of native ACL kinematics and biomechanics is achieved with independent femoral drilling techniques that re-create a central footprint single-bundle ACL reconstruction or double-bundle reconstruction. However, to date, limited short-term and long-term clinical outcome data have been reported that support using either of these techniques rather than a transtibial drilling technique. This lack of clear clinical advantage for femoral independent and/or double-bundle techniques may arise because of the potentially offsetting biologic incorporation challenges of these grafts when placed using these techniques or could result from modifications made in traditional endoscopic transtibial techniques that allow improved femoral and tibial footprint restoration. PMID:27243794

  5. Return to Play Following Anterior Cruciate Ligament Reconstruction.

    PubMed

    Morris, Ryan C; Hulstyn, Michael J; Fleming, Braden C; Owens, Brett D; Fadale, Paul D

    2016-10-01

    Anterior cruciate ligament reconstructions are commonly performed in an attempt to return an athlete to sports activities. Accelerated rehabilitation has made recovery for surgery more predictable and shortened the timeline for return to play. Despite success with and advancements in anterior cruciate ligament reconstructions, some athletes still fail to return to play. PMID:27543405

  6. Endoscopic Ankle Lateral Ligament Graft Anatomic Reconstruction.

    PubMed

    Michels, Frederick; Cordier, Guillaume; Guillo, Stéphane; Stockmans, Filip

    2016-09-01

    Chronic instability is a common complication of lateral ankle sprains. If nonoperative treatment fails, a surgical repair or reconstruction may be indicated. Today, endoscopic techniques to treat ankle instability are becoming more popular. This article describes an endoscopic technique, using a step-by-step approach, to reconstruct the ATFL and CFL with a gracilis graft. The endoscopic technique is reproducible and safe with regard to the surrounding anatomic structures. Short and midterm results confirm the benefits of this technique. PMID:27524711

  7. [Results of ligament reconstruction in advanced scapholunate dissociation].

    PubMed

    Wieloch, P T; Martini, A-K; Daecke, W

    2005-04-01

    Scapholunate dissociation is one of the most common disorders of the wrist. Untreated it might lead to osteoarthrosis (scapholunate advanced collapse, SLAC wrist). Choosing the best surgical treatment option is still challenging, especially in cases of carpal collapse in combination with beginning osteoarthrosis of the radial styloid and the proximal pole of the scaphoid. We report the results of a homogenous group of eight patients with reducible carpal collapse and beginning arthrosis treated by reconstruction of the scapholunate ligament. The operation was performed 66 (range: 20 to 252) months after trauma. The average length of follow-up was two years. Five patients stated general improvement, while three reported a change for the worse. At follow-up, the average total range of motion of the operated wrist was decreased by 16 % compared to the unaffected side. The average grip-strength (measured with a Jamar dynamometer) was 77 % of the uninvolved wrist. The DASH score was 43 +/- 25. In three cases the Martini score showed a good or an excellent result. The average scapholunate angle was 72.3 degrees preoperatively and decreased to 61.0 degrees at follow-up. At follow-up as well as pre- and postoperatively the carpal height ratio showed pathologic mean values. Therefore, reconstruction of the carpal alignment was not achieved in most of the cases. Progression of the osteoarthrosis has to be expected. Reconstruction of the scapholunate ligament for treatment of carpal collapse with beginning osteoarthrosis therefore remains an unsolved problem. PMID:15877269

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    1998-11-01

    The consequences of athletic injuries extend beyond the musculoskeletal system. Depression, anger, and tension have been observed in athletes with athletic injuries. It was hypothesized that among student athletes, the psychologic impact of injury may be seen as a drop in academic performance. Thirty-eight students who had an anterior cruciate ligament injury and subsequent reconstruction were evaluated retrospectively by academic transcript and questionnaire to measure their academic performance before their injury, in the semester of their injury, and in the semester after their surgery. The patients were compared with randomly selected undergraduate control subjects. To evaluate any effect of the timing of the surgery on academic performance, the patients were separated into two groups, according to the timing of their reconstruction: those who had surgery during the academic semester, and those who elected to wait for a school break. There was a significant drop in grade point average of 0.3 grade points during the semester of injury among all injured students. Compared with those who had surgery during a break, the students who had surgery during the semester received more frequently the grade of failure (6% versus 0%) or incomplete (33% versus 9%). These students also missed more school days (10.5 days versus 1.5 days) and examinations (2.2 examinations versus 0.1 examinations). Only 47% of students who had surgery during the semester were satisfied with their decision for surgical timing, compared with 96% satisfied with the timing during an academic break. Acute anterior cruciate ligament rupture, and surgical reconstruction during an academic semester, have a significant academic effect in university students. PMID:9917686

  10. Clinical Outcomes After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Tibor, Lisa M.; Long, Joy L.; Schilling, Peter L.; Lilly, Ryan J.; Carpenter, James E.; Miller, Bruce S.

    2010-01-01

    Background: Clinical outcomes of autograft and allograft anterior cruciate ligament (ACL) reconstructions are mixed, with some reports of excellent to good outcomes and other reports of early graft failure or significant donor site morbidity. Objective: To determine if there is a difference in functional outcomes, failure rates, and stability between autograft and allograft ACL reconstructions. Data Sources: Medline, Cochrane Central Register of Controlled Trials (Evidence Based Medicine Reviews Collection), Cochrane Database of Systematic Reviews, Web of Science, CINAHL, and SPORTDiscus were searched for articles on ACL reconstruction. Abstracts from annual meetings of the American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America were searched for relevant studies. Study Selection: Inclusion criteria for studies were as follows: primary unilateral ACL injuries, mean patient age less than 41 years, and follow-up for at least 24 months postreconstruction. Exclusion criteria for studies included the following: skeletally immature patients, multiligament injuries, and publication dates before 1990. Data Extraction: Joint stability measures included Lachman test, pivot-shift test, KT-1000 arthrometer assessment, and frequency of graft failures. Functional outcome measures included Tegner activity scores, Cincinnati knee scores, Lysholm scores, and IKDC (International Knee Documentation Committee) total scores. Results: More than 5000 studies were identified. After full text review of 576 studies, 56 were included, of which only 1 directly compared autograft and allograft reconstruction. Allograft ACL reconstructions were more lax when assessed by the KT-1000 arthrometer. For all other outcome measures, there was no statistically significant difference between autograft and allograft ACL reconstruction. For all outcome measures, there was strong evidence of statistical heterogeneity between

  11. Bone Osteolysis Following Acromioclavicular Joint Reconstruction Using Synthetic Ligament (Surgilig™)

    PubMed Central

    Sarda, Praveen; Richards, Andrew M.; Corbett, Steven A.

    2013-01-01

    Good short term results have led to increased use of synthetic ligaments for acute and chronic acromioclavicular joint (ACJ) disruption. They have proved quite safe in the short term but we present two cases of osteolysis following ACJ reconstruction using a synthetic ligament, reminding surgeons of potential complications with artificial ligaments. A high index of suspicion is needed to diagnose such complications early before irretrievable bone loss to osteolysis.

  12. Medial Patellofemoral Ligament Reconstruction for Patellar Dislocation

    PubMed Central

    Mackay, Nicola D.; Smith, Nicholas A.; Parsons, Nick; Spalding, Tim; Thompson, Peter; Sprowson, Andrew P.

    2014-01-01

    Background: With improved understanding of the biomechanical importance of the medial patellofemoral ligament (MPFL), its reconstruction for patellar dislocation has become increasingly popular. The aim of this systematic review was to critically determine the effectiveness of MPFL reconstruction for patellar dislocation. Hypothesis: MPFL reconstruction for patellar dislocation leads to a low redislocation rate with improved Kujala scores. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed using Embase and Medline (Ovid) databases. Inclusion criteria included first-time and recurrent patellar dislocation, subluxation, or persistent instability with a minimum follow-up of 12 months and documentation of postoperative redislocation rate or Kujala score. The studies were systematically appraised, and a meta-analysis was performed. Results: Twenty-two studies were included: 2 randomized controlled trials, 3 parallel case series, and 17 case series. There were a total of 655 knees in the review, with an age range at time of surgery from 11 to 52 years. The pooled postoperative redislocation rate from all 17 case series showed a mean of 2.44%. The pooled preoperative Kujala scores from 12 case series showed a mean of 51.6 (95% CI, 46.71-56.49). The pooled postoperative Kujala scores from 16 case series showed a mean of 87.77 (95% CI, 85.15-90.39). Conclusion: Although the studies were of low quality, the meta-analysis of 17 case series shows that MPFL reconstruction for recurrent patellar dislocation results in a significant improvement in Kujala scores, a low redislocation rate, and acceptable complication rate. Randomized trials would be needed to draw influences on the superiority of MPFL reconstruction compared with other treatments. PMID:26535352

  13. Anterior Cruciate Ligament Reconstruction and Osteoarthritis

    PubMed Central

    Duthon, Victoria; Servien, Elvire; Neyret, Philippe

    2013-01-01

    Objective: The goals of this study are to address several questions, the answers to which are key to the understanding and eventually to the prevention of this frequent source of morbidity. These questions include the following: (1) What is the natural history of anterior cruciate ligament (ACL) deficiency? (2) How important is the status of the meniscus at the time of reconstruction? (3) Does ACL reconstruction prevent the development of osteoarthritis in the long term? (4) Can we predict which patients will develop osteoarthritis? (5) What can be done? Design: This study addresses the key questions above through the long-term follow-up of a cohort of patients treated with ACL reconstruction by Professor Henri Dejour in Lyon, France, supplemented with a review of the relevant literature. Results: The prevalence of osteoarthritis in ACL-deficient knees is about 40% after 15 years and close to 90% after 25 to 35 years. It remains unclear whether reconstruction of the ACL significantly reduces this risk. The status of the meniscus at the time of ACL reconstruction is a strong predictor of the risk of osteoarthritis: Patients who undergo total meniscectomy are at 2- to 10-fold increased risk of developing osteoarthritis relative to those with intact menisci. Patients showing early evidence of arthritis at short- to medium-term follow-up are at high risk for progression over subsequent years. Numerous emerging techniques may provide tools to more effectively prevent and treat osteoarthritis following ACL injury in the future. Conclusion: Osteoarthritis following ACL injury continues to be a major problem requiring further research. PMID:26069662

  14. All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique

    PubMed Central

    Prince, Matthew R.; Stuart, Michael J.; King, Alexander H.; Sousa, Paul L.; Levy, Bruce A.

    2015-01-01

    Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal approach. We describe our preferred operative technique to reconstruct the PCL using an all-inside arthroscopic approach with a quadrupled tibialis anterior or peroneus longus allograft with both tibial and femoral suspensory fixation. PMID:26900564

  15. Suspensory Anterior Tibial Fixation in the Anatomic Transtibial Posterior Cruciate Ligament Reconstruction

    PubMed Central

    Elazab, Ashraf; Lee, Yong Seuk; Kang, Seo Goo

    2016-01-01

    The transtibial technique is the most relevant among many surgical techniques for posterior cruciate ligament reconstruction, and many types of fixation devices are used for tibial fixation according to the technique and the length of the graft. However, bone density in the fixation areas should be taken into consideration when choosing the fixation device to achieve rigid and stable fixation. However, density is not a substantial issue for anteromedial cortical fixation using a cortical suspension device. We describe tibial fixation with a TightRope RT (Arthrex, Naples, FL), which is a cortical suspension device, in anatomic transtibial posterior cruciate ligament reconstruction. PMID:27073781

  16. All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique.

    PubMed

    Prince, Matthew R; Stuart, Michael J; King, Alexander H; Sousa, Paul L; Levy, Bruce A

    2015-10-01

    Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal approach. We describe our preferred operative technique to reconstruct the PCL using an all-inside arthroscopic approach with a quadrupled tibialis anterior or peroneus longus allograft with both tibial and femoral suspensory fixation. PMID:26900564

  17. Combined Intra- and Extra-articular Reconstruction of the Anterior Cruciate Ligament: The Reconstruction of the Knee Anterolateral Ligament

    PubMed Central

    Helito, Camilo Partezani; Bonadio, Marcelo Batista; Gobbi, Riccardo Gomes; da Mota e Albuquerque, Roberto Freire; Pécora, José Ricardo; Camanho, Gilberto Luis; Demange, Marco Kawamura

    2015-01-01

    We present a new technique for the combined intra- and extra-articular reconstruction of the anterior cruciate ligament. Intra-articular reconstruction is performed in an outside-in manner according to the precepts of the anatomic femoral tunnel technique. Extra-articular reconstruction is performed with the gracilis tendon while respecting the anatomic parameters of the origin and insertion points and the path described for the knee anterolateral ligament. PMID:26258037

  18. Anterior cruciate ligament reconstruction graft harvesting: pitfalls and tips.

    PubMed

    McGuire, David A; Hendricks, Stephen D

    2007-12-01

    Surgical treatment for anterior cruciate ligament deficiency has relied predominantly on reconstruction with autografts. Grafts taken from patients' own central third of their patellar tendon, bone-patellar tendon bone, or one or more of the hamstring tendons, semitendinosus, and gracilis, constitute the majority of grafts used for these purposes. Although there is no single graft option that clearly outperforms another, an abundance of articles replete with complications associated with harvest and use are available from peer-reviewed journals. It is these complications and their prevention that will be addressed in the following chapter. The idea in mind is that the reader might adopt these techniques to improve their patient outcomes by minimizing, or eliminating, the ongoing problems that such complications produce. PMID:18004217

  19. Adaptation Strategies of Individuals With Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Roper, Jaimie A.; Terza, Matthew J.; Tillman, Mark D.; Hass, Chris J.

    2016-01-01

    Background: Despite the strong implications for rehabilitation design, the capability of individuals with anterior cruciate ligament reconstruction (ACLR) to adapt and store novel gait patterns have not been well studied. Purpose: To investigate how reconstructive surgery may affect the ability to adapt and store novel gait patterns in persons with ACLR while walking on a split-belt treadmill. Study Design: Controlled laboratory study. Methods: Gait adaptation was compared between 20 participants with ACLR and 20 healthy controls during split-belt treadmill walking. Gait adaptation was assessed in slow- and fast-adapting parameters by (1) the magnitude of symmetry during late adaptation and (2) the amount of the asymmetry during de-adaptation. Results: Healthy individuals adapted a new walking pattern and stored the new walking pattern equally in both the dominant and nondominant limbs. Conversely, individuals with ACLR displayed impairments in both slow-adapting and fast-adapting derived gait adaptation and significant differences in behavior between the reconstructed and uninjured limb. Conclusion: While surgical reconstruction and physical therapy are aimed at improving mechanical stability to the knee, the study data suggest that fundamental features of motor control remain altered. After ACLR, participants display an altered ability to learn and store functional gait patterns. PMID:26894200

  20. Current Trends in Anterior Cruciate Ligament Reconstruction: A Review.

    PubMed

    Vaishya, Raju; Agarwal, Amit Kumar; Ingole, Sachin; Vijay, Vipul

    2015-01-01

    Anterior cruciate ligament reconstruction (ACLR) is an accepted and established surgical technique for anterior cruciate ligament (ACL) injuries and is now being practiced across the globe in increasing numbers. Although most patients get good to excellent results in the short-term after ACLR, its consequences in the long-term in prevention or acceleration of knee osteoarthritis (OA) are not yet well-defined. Still, there are many debatable issues related to ACLR, such as the appropriate timing of surgery, graft selection, fixation methods of the graft, operative techniques, rehabilitation after surgery, and healing augmentation techniques. Most surgeons prefer not to wait long after an ACL injury to do an ACLR, as delayed reconstruction is associated with secondary damages to the intra- and periarticular structures of the knee. Autografts are the preferred choice of graft in primary ACLR, and hamstring tendons are the most popular amongst surgeons. Single bundle ACLR is being practiced by the majority, but double bundle ACLR is getting popular due to its theoretical advantage of providing more anatomical reconstruction. A preferred construct is the interference fixation (Bio-screw) at the tibial site and the suspensory method of fixation at the femoral site. In a single bundle hamstring graft, a transportal approach for creating a femoral tunnel has recently become more popular than the trans-tibial technique. Various healing augmentation techniques, including the platelet rich plasma (PRP), have been tried after ACLR, but there is still no conclusive proof of their efficacy. Accelerated rehabilitation is seemingly more accepted immediately after ACLR. PMID:26697280

  1. Current Trends in Anterior Cruciate Ligament Reconstruction: A Review

    PubMed Central

    Vaishya, Raju; Ingole, Sachin; Vijay, Vipul

    2015-01-01

    Anterior cruciate ligament reconstruction (ACLR) is an accepted and established surgical technique for anterior cruciate ligament (ACL) injuries and is now being practiced across the globe in increasing numbers. Although most patients get good to excellent results in the short-term after ACLR, its consequences in the long-term in prevention or acceleration of knee osteoarthritis (OA) are not yet well-defined. Still, there are many debatable issues related to ACLR, such as the appropriate timing of surgery, graft selection, fixation methods of the graft, operative techniques, rehabilitation after surgery, and healing augmentation techniques. Most surgeons prefer not to wait long after an ACL injury to do an ACLR, as delayed reconstruction is associated with secondary damages to the intra- and periarticular structures of the knee. Autografts are the preferred choice of graft in primary ACLR, and hamstring tendons are the most popular amongst surgeons. Single bundle ACLR is being practiced by the majority, but double bundle ACLR is getting popular due to its theoretical advantage of providing more anatomical reconstruction. A preferred construct is the interference fixation (Bio-screw) at the tibial site and the suspensory method of fixation at the femoral site. In a single bundle hamstring graft, a transportal approach for creating a femoral tunnel has recently become more popular than the trans-tibial technique. Various healing augmentation techniques, including the platelet rich plasma (PRP), have been tried after ACLR, but there is still no conclusive proof of their efficacy. Accelerated rehabilitation is seemingly more accepted immediately after ACLR. PMID:26697280

  2. REHABILITATION PROTOCOL AFTER ISOLATED POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    PubMed Central

    de Paula Leite Cury, Ricardo; Kiyomoto, Henry Dan; Rosal, Gustavo Fogolin; Bryk, Flávio Fernandes; de Oliveira, Victor Marques; de Camargo, Osmar Pedro Arbix

    2015-01-01

    To create a rehabilitation protocol following reconstruction of the posterior cruciate ligament (PCL), through a literature review. The literature review was conducted in the Medline and Embase databases, to search for data on biomechanical concepts and analyses relating to the posterior cruciate ligament of the knee. The search strategy was set up using the following rules: problem or injury in association with anatomical location terms; or surgical intervention procedure in association with rehabilitation terms. We began the process in this manner and subsequently introduced restrictions on certain terms to improve the search specificity. To design the protocol, a table was created for better data assessment, based on the time that elapsed between surgery and the start of physiotherapy. A rehabilitation protocol was created to improve weight-bearing control in the initial weeks after surgery, with the aid of a knee brace. Our aim was to achieve gains in total range of motion of the knee, which should be attained by the third month, thereby avoiding contractures resulting from the tissue healing process. Strengthening exercises and sensory-motor training were guided accordingly, thus avoiding overload on the graft and respecting the healing phases. The protocol proposed through this review was based on the current evidence relating to this subject. PMID:27047844

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

    PubMed Central

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

    2016-01-01

    The influences and mechanisms of the physiology, rupture and reconstruction of the anterior cruciate ligament (ACL) on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades. The knee is a complex joint with shifting contact points, pressures and axes that are affected when a ligament is injured. The ACL, as one of the intra-articular ligaments, has a strong influence on the resulting kinematics. Often, other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes. Knowing the surgical options, anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome. PMID:26925379

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

    PubMed

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

    2016-02-18

    The influences and mechanisms of the physiology, rupture and reconstruction of the anterior cruciate ligament (ACL) on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades. The knee is a complex joint with shifting contact points, pressures and axes that are affected when a ligament is injured. The ACL, as one of the intra-articular ligaments, has a strong influence on the resulting kinematics. Often, other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes. Knowing the surgical options, anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome. PMID:26925379

  5. Failure of Anterior Cruciate Ligament Reconstruction

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    Mascarenhas, Randy; MacDonald, Peter B.

    2008-01-01

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

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

    PubMed

    Mascarenhas, Randy; MacDonald, Peter B

    2008-01-01

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

  8. Anatomical reconstruction of the spring ligament complex: "internal brace" augmentation.

    PubMed

    Acevedo, Jorge; Vora, Anand

    2013-12-01

    The calcaneonavicular (spring) ligament complex is a critical static support of the medial arch of the foot. Compromise of this structure has been implicated as a primary causative factor of talar derotation leading to the clinical deformity of peritalar subluxation. Few procedures have been described to address this deficiency. The technique we describe here is a simple yet effective method to reconstruct the spring ligament complex that can easily be used in conjunction with other more commonly used procedures for extra-articular reconstructions of this deformity. We believe this procedure allows for a more powerful deformity correction and may decrease dependency on other nonanatomic reconstructive procedures. PMID:23925791

  9. Anatomic Reconstruction Technique for a Plantar Calcaneonavicular (Spring) Ligament Tear.

    PubMed

    Palmanovich, Ezequiel; Shabat, Shay; Brin, Yaron S; Feldman, Viktor; Kish, Benny; Nyska, Meir

    2015-01-01

    Acquired flatfoot deformity in adults is usually due to partial or complete tearing of the posterior tibial tendon, with secondary failure of other structures such as the plantar calcaneonavicular (spring) ligament (SL), which maintain the medial longitudinal arch. In flexible cases, the tibialis posterior can be replaced with the flexor digitorum longus. It is common practice to suture the SL directly in the case of a tear; however, if the tear is complete, suturing directly to the ligament alone will not be possible. Reconstruction of the ligament is needed; however, no validated methods are available to reconstruct this ligament. The operative technique of SL reconstruction described in this report as a part of acquired flatfoot deformity reconstruction consists of augmenting remnants of the spring from the navicularis to the sustentaculum tali and suspending it to the medial malleolus using 2-mm-wide, long-chain polyethylene suture tape. This technique results in the firm anatomic reconstruction of the SL, in addition to "classic" medial arch reconstruction. We recommend SL reconstruction for medial arch reconstruction when the SL is torn. PMID:26253476

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

    PubMed Central

    de Souza Leao, Marcos George; Pampolha, Abelardo Gautama Moreira; Orlando Junior, Nilton

    2015-01-01

    Objectives To evaluate knee function in patients undergoing reconstruction of the anterior cruciate ligament (ACL) using the central third of the patellar ligament or the medial flexor tendons of the knee, i.e. quadruple ligaments from the semitendinosus and gracilis (ST-G), by means of the Knee Society Score (KSS) and the Lysholm scale. Methods This was a randomized prospective longitudinal study on 40 patients who underwent arthroscopic ACL reconstruction between September 2013 and August 2014. They comprised 37 males and three females, with ages ranging from 16 to 52 years. The patients were numbered randomly from 1 to 40: the even numbers underwent surgical correction using the ST-G tendons and the odd numbers, using the patellar tendon. Functional evaluations were made using the KSS and Lysholm scale, applied in the evening before the surgical procedure and six months after the operation. Results From the statistical analysis, it could be seen that the patients’ functional capacity was significantly greater after the operation than before the operation. There was strong evidence that the two forms of therapy had similar results (p = >0.05), in all the comparisons. Conclusions The results from the ACL reconstructions were similar with regard to functional recovery of the knee and improvement of quality of life, independent of the type of graft. It was not possible to identify the best method of surgical treatment. The surgeon's clinical and technical experience and the patient are the factors that determine the choice of graft type for use in ACL surgery. PMID:27218084

  11. Anterolateral Ligament of the Knee: Back to the Future in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Bonasia, Davide Edoardo; D’Amelio, Andrea; Pellegrino, Pietro; Rosso, Federica; Rossi, Roberto

    2015-01-01

    Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes. PMID:26330991

  12. Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

    PubMed Central

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

    2016-01-01

    Although the medial patellotibial ligament (MPTL) has been neglected regarding its function in patellar stability, recently, its importance in terminal extension and during flexion has been recognized. Indications for reconstruction of the medial patellofemoral ligament combined with the MPTL are extension subluxation, flexion instability, children with anatomic risk factors for patellar instability, and knee hyperextension associated with generalized laxity. We describe a combined reconstruction of the medial patellofemoral ligament with quadricipital tendon and reconstruction of the MPTL with patellar tendon autografts. PMID:27073782

  13. Anterior Cruciate Ligament Reconstruction With Autologous Hamstring

    PubMed Central

    Grawe, Brian M.; Williams, Phillip N.; Burge, Alissa; Voigt, Marcia; Altchek, David W.; Hannafin, Jo A.; Allen, Answorth A.

    2016-01-01

    Background: Recent clinical investigations have identified inadequate autograft hamstring graft diameter (<8 mm) to be predictive of failure after reconstruction of the anterior cruciate ligament (ACL). Purpose/Hypothesis: The objective of this study was to determine the utility of preoperative magnetic resonance imaging (MRI) variables of the hamstring tendons for the prediction of graft diameter at the time of surgery. The hypothesis was that cross-sectional area (CSA) of the hamstring tendon measured on MRI could accurately predict graft diameter, and threshold measurements could be established to predict graft diameter at the time of surgery. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 84 consecutive skeletally mature patients prospectively enrolled in our ACL reconstruction patient registry were identified for study purposes. Patients were included if they underwent an MRI of the affected knee at our institution prior to ACL reconstruction with hamstring (HT) autograft. Graft preparation was performed via a standard quadrupled hamstring technique after harvesting both the gracilis and semitendinosus (4-GST). The smallest diameter end of the HT autograft was then utilized for measurement analysis. Total CSA was calculated for both hamstring tendons using the “region of interest tool” on the corresponding proton density–weighted axial image of the knee at the widest condylar dimension. Three independent reviewers measured the MRI scans so that intra- and interrater reliability of the measurements could be determined. A trend analysis was then undertaken to establish correlations between the MRI CSA and graft diameter. Predictive analysis was then performed to establish threshold MRI measurement values for specific graft diameters and determine whether any patient-specific factors would affect graft diameter (age, sex, and body mass index). Results: Mean patient age at the time of surgery was 36 years (range, 11

  14. Anterior Cruciate Ligament Reconstruction in Ehlers-Danlos Syndrome.

    PubMed

    Williams, John; Hutt, Jonathan; Rickman, Mark

    2015-01-01

    This report details the reconstruction of the anterior cruciate ligament in an 18-year-old man with Ehlers-Danlos syndrome (EDS). The reduced mechanical properties of the tissue in EDS can pose a challenge to the orthopaedic surgeon. In this case, we describe the use of a hamstring autograft combined with a Ligament Advanced Reinforcement System (LARS). There was a good radiographical, clinical, and functional outcome after two years. This technique gave a successful outcome in the reconstruction of the ACL in a patient with EDS and therefore may help surgeons faced with the same clinical scenario. PMID:26221555

  15. Reconstruction of the Scapholunate Ligament Using Capitohamate Bone-Ligament-Bone.

    PubMed

    Nakamura, Toshiyasu; Abe, Koji; Iwamoto, Takuji; Ochi, Kensuke; Sato, Kazuki

    2015-11-01

    Background The biomechanical properties of the capitohamate (CH) ligament are equivalent to those of the scapholunate (SL) interosseous ligament. We reconstructed the SL ligament using the CH bone-ligament-bone substitute for chronic injury of the SL ligament. Patients and Methods Beginning in 2008, 15 wrists of 14 patients with an average age of 38 years underwent this procedure with a minimum follow-up of 2 years. Thirteen wrists had an SL joint gap more than 3 mm, and two had a complete SL ligament disruption with a severe dorsal intercalated segment instability (DISI) deformity. Kirschner wires (K-wires) were removed 8 weeks after the surgery, then active ROM exercise began. Pain (on visual analog scale [VAS]), wrist motion (angle), radiographic characteristics, such as SL gap (mm) and SL angle, and Modified Mayo Wrist Score (MMWS) were evaluated. Technique The SL joint was reduced by manipulation or with the use of joysticks, then temporary fixed with K-wires. A dorsal trough was then made between the scaphoid and the lunate. The proximal half of the CH ligament was harvested with attached bone from the capitate and hamate (CH bone-ligament-bone), inset into the SL trough, and fixed firmly with 1.2-mm diameter titanium screws in the scaphoid and lunate, respectively. Results The VAS improved from 77 preoperatively to 12 postoperatively. The average wrist extension/flexion was 74°/60°. There was no ossification of the reconstructed SL at the final follow-up. The SL gap improved from an average of 4.8 mm to an average of 2.1 mm, and the SL angle changed from 67° to 55°. The MMWS improved to 82 points postoperatively from a preoperative average of 47 with eight excellent, five good, and two fair results. PMID:26539327

  16. Anterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity

    PubMed Central

    Kim, Sung-Jae; Kumar, Praveen

    2010-01-01

    Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation. PMID:20808583

  17. Minimally Invasive Anterolateral Ligament Reconstruction in the Setting of Anterior Cruciate Ligament Injury.

    PubMed

    Sonnery-Cottet, Bertrand; Barbosa, Nuno Camelo; Tuteja, Sanesh; Daggett, Matt; Kajetanek, Charles; Thaunat, Mathieu

    2016-02-01

    Recent evidence on the anatomy, function, and biomechanical properties of the anterolateral ligament has led to the recognition of the importance of this structure in the rotational control of the knee. This article describes a technique that allows for minimally invasive anterolateral ligament reconstruction as a complement to most techniques of anterior cruciate ligament reconstruction. A gracilis tendon autograft is harvested and prepared in a double-strand, inverted V-shaped graft. The graft is percutaneously placed through a femoral stab incision, and each strand is then passed deep to the iliotibial band, emerging through each tibial stab incision. After the femoral-end loop graft is fixed, the tibial fixation of each strand is performed in full extension for optimal isometry. PMID:27274456

  18. Ligament reconstruction with tendon interposition using an acellular dermal allograft for thumb carpometacarpal arthritis.

    PubMed

    Kokkalis, Zinon T; Zanaros, George; Sotereanos, Dean G

    2009-03-01

    Ligament reconstruction tendon interposition arthroplasty is currently the preferred technique for carpometacarpal joint arthritis of the thumb by most surgeons. Despite its efficacy, morbidity has been associated with the harvest of the flexor carpi radialis tendon. Using an allograft as material for arthroplasty, donor site morbidity is avoided. In this report, we present our surgical technique to perform ligament reconstruction tendon interposition arthroplasty using an acellular dermal matrix allograft (GraftJacket) in patients with Eaton stages II, III, and IV symptomatic first carpometacarpal arthritis.One hundred thumbs with trapeziometacarpal osteoarthritis underwent surgical treatment using GraftJacket allograft instead of the flexor carpi radialis tendon autograft. Each patient was followed for a minimum of 12 months. The surgical procedure included trapezial excision and identification of the flexor carpi radialis. The allograft was cut to create a 15-cm strip. The ligament reconstruction was performed by passing the strip around the flexor carpi radialis tendon and suturing it to the base of the thumb metacarpal base through an intramedullary drill hole. The remaining portion of the allograft was fashioned as an interposition mass (anchovy) and interposed between the scaphoid and the base of the first metacarpal.All but 1 patient experienced significant improvement in his or her pain scale rating and grip and pinch strengths. Outcomes from this study compare very favorably with those of other series. No patients experienced a foreign body reaction or infection in this series. We believe that the use of an acellular dermal allograft for both ligament reconstruction and tendon interposition provides a safe and an effective alternative technique for the treatment of advanced first carpometacarpal arthritis. PMID:19276927

  19. Posterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity

    PubMed Central

    Kim, Sung-Jae; Chang, Ji-Hoon

    2008-01-01

    Generalized joint laxity has been considered a risk factor causing late failure of reconstructed anterior cruciate ligaments, although it is unknown whether that is the case for reconstructed posterior cruciate ligaments. We hypothesized patients with generalized joint laxity, compared with those without laxity, would have similar postoperative knee stability, range of motion, and functional scores after posterior cruciate ligament reconstruction. The Beighton and Horan criteria were used to determine generalized joint laxity. We enrolled 24 patients with generalized joint laxity (Group L) and 29 patients without any positive findings of joint laxity (Group N) matched by gender and age. The average side-by-side differences of posterior tibial translation were 4.72 mm in Group L and 3.63 mm in Group N. We observed no differences in posterior tibial translation with differing graft materials or combined procedures. In Group L the International Knee Documentation Committee score was normal in 12.5% and nearly normal in 45.8% whereas in Group N, 24.1% were normal and 55.2% nearly normal. Patients with generalized joint laxity showed more posterior laxity than patients without joint laxity. Generalized joint laxity therefore appears to be a risk factor associated with posterior laxity after posterior cruciate ligament reconstruction. Level of Evidence: Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18843524

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

    PubMed Central

    El-Tawil, Sherif; Elfons Tawafig, Marian; Miles, Jonathan

    2015-01-01

    Patellar instability is a common finding in patients with below-knee amputation and yet management options are not commonly described in the literature. We describe the first reported case of a medial patellofemoral ligament reconstruction using allograft in a patient with a below-knee amputation. Clinical outcome at two-year follow-up remains very good. PMID:26579321

  1. Anatomic Double-Bundle Posterior Cruciate Ligament Reconstruction.

    PubMed

    Chahla, Jorge; Nitri, Marco; Civitarese, David; Dean, Chase S; Moulton, Samuel G; LaPrade, Robert F

    2016-02-01

    The posterior cruciate ligament (PCL) is known to be the main posterior stabilizer of the knee. Anatomic single-bundle PCL reconstruction, focusing on reconstruction of the larger anterolateral bundle, is the most commonly performed procedure. Because of the residual posterior and rotational tibial instability after the single-bundle procedure and the inability to restore the normal knee kinematics, an anatomic double-bundle PCL reconstruction has been proposed in an effort to re-create the native PCL footprint more closely and to restore normal knee kinematics. We detail our technique for an anatomic double-bundle PCL reconstruction using Achilles and anterior tibialis tendon allografts. PMID:27284530

  2. The Evolution of Anatomic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Getgood, Alan; Spalding, Tim

    2012-01-01

    Anterior cruciate ligament reconstruction has evolved significantly since the early 1900’s, back when an emphasis was placed on repair and not reconstruction. Over the past century, the technique has evolved from intra-articular non anatomic reconstruction, to extra articular reconstruction, back to intra articular (performed arthroscopically), to now, the advent of anatomic insertion site restoration. This review will aim to illustrate the changes that have occurred, describing the rational for this process, based upon anatomical, radiological, biomechanical and clinical studies, all of which have aimed to improve patient function following ACL injury. PMID:22905073

  3. Histological characteristics and ultrastructure of polyethylene terephthalate LARS ligament after the reconstruction of anterior cruciate ligament in rabbits

    PubMed Central

    Yu, Shao-Bin; Yang, Rong-Hua; Zuo, Zhong-Nan; Dong, Qi-Rong

    2014-01-01

    Polyethylene terephthalate LARS ligament were the remnant of LARS ligament used for repairing posterior cruciate ligament obtained from operation. We want to study histological characteristics and ultrastructure of polyethylene terephthalate LARS ligament after the reconstruction of anterior cruciate ligament in rabbits. Therefore, we replaced the original ACL with polyethylene terephthalate LARS ligament which was covering with the remnant of ACL in 9 rabbits (L-LARS group), while just only polyethylene terephthalate LARS ligament were transplanted in 3 rabbits (LARS group) with the remnant of ACL. Compared with group LARS, inflammatory cell reaction and foreign body reaction were more significant in group L-LARS. Moreover, electron microscopy investigation showed the tissue near LARS fibers was highly cellular with a matrix of thin collagen fibrils (50-100 nm) in group L-LARS. These above findings suggest the polyethylene terephthalate LARS ligament possess the high biocompatibility, which contributes to the polyethylene terephthalate LARS covered with recipient connective tissues. PMID:25356104

  4. Arthroscopically Assisted Anatomic Coracoclavicular Ligament Reconstruction Technique Using Coracoclavicular Fixation and Soft-Tissue Grafts

    PubMed Central

    Millett, Peter J.; Warth, Ryan J.; Greenspoon, Joshua A.; Horan, Marilee P.

    2015-01-01

    Acromioclavicular joint injuries are common and are often seen in contact athletes. Good to excellent clinical results have been reported using soft-tissue grafts to reconstruct the coracoclavicular ligaments; however, complications remain. Some complications are unique to the surgical technique, particularly clavicle and coracoid fractures that are associated with drilling large or multiple bone tunnels. The described technique allows for an anatomic coracoclavicular reconstruction using a large soft-tissue graft while minimizing the risk of clavicle fracture by avoiding large bone tunnels. PMID:26900558

  5. MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION TO TREAT RECURRENT PATELLAR DISLOCATION

    PubMed Central

    Gonçaives, Matheus Braga Jacques; Júnior, Lúcio Honório de Carvalho; Soares, Luiz Fernando Machado; Gonçaives, Tiago Jacques; dos Santos, Rogério Luciano; Pereira, Marcelo Lobo

    2015-01-01

    Objective: To present a new technique for reconstruction of the medial patellofemoral ligament (MPFL) in patients with recurrent patellar dislocation and to evaluate the clinical findings from this. Methods: Between January 2007 and January 2008, 23 patients underwent reconstruction of the MPFL with a free graft from the semitendinosus tendon. After a minimum of 24 months of follow-up, 22 patients were evaluated using the Kujala and Lysholm clinical protocols. Results: The mean follow up was 26.2 months. According to the Lysholm protocol, the patients had a mean score of 53.72 points preoperatively and 93.36 points postoperatively (p = 0.000006). According to the Kujala protocol, the mean score was 59.81 points preoperatively and 83.54 points postoperatively (p = 0.002173). Conclusion: Reconstruction of the medial patellofemoral ligament using the proposed technique showed excellent results over the short term, when evaluated by means of clinical protocols. PMID:27027005

  6. Psychological Factors Associated With Anterior Cruciate Ligament Reconstruction Recovery

    PubMed Central

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

    2016-01-01

    Background: Psychological factors may have underappreciated effects on surgical outcomes after anterior cruciate ligament (ACL) reconstruction; however, few studies have investigated the relationship between specific psychological factors, objective clinical data, and patient-oriented outcomes. Purpose: Psychological factors are significantly associated with patient perceptions and functional outcomes after ACL reconstruction. The purpose of this study was to demonstrate relationships between self-esteem, health locus of control, and psychological distress with objective clinical outcomes, patient-oriented outcomes, and return to sport. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty-seven patients who were 6 to 24 months post–computer-assisted ACL reconstruction by a single surgeon consented to participate in the study (52% response rate). Participants had a 1-time visit with a physician consisting of: a physical examination, a single-leg hop test, KT-1000 arthrometer measurements, and survey completion. Psychological measures included the Multidimensional Health Locus of Control Scale, Rosenberg Self-Esteem Scale, and Brief Profile of Mood States. Outcome measures included the Tegner activity scale, International Knee Documentation Committee (IKDC) Subjective Knee Score, Knee injury and Osteoarthritis Outcome Score–Quality of Life subscale (KOOS-QOL), and Short Form–36 (SF-36). Patient charts were also reviewed for pertinent operative details. Results: The mean age of patients (±SD) was 25.7 ± 8.4 years, and the mean duration of time since surgery was 16.5 ± 5.9 months. The majority (89%) of the patients identified themselves as athletes, and of these, 65% reported returning to sports at a competitive level. Sport returners were found to have higher levels of self-esteem (P = .002) and higher reported KOOS-QOL scores (P = .02). Self-esteem was significantly associated with IKDC scores (r = 0.46, P < .05), KOOS-QOL scores (r = 0

  7. Delay to Reconstruction of the Adolescent Anterior Cruciate Ligament

    PubMed Central

    Newman, Justin T.; Carry, Patrick M.; Terhune, Elizabeth B.; Spruiell, Murray; Heare, Austin; Mayo, Meredith; Vidal, Armando F.

    2014-01-01

    Background: A delay in pediatric and adolescent anterior cruciate ligament (ACL) reconstruction is associated with an increase in the number of concomitant meniscal and chondral injuries. Factors that contribute to this delay have not been well described. Hypothesis: Socioeconomic and demographic factors are related to ACL surgery timing. Study Methods: Cohort study; Level of evidence, 3. Methods: All subjects who underwent primary ACL reconstruction at a single tertiary pediatric hospital between 2005 and 2012 were retrospectively reviewed. Variables included concomitant knee injuries (cartilage or meniscus injuries requiring additional operative treatment) and chronologic, demographic, and socioeconomic factors. Multivariable Cox proportional-hazards analyses were used to identify factors related to ACL surgery timing. Results: The mean age of the 272 subjects was 15.2 ± 2.12 years. Time to surgery was significantly different among subjects who required multiple additional surgical procedures at time of ACL reconstruction (median, 3.3 months) compared with subjects with 1 (median, 2.0 months) or no additional injuries (median, 1.6 months). Subjects underwent ACL reconstruction significantly sooner if they were older at the time of injury (hazard ratio [HR], 1.2 per 1 year; 95% CI, 1.1-1.2; P < .0001) or were covered by a commercial insurance plan (HR, 2.0; 95% CI, 1.6-2.6; P < .0001). Median time to ACL surgery was 1.5 months (95% CI, 1.3-1.7) for subjects with commercial insurance plans compared with 3.0 months (95% CI, 2.3-3.3) for subjects with noncommercial insurance coverage. Conclusion: The risk of delayed ACL surgery was significantly higher among pediatric and adolescent subjects who were less affluent, who were covered by a noncommercial insurance plan, and who were younger. This study also confirms previous studies that have reported an association between a delay in ACL surgery and the presence of additional knee injuries requiring operative treatment

  8. Reconstruction of the anterior cruciate ligament in skeletally immature patients: an individualized approach☆☆☆

    PubMed Central

    Lopes Júnior, Osmar Valadão; Saggin, Paulo Renato; Matos do Nascimento, Gilberto; Kuhn, André; Saggin, José; Inácio, André Manoel

    2014-01-01

    Objective to evaluate a series of skeletally immature patients who underwent three surgical techniques for anterior cruciate ligament (ACL) reconstruction according to each patient's growth potential. Methods a series of 23 skeletally immature patients who underwent ACL reconstruction surgery at ages ranging from 7 to 15 years was evaluated prospectively. The surgical technique was individualized according to the Tanner sexual maturity score. The surgical techniques used were transphyseal reconstruction, partial transphyseal reconstruction and extraphyseal reconstruction. Four patients underwent the extraphyseal technique, seven the partial transphyseal technique and twelve the full transphyseal technique, on the ACL. The postoperative evaluation was based on the Lysholm score, clinical analysis on the knee and the presence of angular deformity or dysmetria of the lower limb. Results the mean Lysholm score was 96.34 (±2.53). None of the patients presented differences in length and/or clinical or radiographic misalignment abnormality of the lower limbs. Conclusion ACL reconstruction using flexor tendon grafts in skeletally immature patients provided satisfactory functional results. Use of individualized surgical techniques according to growth potential did not give rise to physeal lesions capable of causing length discrepancies or misalignments of the lower limbs, even in patients with high growth potential. PMID:26229809

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

    PubMed

    Mirzatolooei, Fardin

    2014-01-01

    Recurrent dislocation of patella may occur in patients with ligament laxity. Method of treatment in this condition is controversial but patellofemoral ligament reconstruction is the most accepted method. We present a patient with Rubinstein-Taybi syndrome and recurrent patellar dislocation who managed successfully by patellofemoral ligament reconstruction. PMID:24901727

  10. An audit of tunnel position in anterior cruciate ligament reconstruction.

    PubMed

    Topliss, C; Webb, J

    2001-03-01

    We audited 114 primary anterior cruciate ligament (ACL) reconstructions. Notes were reviewed and tunnel positions assessed on lateral and AP radiographs. A literature review established optimal tunnel position. Sixteen surgeons performed 57 arthroscopic and 57 open reconstructions, using 24 hamstring and 90 bone-tendon-bone autografts. Eighty-five sets of radiographs were available for review. Sixty-five percent of femoral tunnels and 59% of the tibial tunnels were malpositioned in the sagittal plane. Guidelines for best practice are required for key procedures in each speciality. Tunnel position in ACL reconstruction can be easily measured and should be correct in at least 90% of cases. PMID:11248570

  11. [Systemic granulomatosis caused by a Dacron prosthetic ligament].

    PubMed

    Aziza, R; Colombier, D; Chaminade, L; Otal, P; Joffre, F

    1997-07-01

    An uncommon systemic reaction mimicking sarcoidosis after ligament reconstruction is reported. Clinical and radiological outcome after surgical treatment led to the diagnosis of a a specific injury caused by the ligament reconstruction device. PMID:9296031

  12. LEG'S COMPARTMENT SYNDROME AFTER RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT: CASE REPORT

    PubMed Central

    Filho, Jorge Sayum; Ramos, Leonardo Adeo; Sayum, Jorge; de Carvalho, Rogério Teixeira; Ejnisman, Benno; Matsuda, Marcelo Mitsuro; Nicolini, Alexandre; Cohen, Moisés

    2015-01-01

    The authors report a case of a patient that was submitted to a surgery of reconstruction of anterior cruciate ligament and collateral medial ligament repair of the left knee that complicated to a compartment syndrome. PMID:27047834

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

    PubMed Central

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

    2016-01-01

    Background: This study aims to retain normal knee kinematics after knee replacement surgeries by reconstructing anterior cruciate ligament during total knee arthroplasty. Method: We use computational simulation tools to establish four dynamic knee models, including normal knee model, posterior cruciate ligament retaining knee model, posterior cruciate ligament substituting knee model, and anterior cruciate ligament reconstructing knee model. Our proposed method utilizes magnetic resonance images to reconstruct solid bones and attachments of ligaments, and assemble femoral and tibial components according representative literatures and operational specifications. Dynamic data of axial tibial rotation and femoral translation from full-extension to 135 were measured for analyzing the motion of knee models. Findings: The computational simulation results show that comparing with the posterior cruciate ligament retained knee model and the posterior cruciate ligament substituted knee model, reconstructing anterior cruciate ligament improves the posterior movement of the lateral condyle, medial condyle and tibial internal rotation through a full range of flexion. The maximum posterior translations of the lateral condyle, medial condyle and tibial internal rotation of the anterior cruciate ligament reconstructed knee are 15.3 mm, 4.6 mm and 20.6 at 135 of flexion. Interpretation: Reconstructing anterior cruciate ligament in total knee arthroplasty has been approved to be an more efficient way of maintaining normal knee kinematics comparing to posterior cruciate ligament retained and posterior cruciate ligament substituted total knee arthroplasty. PMID:27347334

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

    PubMed Central

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

    2013-01-01

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

  15. Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using a Three-Dimensional Fluoroscopic Navigation System

    PubMed Central

    Inui, Hiroshi; Sanada, Takaki; Nakamura, Kensuke; Yamagami, Ryota; Masuda, Hironari; Tanaka, Sakae; Nakagawa, Takumi

    2014-01-01

    Introduction Recently, remnant-preserving anterior cruciate ligament (ACL) reconstruction has been increasingly performed to achieve revascularization, cell proliferation, and recovery of high-quality proprioception. However, poor arthroscopic visualization makes accurate socket placement during remnant-preserving ACL reconstruction difficult. This study describes a surgical technique used to create an anatomical femoral socket with a three-dimensional (3D) fluoroscopy based navigation system during technically demanding remnant-preserving ACL reconstruction. Surgical Technique After a reference frame was attached to the femur, an intraoperative image of the distal femur was obtained, transferred to the navigation system and reconstructed into a 3D image. A navigation computer helped the surgeon visualize the entire lateral wall of the femoral notch and lateral intercondylar ridge, even when the remnant of the ruptured ACL impeded arthroscopic visualization of the bone surface. When a guide was placed, the virtual femoral tunnel overlapped the reconstructed 3D image in real time; therefore, only minimal soft tissue debridement was required. Materials and Methods We treated 47 patients with remnant-preserving ACL reconstruction using this system. The center of the femoral socket aperture was calculated according to the quadrant technique using 3D computed tomography imaging. Results The femoral socket locations were considered to be an anatomical footprint in accordance with previous cadaveric studies. Conclusions The 3D fluoroscopy-based navigation can assist surgeons in creating anatomical femoral sockets during remnant-preserving ACL reconstruction. PMID:25229047

  16. RANDOMIZED PROSPECTIVE STUDY COMPARING TRANSVERSE AND EXTRACORTICAL FIXATION IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    PubMed Central

    da Silva Guarilha, Eduardo; de Andrade Fígaro Caldeira, Paulo Roberto; de Almeida Lira Neto, Ozorio; Navarro, Marcelo Schmidt; Milani, Antonio; Filho, Mario Carneiro

    2015-01-01

    Objective: This study had the objective of prospectively comparing transverse fixation (Cross-Pin™) with extracortical fixation (EZLoc™) for the femur, in surgical reconstruction of the anterior cruciate ligament, from a clinical, biomechanical and functional point of view. Methods: Between April 2007 and November 2009, 50 patients with acute or chronic anterior cruciate ligament injuries underwent arthroscopic reconstruction using the homologous flexor tendons (gracilis and semitendinosus). Randomization of the femoral fixation method was done by means of a draw at the time of the procedure. Patients were excluded if they presented multiple ligament lesions, fractures, previous surgery, autoimmune disease and impairment of the contralateral knee. The Lysholm scale, SF36 quality-of-life questionnaire and KT1000™ arthrometer were used. Results: After a mean follow-up of 18.1 months, there were no statistically significant differences between the groups regarding the Lysholm scale and KT1000™ measurements. However, the SF36 questionnaire showed a statistical difference such that transverse fixation was superior regarding pain and vitality. Conclusion: Both techniques were shown to be efficient for transfemoral fixation, but with almost no statistically significant difference between them. We believe that new studies will be necessary for better understanding of these differences. PMID:27042646

  17. Recurrent pretibial ganglion cyst formation over 5 years after anterior cruciate ligament reconstruction.

    PubMed

    Sekiya, Jon K; Elkousy, Hussein A; Fu, Freddie H

    2004-03-01

    Although ganglion cysts of the anterior cruciate ligament have been described in the literature, they are a relatively rare phenomenon. Cyst formation after anterior cruciate ligament reconstruction is even less frequent, with only a few reported cases. The proposed etiology of these cysts has been attributed to a number of causes, including the use of bioabsorbable screws, Gore-Tex (W. L. Gore and Associates, Flagstaff, AZ) grafts, extra-articular fluid extravasation secondary to direct tibial tunnel communication, allografts with or without ethylene oxide sterilization, and the use of nonabsorbable suture. We report an unusual case of a recurrent pretibial ganglion cyst that initially formed more than 5 years after an anterior cruciate ligament reconstruction and recurred 2 years after resection of the mass. We believe the initial surgical resection was unsuccessful probably because the foreign body irritant was not identified. Only after resection of the entire stalk of the cyst and removal of all of the inciting suture material that was found near the entrance of the tibial tunnel were we able to definitively eradicate the ganglion cyst. PMID:15007323

  18. Rehabilitative techniques for athletes after reconstruction of the anterior cruciate ligament.

    PubMed

    Lutz, G E; Stuart, M J; Sim, F H; Scott, S G

    1990-10-01

    A wide spectrum of protocols is available for rehabilitation after anterior cruciate ligament reconstruction, and little agreement exists on the specifics of strengthening exercises or the sequence of activities. In this article, we discuss the current rehabilitative techniques used at the Mayo Clinic for athletes who have undergone anterior cruciate ligament reconstruction. These techniques are based on established principles of rehabilitation, clinical experience, and new information about the related biomechanics of the knee. An illustrative case reflects the benefits of this rehabilitation program, which lasts up to 1 year and is divided into five stages. The early stages focus on protected mobilization and a strengthening program that emphasizes closed rather than open kinetic chain exercises. Later, neuromuscular-proprioceptive training and sport-specific agility training redevelop the reaction time and the "coordination engrams" necessary for athletic competition. High-quality surgical care and a closely supervised rehabilitation program, based on kinesiologic and biomechanical factors as they pertain to the anterior cruciate ligament, are necessary for a successful outcome. PMID:2214879

  19. Physiotherapy after reconstruction of anterior cruciate ligament

    PubMed Central

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

    2012-01-01

    The purpose of this study was to evaluate the existence of differences in the rehabilitation of patients after ACL reconstruction using bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts, through a literature revision. The researched databases were MEDLINE, EMBASE, LILACS, COCHRANE and PEDro. The inclusion criteria were published studies with methodology draw from randomized clinical trials with or without meta-analysis, individuals with ACL injury, associated or not to meniscal injury, submitted to ligamentoplasty using the bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts and physiotherapy; clinical trials comparing the differences in the rehabilitation of these patients, in Portuguese, English and Spanish, from 1990 to June, 2011. Five clinical trials were reviewed. No difference was observed between the techniques, however, with a recommendation for a less aggressive rehabilitation and greater attention to the strengthening of the hamstring when they are used as grafts. PMID:24453634

  20. The effect of immediate weightbearing after anterior cruciate ligament reconstruction.

    PubMed

    Tyler, T F; McHugh, M P; Gleim, G W; Nicholas, S J

    1998-12-01

    Immediate weightbearing has been advocated after anterior cruciate ligament reconstruction and is thought to enhance the return of quadriceps muscle activity and knee extension range of motion without jeopardizing graft integrity. This study examined the effect of immediate weightbearing after anterior cruciate ligament reconstruction on the return of vastus medialis oblique electromyography activity, knee extension range of motion, knee stability, physical examination, Lysholm score, and anterior knee pain. Forty-nine patients (24 men and 25 women) undergoing endoscopic central third patella tendon autograft reconstruction were randomized prospectively into two groups. Group 1 patients underwent immediate weightbearing as tolerated. Group 2 patients were kept nonweightbearing for 2 weeks. All measurements were taken before surgery, 2 weeks after surgery, and between 6 and 14 months (average, 7.3 months) followup. There was no effect of weightbearing on knee extension range of motion or vastus medialis oblique function at followup. In addition, knee stability was not compromised after surgery. Seven of 20 (35%) nonweightbearing patients and only two of 25 (8%) immediate weightbearing patients reported anterior knee pain at followup. Overall, immediate weightbearing did not compromise knee joint stability and resulted in a better outcome with a decreased incidence of anterior knee pain. PMID:9917711

  1. Biomechanical Comparison of Fracture Risk Created by 2 Different Clavicle Tunnel Preparations for Coracoclavicular Ligament Reconstruction

    PubMed Central

    Nuzzo, Michael S.; Adamson, Gregory J.; Lee, Thay Q.; McGarry, Michelle H.; Husak, Lisa

    2014-01-01

    than the 2-tunnel group. Conclusion: The single anterior-to-posterior clavicle tunnel had similar biomechanical properties to the 2-tunnel technique. However, the single-tunnel technique better reproduced the anatomic footprint of the conoid ligament. Utilizing this single-tunnel technique may yield an anatomic advantage that may also reduce the rate of complications caused by posterior wall blowout. Clinical Relevance: Acromioclavicular joint injuries are common in collision sports. Surgical management is often indicated to reconstruct the joint. This study assesses the feasibility of a novel surgical approach. PMID:26535281

  2. Return to Play Following Ankle Sprain and Lateral Ligament Reconstruction.

    PubMed

    Shawen, Scott B; Dworak, Theodora; Anderson, Robert B

    2016-10-01

    Ankle sprains are the most common musculoskeletal injury occurring during athletics. Proper initial treatment with supportive pain control, limited immobilization, early return to weight bearing and range of motion, and directed physical therapy are essential for preventing recurrent injury. Reconstruction of the lateral ligaments is indicated for patients with continued instability and dysfunction despite physical therapy. Return to athletic activity should be reserved for athletes who have regained strength, proprioception, and range of motion of the injured ankle. Athletes with a history of an ankle sprain should be prophylactically braced or tapped to reduce risk of recurrent injury. PMID:27543408

  3. Surgical technique affects outcomes in acromioclavicular reconstruction.

    PubMed

    Grassbaugh, Jason A; Cole, Chad; Wohlrab, Kurt; Eichinger, Josef

    2013-01-01

    Optimal treatment for acromioclavicular (AC) dislocation is unknown. Numerous surgical procedures for AC injuries have been described with little comparison. This study sought to compare the clinical and radiographic results of various surgical techniques in order to identify the optimal surgical technique. Ninety patients met inclusion criteria of AC reconstruction at this institution. A retrospective review of outcomes was performed using the electronic records system. Radiographs were measured for pre- and postoperative grade and percent elevation versus the contralateral side. Overall revision rate was 9%. Suture button fixation had a revision rate of 0% compared to 14% (p = .01). Reconstruction procedures performed with distal clavicle excision showed a higher revision rate, 17% compared to 0% (p = .003). There were no statistically significant clinical differences. AC reconstructions performed with suture button construct were superior to other surgical techniques. Procedures performed with distal clavicle excision were inferior to those without. PMID:23449059

  4. Treatment of ligament laxity by electrothermal shrinkage or surgical plication: a morphologic and mechanical comparison.

    PubMed

    Hill, Adam M; Jones, Ioan T; Hansen, Ulrich; Suri, Amrita; Sandison, Ann; Moss, Jill; Wallace, Andrew L

    2007-01-01

    Capsular plication or thermal shrinkage can be used to enhance surgical joint stabilization. We compared mechanical or morphologic properties of the medial collateral ligament of the rabbit knee treated by either bipolar radiofrequency electrothermal shrinkage or surgical plication. After 12 weeks, the medial collateral ligaments were procured from treated and contralateral knees to undergo viscoelastic (creep) testing, quantitative transmission electron microscopy, and immunohistochemistry. Creep strain in thermal (1.85% +/- 0.32%) and plicated (1.92% +/- 0.36%) ligaments was almost twice that of the control group (1.04% +/- 0.15%), although there was no difference between treatment modalities. The morphologic parameters of all 3 groups were significantly different (P < .001). The thermal ligaments demonstrated predominantly small fibrils, whereas the plicated group displayed an intermediate distribution of heterogeneous fibrils, suggesting a different pattern of remodeling. Viscoelastic properties are similar after thermal shrinkage or plication, though inferior to those of intact ligaments. PMID:17030129

  5. Risk Factors for Revision Anterior Cruciate Ligament Reconstruction.

    PubMed

    Ponce, Brent A; Cain, E Lyle; Pflugner, Ryan; Fleisig, Glenn S; Young, Bradley L; Boohaker, Hikel A; Swain, Thomas A; Andrews, James R; Dugas, Jeffrey R

    2016-05-01

    Purpose The purpose of this study was to identify risk factors for revision surgery following primary anterior cruciate ligament (ACL) reconstruction. Methods A retrospective analysis of 2,965 patients who underwent a primary ACL reconstruction were separated into two groups: those who returned to our center for revision of their reconstruction (n = 67) and those who did not return to our center for revision of their reconstruction (n = 2,898). Patient characteristics assessed at the time of primary reconstruction include age, gender, graft type, graft source, meniscal and/or chondral injury, sport, side of effected extremity, level of competition, and surgeon. Multivariable analyses were performed to identify significant, independent associations with the need for revision. Results The portion of patients who returned for revision reconstruction after primary ACL reconstruction was 2.3% (67/2,965). Age (p < 0.001), sport type (p = 0.007), and level of participation (p < 0.001) were significantly different between the nonrevision and revision patients. Graft type preferences varied among surgeons (p < 0.001). Accounting for sport type or level of competition, age (p = 0.014) and surgeon (p = 0.041) were independently associated with revision. Gender, extremity (R vs. L), meniscal or chondral injury, and graft characteristics were not associated with revision. Conclusion Revision of primary ACL reconstructions is independently associated with age and choice of surgeon at the time of primary reconstruction. PMID:26238768

  6. Medial Patellofemoral Ligament Reconstruction: A Longitudinal Study Comparison of 2 Techniques with 2 and 5-Years Follow-Up

    PubMed Central

    Astur, Diego C; Gouveia, Gustavo B; Borges, José H. de Souza; Astur, Nelson; Arliani, Gustavo G; Kaleka, Camila C; Cohen, Moises

    2015-01-01

    Background : The purpose of this study was to compare the results of two popular surgical techniques for medial patellofemoral ligament MPFL reconstruction with a minimum of two-year follow-up. Methods : Fifty-eight patients with traumatic tear of the medial patellofemoral ligament were included in one of the two surgical groups. Group 1 MPFLs were reconstructed through graft endobutton fixation and Group 2 through graft anchor fixation into the patella. After two to five-year follow-up, patients were asked to answer knee function questionnaires (Fulkerson and Kujala) as well as the SF-36 life quality score. Results : There were no statistical difference among postoperative Kujala, Fulkerson, and SF-36 questionnaires scores between Groups 1 and 2. There were statistical significant differences favorable to patients in Group 1 with a shorter follow-up length (2-5 years) compared to those with a longer period of 5-10 years for both Kujala and Fulkerson scores and no difference for group 2. Conclusion : Both medial patellofemoral ligament reconstruction techniques had similar results in a two to ten-year follow-up according to functions and life quality questionnaires. Furthermore, endobutton fixation for the patellar edge of the graft had better results in patients with 2 years of follow-up than those with 5 years. Gender was not significant for surgical results. Moreover, group 1 patients had higher number of complications. PMID:26161157

  7. Acute patellar dislocation with multiple ligament injuries after knee dislocation and single session reconstruction.

    PubMed

    Gormeli, Gokay; Gormeli, Cemile Ayse; Karakaplan, Mustafa; Gurbuz, Sukru; Ozdemir, Zeynep; Ozer, Mustafa

    2016-06-01

    Knee dislocation is a relatively rare condition of all orthopaedic injuries. Accompanying multiple ligament injuries are common after knee dislocations. A 41-year-old male presented to the emergency department suffering from right knee dislocation in June 2013. The patient had anterior cruciate ligament, medial collateral ligament (MCL), medial patellofemoral ligament (MPFL) rupture, and lateral meniscal tear. A single-bundle anatomic reconstruction, medial collateral ligament reconstruction, medial patellofemoral ligament reconstruction and meniscus repair were performed in single session. At twelve months follow-up; there was 160º flexion and 10° extension knee range of motion. Lysholm knee score was 90. Extensive forces can cause both MCL and MPFL injury due to overload and the anatomical relationship between these two structures. Therefore, patients with valgus instability should be evaluated for both MPFL and MCL tears to facilitate successful treatment. PMID:27339584

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

    PubMed Central

    Rayan, Faizal; Nanjayan, Shashi Kumar; Quah, Conal; Ramoutar, Darryl; Konan, Sujith; Haddad, Fares S

    2015-01-01

    Anterior cruciate ligament (ACL) rupture is one of the commonest knee sport injuries. The annual incidence of the ACL injury is between 100000-200000 in the United States. Worldwide around 400000 ACL reconstructions are performed in a year. The goal of ACL reconstruction is to restore the normal knee anatomy and kinesiology. The tibial and femoral tunnel placements are of primordial importance in achieving this outcome. Other factors that influence successful reconstruction are types of grafts, surgical techniques and rehabilitation programmes. A comprehensive understanding of ACL anatomy has led to the development of newer techniques supplemented by more robust biological and mechanical concepts. In this review we are mainly focussing on the evolution of tunnel placement in ACL reconstruction, focusing on three main categories, i.e., anatomical, biological and clinical outcomes. The importance of tunnel placement in the success of ACL reconstruction is well researched. Definite clinical and functional data is lacking to establish the superiority of the single or double bundle reconstruction technique. While there is a trend towards the use of anteromedial portals for femoral tunnel placement, their clinical superiority over trans-tibial tunnels is yet to be established. PMID:25793165

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

    PubMed Central

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

    2014-01-01

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

  10. Healing of a surgically created partial detachment of the posterior cruciate ligament using marrow stimulation: an experimental study in dogs.

    PubMed

    Rodkey, William G; Arnoczky, Steven P; Steadman, J Richard

    2006-01-01

    The inability of intra-articular (cruciate) ligaments to generate a substantive reparative response may preclude the primary surgical repair of such lesions. A marrow stimulation technique that provides access to a fibrin scaffold, cytokines, and mesenchymal stem cells has been shown to be successful in generating a repair response in articular cartilage. We hypothesized that a similar approach may be effective in initiating and supporting a healing response in cruciate ligament injuries. The ability to treat cruciate ligament injuries by primary repair may have significant advantages over the more extensive reconstructive procedures currently advocated. Bilateral subtotal (75% of width) lacerations were made in the proximal aspect of the posterior cruciate ligament (PCL) in 10 adult mongrel dogs. A marrow stimulation technique in which small holes were made through the femoral origin of the PCL into the marrow cavity immediately adjacent to the lesion was performed in one limb. The contralateral limb served as the non-stimulated control. Twelve weeks after surgery the extent of healing and the histological character of the repair tissue in both groups were compared. Marrow stimulation resulted in a statistically significant (P<.05) improvement in the healing of subtotal lacerations made in the PCL. The marrow-stimulated repair tissue was more cellular and had a more organized extracellular matrix than the repair tissue in the non-stimulated group. Our hypothesis was confirmed. Marrow stimulation can induce a "healing response" in intra-articular (cruciate) ligaments. This technique may have clinical applications in primary surgical repair of these structures. PMID:16468489

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

    PubMed Central

    2016-01-01

    A 19-year-old male subject was diagnosed with medial meniscal, lateral meniscal and anterior cruciate ligament (ACL) tear. The symptoms did not subside after 4 months of physical therapy, and he underwent arthroscopic partial medial and lateral meniscectomy and ACL reconstruction. Immediately after the patient woke up from general anesthesia, he started experience loss of sensation in the area of superficial peroneal nerve with inverted dorsiflexion of foot and ankle. Instantly, the bandage and knee brace was removed and a diagnosis of compartment syndrome was ruled out. After eight hours, post-operatively, the patient started receiving physiotherapy. He complained of numbness and tingling in the same area. After 24 h, post-operatively, the patient started to regain dorsiflexion and eversion gradually. Two days after the surgery, the patient exhibited complete recovery of neurological status. PMID:27478579

  12. Popliteal pseudoaneurysm after arthroscopic posterior cruciate ligament reconstruction.

    PubMed

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

    2014-09-01

    This report presents the case of a 30-year-old motocross (BMX) cyclist with a third-degree posterior cruciate ligament rupture. The technique used for reconstruction was the transtibial single-bundle autologous hamstring technique. Unfortunately, the procedure was complicated by a popliteal pseudoaneurysm, which was located in line with the tibial canal. The pseudoaneurysm was treated with an end-to-end anastomosis and the patient recovered without further complaints. In this case, the popliteal artery was damaged most probably by the edge of the reamer or the guide wire during removal. Vascular complications can be limb- and life-threatening. This case report aims to increase the awareness of this serious complication with a review of the literature. PMID:25229050

  13. Soft-Tissue Loop for Medial Patellofemoral Ligament Reconstruction.

    PubMed

    Miswan, Mohd Fairudz Bin Mohd; Al-Fayyadh, Mohamed Zubair Mohamed; Seow Hui, Teo; Mohamed Ali, Mohamed Razif Bin; Ng, Wuey Min

    2016-04-01

    A patient with patellar instability frequently presents with anterior knee pain, patellar subluxation, or dislocation. Medial patellofemoral ligament (MPFL) has a key role for normal patella tracking and stability. Reconstruction of the MPFL using a hamstring graft is a commonly used procedure for the treatment of chronic lateral subluxation of patella. Anchor sutures and bony tunnels are used for the patellar attachment of the graft. This can be associated with complications such as patella fracture; besides, it does not produce an anatomical reconstruction for the native MPFL that can alter the direction of tension applied on the patella. To overcome these problems, a soft-tissue loop technique is used for MPFL reconstruction. During this procedure, a semitendinosus graft was passed through the prepatellar extensor retinaculum and secured with sutures. The free ends of the graft were then passed between the second and third layers of the medial patellofemoral retinaculum and fixed to a femoral tunnel on the medial femoral condyle with an interference screw. The desired amount of tension on the graft is achieved under direct vision of patella tracking arthroscopically. We found this method to be relatively safe and fast. It is more anatomical and can avoid the complications during the conventional bony procedures. PMID:27354953

  14. Revision Anterior Cruciate Ligament Reconstruction in Military Personnel.

    PubMed

    Balazs, George C; Grimm, Patrick D; Donohue, Michael A; Keblish, David J; Rue, John-Paul

    2016-08-01

    This study aims to report the clinical and functional outcomes of revision anterior cruciate ligament (ACL) reconstruction in a young, active duty military population. Patients undergoing revision ACL reconstruction were enrolled in an institutional clinical database and followed prospectively. The primary outcomes were patients' scores on a timed run, as compared with recorded scores before reinjury. Secondary outcomes included scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the International Knee Documentation Committee subjective (IKDC subjective), the Short Form - 36 health survey (SF-36) version 2, the Single Assessment Numeric Evaluation (SANE), and the Tegner activity scale. A total of 13 patients were identified who met the inclusion criteria and had complete follow-up. The mean age at revision ACL reconstruction was 20.5 years (range, 19-22 years), and mean follow-up was 40.2 months (range, 13-66 months). All patients underwent a single stage revision ACL reconstruction with ipsilateral bone-patellar tendon-bone autograft, ipsilateral hamstring autograft, or bone-tendon-bone allograft. Mean physical readiness test (PRT) score at final follow-up was not statistically different than documented preinjury PRT score (77.9 vs. 85.5, p > 0.05), nor was the mean run time (7:12 vs. 6:43/mile, p > 0.05). Significant improvements exceeding published minimal clinically important differences were seen in SANE score, SF-36 physical component summary score, KOOS sports and recreation, KOOS quality of life, WOMAC pain score, and WOMAC function score. Patients undergoing revision ACL reconstruction at our facility show good recovery of baseline physical performance as measured by the semiannual PRT and timed run test, and significant improvements in patient-reported outcome scores. Level of Evidence Level IV, case series. PMID:26524090

  15. Arthroscopic posterior cruciate ligament reconstruction with allograft versus autograft

    PubMed Central

    Sun, Xiujiang; Zhang, Jianfeng; Qu, Xiaoyi

    2015-01-01

    Introduction The aim of the study was to compare and analyze retrospectively the outcomes of arthroscopic posterior cruciate ligament reconstruction with autograft versus allograft. Material and methods Seventy-one patients who underwent arthroscopic posterior cruciate ligament reconstruction with an autograft or allograft met our inclusion criteria. There were 36 patients in the autograft group and 35 patients in the allograft group. All the patients were evaluated by physical examination and a functional ligament test. Comparative analysis was done in terms of operation time, incision length, fever time, postoperative infection rate, incidence of numbness and dysesthesia around the incision, as well as a routine blood test. Results The average follow-up of the autograft group was 3.2 ±0.2 years and that of the allograft group was 3.3 ±0.6 years; there was no significant difference (p > 0.05). No differences existed in knee range of motion, Lysholm scores, International Knee Documentation Committee standard evaluation form and Tegner activity score at final follow-up (p > 0.05), except that patients in the allograft group had a shorter operation time and incision length and a longer fever time (p < 0.05). We found a difference in posterior drawer test and KT-2000 arthrometer assessment (p < 0.05). The posterior tibia displacement averaged 3.8 ±1.5 mm in the autograft group and 4.8 ±1.7 mm in the allograft group (p < 0.05). The incidence of numbness and dysesthesia around the incision in the autograft group was higher than that in the allograft group (p < 0.05). There was no infection postoperatively. The white blood cells and neutrophils in the allograft group increased more than those in the autograft group postoperatively (p < 0.05). Conclusions Both groups of patients had satisfactory outcomes after the operation. However, in the instrumented posterior laxity test, the autograft gave better results than the allograft. No differences in functional scores

  16. Spatial Change of Cruciate Ligaments in Rat Embryo Knee Joint by Three-Dimensional Reconstruction

    PubMed Central

    Zhang, Xiangkai; Aoyama, Tomoki; Takaishi, Ryota; Higuchi, Shinya; Yamada, Shigehito; Kuroki, Hiroshi; Takakuwa, Tetsuya

    2015-01-01

    This study aimed to analyze the spatial developmental changes of rat cruciate ligaments by three-dimensional (3D) reconstruction using episcopic fluorescence image capture (EFIC). Cruciate ligaments of Wister rat embryos between embryonic day (E) 16 and E20 were analyzed. Samples were sectioned and visualized using EFIC. 3D reconstructions were generated using Amira software. The length of the cruciate ligaments, distances between attachment points to femur and tibia, angles of the cruciate ligaments and the cross angle of the cruciate ligaments were measured. The shape of cruciate ligaments was clearly visible at E17. The lengths of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) increased gradually from E17 to E19 and drastically at E20. Distances between attachment points to the femur and tibia gradually increased. The ACL angle and PCL angle gradually decreased. The cross angle of the cruciate ligaments changed in three planes. The primordium of the 3D structure of rat cruciate ligaments was constructed from the early stage, with the completion of the development of the structures occurring just before birth. PMID:26098761

  17. Twenty-Year Experience of a Double-Bundle Anterior Cruciate Ligament Reconstruction

    PubMed Central

    2015-01-01

    Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction using a four-strand semitendinosus tendon was started in our department in July 1994. The motivation for starting the procedure was that the EndoButton with an inside-out procedure instrument became available in Japan. A review article of our DB ACL reconstruction procedure was summarized for the twentieth anniversary of the surgical procedure. Initial tension setting of the two grafts was changed in the first 8 years to achieve better stability during DB ACL reconstruction. A randomized clinical trial (RCT) was started in July 2002 to clarify superiority of the DB procedure to single-bundle (SB) reconstruction under the concept of anatomic reconstruction. Several anatomic studies were performed to describe normal ACL anatomy, which is essential for realizing anatomic reconstruction. A remnant-preserving technique would be an additional option for our DB procedure to improve reconstruction outcomes. Thus, a new remnant-preserving DB procedure was started in 2012. The reproducibility of the new procedure was investigated using three-dimensional computed tomography images. More complex procedures were performed using a transtibial technique and EndoButtons. Initial tension balancing between the two grafts was important for a better outcome. Superiority of knee stability after the DB compared to that after the SB procedure was clarified by the RCT. However, no patient consensus has been reached on any subjective advantage to the DB procedure. Studies of normal ACL anatomy have left questions unresolved regarding where the two tunnels should be created for direct and indirect insertions based on normal anatomy. A new remnant-preserving DB ACL procedure has been practiced. The procedure was more reproducible with respect to creating the femoral tunnel. DB ACL reconstruction using a semitendinosus tendon is an attractive option when pursuing a better outcome for patients. PMID:26217458

  18. The in vivo assessment of tibial motion in the transverse plane in anterior cruciate ligament-reconstructed knees.

    PubMed

    Nordt, W E; Lotfi, P; Plotkin, E; Williamson, B

    1999-01-01

    Twenty-one knees with acutely injured anterior cruciate ligaments were reconstructed with patellar tendon autografts. Eight of the knees had concomitant medial ligament injuries that were not addressed surgically. Follow-up evaluation (average, 25 months) included computed tomography measurements to analyze transverse-plane laxity in both translation and rotation. These measurements were performed with the patient's leg in a load cell device that stabilizes the distal femur and applies known anterior translational force to the proximal tibia at approximately 20 degrees of flexion. A torque apparatus was used to apply internal and external rotational torque to the leg. Images of the tibial plateau in neutral, internal, and external rotation were performed, with and without an anterior translational force. Both knees of each patient were tested and categorized as group I (anterior cruciate ligament-reconstructed) or group II (uninjured). Translation as measured by computed tomography averaged 1 mm side-to-side difference. Internal rotation averaged 8.7 degrees in group I knees and 10.8 degrees in group II knees. External rotation averaged 9.1 degrees in group I knees and 7.4 degrees in group II knees. The eight knees with concomitant medial ligament injuries were analyzed separately; external rotation without anterior load in group I was 9.5 degrees, compared with 5 degrees in group II. This difference was significant (P < 0.01). PMID:10496578

  19. Anterior Cruciate Ligament Reconstruction Using a Flexible Reamer System

    PubMed Central

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

    2015-01-01

    Anatomic reconstruction of the anterior cruciate ligament (ACL) has been shown to improve stability of the knee, particularly rotational stability, potentially leading to superior clinical outcomes and a shorter return to sport. Nonanatomic ACL reconstruction has been linked to graft failure and abnormal cartilage loading thought to contribute to progression of degenerative joint disease. Use of the far anteromedial portal (FAMP) to uncouple the tibial and femoral tunnels has led to improved reproduction of the femoral footprint and facilitates drilling of the femoral tunnel in an anatomic position. The use of the FAMP and straight reamer systems introduces its own set of potential complications, including short femoral tunnels and peroneal nerve injury. These potential complications have been addressed by drilling the femoral tunnel in a hyperflexed position, which can lead to difficulty with positioning the operative extremity, visualization, and identification of anatomic landmarks. The purpose of this case report was to review the advantages and technical aspects of using a flexible reamer system and the FAMP to achieve an anatomic ACL reconstruction while avoiding potential complications and pitfalls. Flexible reamer systems allow an additional way of uncoupling the tibial and femoral tunnels to clearly visualize and establish an anatomic starting point within the femoral footprint of the native ACL while avoiding the complications associated with knee hyperflexion and straight reamers with the far anteromedial portal. In the authors’ experience, an anatomic reconstruction of the ACL can be achieved safely using flexible reamers while avoiding some of the difficulties seen with straight reamers used in conjunction with an uncoupled, far anteromedial approach. PMID:26673860

  20. Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients

    PubMed Central

    Yercan, Hüseyin Serhat; Kale, Gürler; Erkan, Serkan; Özalp, Taçkın; Okcu, Güvenir

    2014-01-01

    Objectives: To evaluate the clinical outcome after medial patellofemoral ligament (MPFL) reconstruction for patellofemoral instability in skeletally immature patients. Methods: Study participants were 8 patients ( median age, 10 years; range, 5-14 and one male , others female) who had suffered from persistent patellofemoral instability. Our technique preserves femoral and patellar insertion anatomy of MPFL using a free semitendinosus autograft, together with tenodesis to the adductor magnus tendon thus sparing the open physis of distal femur and the patellar attachment of MPFL. The clinical results were evaluated preoperatively and the final follow-up period using the Kujala patellofemoral score. Patellar shift, tilt and height were measured preoperatively and on the latest follow-up on plain radiographs. Results: At average 42 months follow-up ( range, 16 to 56), %80 of patients were satisfied with the treatment. Redislocation or instability symptoms occurred in two patients. No apprehension signs or redislocations were seen in the remanining six patients. A significant improvement (p‹0.05) in Kujala score (from 36 to 77) was found. Patellar shift & tilt decreased to anatomic values in six patients but patella alta persisted. Conclusion: The result of this study show that MPFL reconstruction with our technique seems to be an effective treatment for recurrent and habitual patellofemoral dislocation in skeletally immature patients; leading to significant increases in stability and functionality.

  1. Basket-Weave Technique for Medial Patellofemoral Ligament Reconstruction.

    PubMed

    Kodkani, Pranjal S

    2015-06-01

    The anatomy of the medial patellofemoral ligament (MPFL) has been well defined, with parts of its uppermost fibers having a soft-tissue insertion onto the vastus intermedius. Bone tunnels and implants on the patellar side therefore cannot replicate this anatomic construct precisely. Because of implants and tunnels, complications have been reported with bone tunnel fracture. Similarly, on the femoral side, rigid fixation with implants can result in over-constraint with compromised results. Moreover, bone tunnels cannot be used in skeletally immature cases. To overcome issues related to bone tunneling and implants, as well as to reconstruct the MPFL in a precise anatomic manner, an all-soft-tissue fixation technique was devised. Bony landmarks were used as reference points instead of radiologic markers to achieve a more precise construct and to eliminate intraoperative radiography. Hamstring graft was used to reconstruct the MPFL. Special suturing techniques were used to achieve optimal graft fixation with minimal suture knots. A special tissue elevator-suture passer device was designed to facilitate graft passage and ease in performing the procedure. This technique permits differential tensioning, and therefore one achieves stability throughout the range of motion. PMID:26258044

  2. Evaluation of pain after arthroscopically assisted anterior cruciate ligament reconstruction.

    PubMed

    Brown, D W; Curry, C M; Ruterbories, L M; Avery, F L; Anson, P S

    1997-01-01

    Pain after arthroscopically assisted anterior cruciate reconstruction was examined during the first 5 postoperative days to evaluate its intensity and duration. One hundred consecutive patients who underwent arthroscopically assisted anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft were examined. During surgery, ketorolac (60 mg) was given intravenously and 0.25% bupivicaine (1 ml/kg total) was injected into the joint space and the graft donor site. After surgery, all patients received scheduled doses of oral acetaminophen (650 mg) and ketorolac (10 mg) four times a day, and they were allowed to take oral oxycodone (5 to 10 mg) every 2 hours as needed. Pain scores at rest and with activity reached a maximum on the 2nd postoperative morning. Oxycodone consumption also peaked on the 2nd postoperative day. Eighty-nine (89%) patients reported overall pain as mild or moderate, and 95 patients (95%) reported either excellent or good overall relief of pain. The 5-day cumulative mean of visual analog scale pain scores for attempting straight leg raises was significantly higher for patients unable to successfully perform that activity than for patients who were able to perform it. The association between elevated pain scores and diminished ability to perform straight leg raises suggests that pain may inhibit function and therefore early rehabilitation. PMID:9079170

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

    PubMed

    Medvecky, Michael J; Nelson, Stephen

    2015-03-01

    Anterior cruciate ligament (ACL) reconstruction is typically recommended for patients who wish to return to aggressive athletic activity. Unfortunately, reconstructive knee surgery is not a guarantee that all patients will return to their preinjury level of function. A recent meta-analysis including 48 studies showed that after a mean follow-up of 41 months, 82% of participants had returned to some kind of athletic activity but only 63% returned to their preinjury level of participation and a disappointing 44% returned to competitive sports. The reasons why some athletes have been unsuccessful in returning to previous levels of activity are vast and our understanding of these factors is limited. The importance of psychological factors has recently been emphasized. One such factor, kinesiophobia, or fear of reinjury, may play a significant role in some patients' inability to successfully return to their previous level of sports participation. In the meta-analysis, kinesiophobia was the most common reason cited for postoperative reduction in, or cessation of, sports participation. PMID:26244221

  4. Anatomical Single-bundle Anterior Cruciate Ligament Reconstruction Using a Freehand Transtibial Technique

    PubMed Central

    Nha, Kyung-Wook; Han, Jae-Hwi; Kwon, Jae-Ho; Kang, Kyung-Woon; Park, Hyung-Joon

    2015-01-01

    Purpose In anatomical single-bundle (SB) anterior cruciate ligament (ACL) reconstruction, the traditional transtibial approach can limit anatomical placement of the femoral tunnel. Surgical Technique We present a novel three-point freehand technique that allows for anatomic SB ACL reconstruction with the transtibial technique. Materials and Methods Between January 2012 and December 2012, 55 ACL reconstructions were performed using the three-point freehand technique. All the patients were followed for a minimum of 12 months post-operatively. Clinical evaluation was done using the Lysholm score and International Knee Documentation Committee (IKDC) grade. All patients were analyzed by 3-dimensional computed tomography (3D CT) at 1 week after surgery. Results The mean Lysholm score improved from 68.2±12.7 points preoperatively to 89.2±8.2 points at final follow-up. At final follow-up, the IKDC grade was normal in 42 patients and nearly normal in 13 patients. None of the patients had a positive pivot shift test, anterior drawer test and Lachman test at final follow-up. The anatomical position of the femoral tunnel was confirmed on 3D CT scans. Conclusions The three-point freehand technique for SB transtibial ACL reconstruction is a simple, anatomic technique showing good clinical results. PMID:26060611

  5. Lateral patellofemoral ligament reconstruction to restore functional capacity in patients previously undergoing lateral retinacular release

    PubMed Central

    Beckert, Mitch; Crebs, Dylan; Nieto, Michael; Gao, Yubo; Albright, John

    2016-01-01

    AIM To study patient outcomes after surgical correction for iatrogenic patellar instability. METHODS This retrospective study looked at 17 patients (19 knees) suffering from disabling medial patellar instability following lateral release surgery. All patients underwent lateral patellofemoral ligament (LPFL) reconstruction by a single surgeon. Assessments in all 19 cases included functional outcome scores, range of motion, and assessment for the presence of apprehension sign of the patella to determine if LPFL reconstruction surgery was successful at restoring patellofemoral stability. RESULTS No patients reported any residual postoperative symptoms of patellar instability. Also no patients demonstrated medial patellar apprehension or examiner induced subluxation with the medial instability test described earlier following LPFL reconstruction. Furthermore, all patients recovered normal range of motion compared to the contralateral limb. For patients with pre and postoperative outcome scores, the mean overall knee injury and osteoarthritis outcome score increased significantly, from 34.39 preoperatively (range: 7.7-70.12) to 69.54 postoperatively (range: 26.82-91.46) at final follow-up (P < 0.0001). CONCLUSION This novel technique for LPFL reconstruction is effective at restoring lateral restraint of the patellofemoral joint and improving joint functionality. PMID:27574606

  6. Surgical reconstruction in female genital mutilation

    PubMed Central

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

    2016-01-01

    Female genital mutilation (FGM) is an unusual condition for our country. However, an increase in FGM in future days can be predicted with the increasing numbers of exchange students coming from African countries, migration of refugees and socioeconomic relations with the African countries. We want to share our experience of two FGM victims admitted to our clinic with the request of reconstructive vulvar surgery before their marriage. Both women had WHO Type III FGM. Physical examination findings and surgical reconstruction techniques were presented. PMID:27274899

  7. Surgical reconstruction in female genital mutilation.

    PubMed

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

    2016-06-01

    Female genital mutilation (FGM) is an unusual condition for our country. However, an increase in FGM in future days can be predicted with the increasing numbers of exchange students coming from African countries, migration of refugees and socioeconomic relations with the African countries. We want to share our experience of two FGM victims admitted to our clinic with the request of reconstructive vulvar surgery before their marriage. Both women had WHO Type III FGM. Physical examination findings and surgical reconstruction techniques were presented. PMID:27274899

  8. Long-term Outcomes After Anterior Cruciate Ligament Reconstruction in Patients 60 Years and Older

    PubMed Central

    Baker, Champ L.; Jones, Jaclyn C.; Zhang, Jeff

    2014-01-01

    Background: Studies evaluating the benefit of surgical reconstruction of the anterior cruciate ligament (ACL) in middle-aged patients have shown promising results, but study populations were limited primarily to patients who were 40 to 60 years old. Some authors have suggested that surgery may benefit these older patients. Hypothesis: Patients aged ≥60 years with functional instability after ACL injury would benefit from ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Medical records from 1984 through 2010 were searched for patients aged ≥60 years who had undergone primary arthroscopic ACL reconstruction at a single institution. Fifteen patients (15 knees) were identified as meeting the above criteria. All patients were contacted for a telephone interview, and they completed Short Form–36 and modified Cincinnati Knee Score forms. One patient was deceased, and 1 had undergone revision to total knee arthroplasty. Among the remaining 13 patients, the mean age at surgery was 63.5 years (range, 60-73 years), and the mean patient age at the time of follow-up was 73 years (range, 65-85 years). Preoperative radiographs showed no obvious evidence of arthritis in 10 (77%) of the 13 patients; small osteophytes without loss of joint space were seen in 3 (23%) patients. The mean length of follow up was 115.7 months (range, 53-193 months). Results: At their last clinic visits, all 13 patients had regained full range of motion and returned to sports or exercise, such as tennis, golf, gym exercise, and yoga. Twelve patients reported no joint laxity. Conclusion: Patients aged ≥60 years with symptomatic instability from ACL injury can have good to excellent subjective outcomes with surgical reconstruction. Clinical Relevance: Physicians who treat active patients older than 60 years should not exclude ACL reconstruction based on the patient’s age alone. PMID:26535289

  9. Functional Performance Testing After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Abrams, Geoffrey D.; Harris, Joshua D.; Gupta, Anil K.; McCormick, Frank M.; Bush-Joseph, Charles A.; Verma, Nikhil N.; Cole, Brian J.; Bach, Bernard R.

    2014-01-01

    Background: When to allow an athlete to return to unrestricted sporting activity after anterior cruciate ligament (ACL) reconstruction remains controversial. Purpose: To report the results of functional performance testing reported in the literature for individuals at differing time points following ACL reconstruction and to examine differences between graft types. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of Medline, Scopus, and Cochrane Central Register of Controlled Trials was performed using PRISMA guidelines. Inclusion criteria were English-language studies that examined any functional rehabilitation test from 6 months to 2 years following ACL reconstruction. All patient-, limb-, and knee-specific demographics were extracted from included investigations. All functional rehabilitation tests were analyzed and compared when applicable. Results: The search term returned a total of 890 potential studies, with 88 meeting inclusion and exclusion criteria. A total of 4927 patients were included, of which 66% were male. The mean patient age was 26.5 ± 3.4 years. The predominant graft choices for reconstruction were bone–patellar tendon–bone (BPTB) autograft (59.8%) and hamstring autograft (37.9%). The most commonly reported functional tests were the hop tests. The results of these functional tests, as reported in the Limb Symmetry Index (LSI), improved with increasing time, with nearly all results greater than 90% at 1 year following primary ACL reconstruction. At 6 months postoperatively, a number of isokinetic strength measurements failed to reach 80% LSI, most commonly isokinetic knee extension testing in both BPTB and hamstring autograft groups. The knee flexion strength deficit was significantly less in the BPTB autograft group as compared with those having hamstring autograft at 1 year postoperatively, while no significant differences were found in isokinetic extension strength between the 2 groups. Conclusion: Hop

  10. Rates of Deep Venous Thrombosis and Pulmonary Embolus After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Erickson, Brandon J.; Saltzman, Bryan M.; Campbell, Kirk A.; Fillingham, Yale A.; Harris, Joshua D.; Gupta, Anil K.; Bach, Bernard R.

    2015-01-01

    Context: Venous thromboembolic (VTE) disease is thought to be an uncommon but serious problem after anterior cruciate ligament (ACL) reconstruction. Rates of VTE after ACL reconstruction are not well documented. Objective: To determine the rates of deep vein thrombosis (DVT) and symptomatic pulmonary emboli (PE) after ACL reconstruction. Data Sources: Five publicly available databases (PubMed, Cochrane Database of Systematic Reviews, Scopus, Embase, and CINAHL Complete) were utilized. Study Selection: All studies that screened patients for DVT and reported rates of DVT and PE after ACL reconstruction were eligible for inclusion. Level 5 evidence, cadaver, biomechanical, and basic science studies; studies reporting only multiligament reconstruction outcomes; studies where rates of DVT and PE could not be separated out from patients undergoing other types of arthroscopic knee procedures; and classification studies were excluded. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: All study, subject, and surgical data were analyzed. Descriptive statistics were calculated. Results: Six studies met the inclusion criteria, with a mean Modified Colman Methodology Score of 30 ± 8.22. A total of 692 patients (488 men [70.5%]; mean age, 31.6 ± 2.82 years; mean follow-up, 7 ± 18.4 months) underwent ACL reconstruction using either semitendinosus-gracilis autograft (77.6%), bone–patellar tendon–bone (BTB) autograft (22%), or allograft (0.4%). No patient received postoperative pharmacological anticoagulation. Fifty-eight patients (8.4%) had a DVT (81% below knee and 19% above knee), while only 1 patient (0.2%) had a symptomatic PE. When reported, 27% of DVT episodes were symptomatic. Conclusion: The rate of DVT after ACL reconstruction in patients who did not receive postoperative pharmacological anticoagulation is 8.4%, while the rate of symptomatic PE is 0.2%. Of the DVT episodes that occurred, 73% were asymptomatic. PMID:26131305

  11. Surgical treatment of simultaneous rupture of the anterior cruciate ligament and the patellar tendon.

    PubMed

    Chiba, Kyohei; Takahashi, Toshiaki; Hino, Kazunori; Watanabe, Seiji; Yamaoka, Gotaro; Shirakata, Haruo; Fujii, Yuko; Miura, Hiromasa

    2013-12-01

    Although the rupture of the anterior cruciate ligament (ACL) is a common sports injury, a simultaneous rupture of the patellar tendon (PT) is relatively rare. We experienced a case in which a patient simultaneously ruptured the ACL, the medial collateral ligament (MCL), and the PT while sliding during a baseball game. We sutured the PT and MCL during the acute stage, and 7 months later we conducted a double-bundle reconstruction of the ACL. To our knowledge, this is the first report of PT repair using only fiber wire thread, and two-phase double-bundle ACL reconstruction. PMID:23288727

  12. Anterior Cruciate Ligament Remnant-Preserving Reconstruction Using a "Lasso-Loop" Knot Configuration.

    PubMed

    Boutsiadis, Achilleas; Karampalis, Christos; Tzavelas, Anastasios; Vraggalas, Vasileios; Christodoulou, Pavlos; Bisbinas, Ilias

    2015-12-01

    Anterior cruciate ligament (ACL) rupture predisposes to altered kinematics and possible knee joint degeneration. Graft fiber maturation and ligamentization may eliminate this risk during ACL reconstruction procedures. ACL remnant-sparing techniques support the theory that the preserved tissue enhances revascularization, preserves the mechanoreceptors, and leads to anatomic remodeling. The purpose of this article is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur. A nonabsorbable suture is passed through the ACL remnant with a "lasso-loop" technique using a curved rotator cuff hook. Femoral and tibial tunnel preparation is performed according to a standard surgical technique for the EndoButton device (Smith & Nephew Endoscopy, Andover, MA). The free ends of the ACL remnant suture are retrieved through the tibial tunnel and passed through each outside hole of the EndoButton device. The hamstring graft is passed through the tibial and femoral tunnels and fixed to the femoral cortex by flipping the EndoButton and to the tibia by an interference screw. Finally, non-sliding half-stitch locking knots are made to secure the ACL remnant suture on the EndoButton device, by use of a knot pusher. This technique offers simple and secure tensioning of the ACL remnant on the fixation device. PMID:26870656

  13. Anterior Cruciate Ligament Remnant–Preserving Reconstruction Using a “Lasso-Loop” Knot Configuration

    PubMed Central

    Boutsiadis, Achilleas; Karampalis, Christos; Tzavelas, Anastasios; Vraggalas, Vasileios; Christodoulou, Pavlos; Bisbinas, Ilias

    2015-01-01

    Anterior cruciate ligament (ACL) rupture predisposes to altered kinematics and possible knee joint degeneration. Graft fiber maturation and ligamentization may eliminate this risk during ACL reconstruction procedures. ACL remnant–sparing techniques support the theory that the preserved tissue enhances revascularization, preserves the mechanoreceptors, and leads to anatomic remodeling. The purpose of this article is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur. A nonabsorbable suture is passed through the ACL remnant with a “lasso-loop” technique using a curved rotator cuff hook. Femoral and tibial tunnel preparation is performed according to a standard surgical technique for the EndoButton device (Smith & Nephew Endoscopy, Andover, MA). The free ends of the ACL remnant suture are retrieved through the tibial tunnel and passed through each outside hole of the EndoButton device. The hamstring graft is passed through the tibial and femoral tunnels and fixed to the femoral cortex by flipping the EndoButton and to the tibia by an interference screw. Finally, non-sliding half-stitch locking knots are made to secure the ACL remnant suture on the EndoButton device, by use of a knot pusher. This technique offers simple and secure tensioning of the ACL remnant on the fixation device. PMID:26870656

  14. Treatment of acute lateral ankle ligament rupture in the athlete. Conservative versus surgical treatment.

    PubMed

    Lynch, S A; Renström, P A

    1999-01-01

    Acute lateral ankle ligament sprains are common in young athletes (15 to 35 years of age). Diagnostic and treatment protocols vary. Therapies range from cast immobilisation or acute surgical repair to functional rehabilitation. The lateral ligament complex includes 3 capsular ligaments: the anterior tibiofibular (ATFL), calcaneofibular (CFL) and posterior talofibular (PTFL) ligaments. Injuries typically occur during plantar flexion and inversion; the ATFL is most commonly torn. The CFL and the PTFL can also be injured and, after severe inversion, subtalar joint ligaments are also affected. Commonly, an athlete with a lateral ankle ligament sprain reports having 'rolled over' the outside of their ankle. The entire ankle and foot must be examined to ensure there are no other injuries. Clinical stability tests for ligamentous disruption include the anterior drawer test of ATFL function and inversion tilt test of both ATFL and CFL function. Radiographs may rule out treatable fractures in severe injuries or when pain or tenderness are not associated with lateral ligaments. Stress radiographs do not affect treatment. Ankle sprains are classified from grades I to III (mild, moderate or severe). Grade I and II injuries recover quickly with nonoperative management. A non-operative 'functional treatment' programme includes immediate use of RICE (rest, ice, compression, elevation), a short period of immobilisation and protection with a tape or bandage, and early range of motion, weight-bearing and neuromuscular training exercises. Proprioceptive training on a tilt board after 3 to 4 weeks helps improve balance and neuromuscular control of the ankle. Treatment for grade III injuries is more controversial. A comprehensive literature evaluation and meta-analysis showed that early functional treatment provided the fastest recovery of ankle mobility and earliest return to work and physical activity without affecting late mechanical stability. Functional treatment was complication

  15. Rehabilitation After Anterior Cruciate Ligament Reconstruction in the Female Athlete

    PubMed Central

    Wilk, Kevin E.; Arrigo, Christopher; Andrews, James R.; Clancy, William G.

    1999-01-01

    Objective: To discuss the rehabilitation program after anterior cruciate ligament (ACL) reconstruction in the female athlete. In addition, we will discuss 8 unique characteristics identified in the female athlete and specific training drills to address and correct the potentially deleterious effects of these unique characteristics. Background: The female athlete appears to be more susceptible to noncontact ACL injuries than the male athlete. There seem to be many differences between the female and male athlete that may contribute to the increased injury rate in the female athlete. These variations include anatomical and neuromuscular considerations and differences. Description: Based on the unique characteristics of the female athlete and the anatomical and neuromuscular dissimilarities, a specially designed rehabilitation program has been established for the female athlete after ACL surgery. Clinical Advantages: The rehabilitation drills discussed in this article challenge the neuromuscular system through proprioception, kinesthesia, dynamic joint stability, neuromuscular control, and perturbation training activities. Improving the female athlete's neuromuscular system will, we believe, expedite the injured athlete's recovery after ACL injury or surgery. Although the concepts discussed are part of a postoperative rehabilitation program after ACL surgery, these concepts may also be implemented as a preventive program to assist in reducing the incidence of ACL injuries in the female athlete. ImagesFigure 1.Figure 2.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10.Figure 11.Figure 12.Figure 13.Figure 14.Figure 15.Figure 16.Figure 17.Figure 18.Figure 19.Figure 20.Figure 21.Figure 22.Figure 23. PMID:16558561

  16. [Infection after anterior cruciate ligament reconstruction: grave error in treatment?].

    PubMed

    Regauer, M; Neu, J

    2012-09-01

    A 28-year-old patient showed clear signs of knee joint infection 8 days after arthroscopic reconstruction of the anterior cruciate ligament. The treating physicians recommended further observation although they stated that a knee joint infection could not be reliably excluded. One week later arthroscopic revision was performed and intraoperative smear tests showed infection by Pseudomonas aeruginosa. Therefore, another 6 days later the obviously infected transplant had to be removed. In the long run painful and limited range of motion of the affected knee joint persisted. The patient complained about medical malpractice concerning management of the complication. The expert opinion stated that due to the fateful course of infection the tendon graft could not be retrieved after the eighth day post surgery anyway. Thus, only flawed delay of treatment was criticized. The arbitration board argued, however, that scientific data concerning the fate of infected tendon grafts do not support the expert opinion and that immediate arthroscopy and antibiotic treatment at least had the potential to influence the course of infection in a positive manner. Evidence clearly shows that survival of an infected tendon graft depends on early diagnosis and emergency treatment rather than just on fate. Due to the fact that, although having in mind the possibility of a knee joint infection, the necessary therapy was delayed for 8 days, the arbitration board considered the described medical malpractice a severe treatment error, leading to reversal of evidence in favour of the patient. PMID:22706649

  17. Systematic Review of Biological Modulation of Healing in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Fu, Sai-Chuen; Cheuk, Yau-Chuk; Yung, Shu-Hang; Rolf, Christer Gustav; Chan, Kai-Ming

    2014-01-01

    Background: Whether biological modulation is effective to promote healing in anterior cruciate ligament (ACL) reconstruction remains unclear. Purpose: To perform a systematic review of both clinical and experimental evidence of preclinical animal studies on biological modulation to promote healing in ACL reconstruction. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic search was performed using the PubMed, Ovid, and Scopus search engines. Inclusion criteria were clinical and animal studies involving subjects with ACL injury with the use of biological modulation to promote healing outcomes. Methodological quality of clinical studies was evaluated using the Critical Appraisal Skill Programme (CASP) appraisal tool, and animal studies were evaluated by a scoring system based on a published checklist of good animal studies. Results: Ten clinical studies and 50 animal studies were included. Twenty-five included studies were regarded as good quality, with a methodological score ≥5. These studies suggested that transforming growth factor–beta (TGF-β), mesenchymal stem cells, osteogenic factors, and modalities that reduce local inflammation may be beneficial to promote graft healing in ACL reconstruction. Conclusion: This systematic review suggests that biological modulation is able to promote healing on top of surgical treatment for ACL injuries. This treatment strategy chiefly works through promotion of healing at the tunnel-graft interface, but the integrity of the intra-articular midsubstance of the graft would be another target for biological modulation. PMID:26535311

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

    PubMed Central

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

    2015-01-01

    Introduction The aim of the study is retrospectively investigated durations for returning to work following anatomic ACL reconstruction by hamstring autograft in miners and the reasons in patients who were delayed to return to work. Methods Miners with symptomatic anterior cruciate ligament rupture underwent arthroscopic reconstruction. Patients were evaluated in terms of range of motion (ROM) values; Lysholm, Cincinati and Tegner activity scales; laxity testing and complications. By modifying the method used by Fitzgerald et al. we decided for the criteria returning to work. Results Thirty three patients were evaluated with mean followup of 22.7 ± 8.3 months (range 13-46 months). Mean age at the surgery was 27.8 (18-38) years. Lysholm, Cincinati and Tegner activity scales were signifi cantly higher from preoperative scores (Lysholm scores: preoperative: 60.7 ± 12.5, postoperative: 90.3 ± 4.8 (P < 0.001); Tegner activity scores: Preoperative 3.5 ± 1.4, postoperative: 6.2 ± 1.5 (P < 0.001); Cincinati scores: Preoperative: 14.8 ± 5.3, postoperative: 26.9 ± 1.6 (P < 0.001). The average time for returning to work was determined as 15,3 ± 4 weeks. There was no significant difference for knee scores and time for returning to work between patients with meniscal injuries and don't have meniscus lesions. Conclusion The reasons for delays in returning to work was work accident. Hematoma or effusion and pain inside the knee were the most significant reason which affected returning to work. PMID:26918069

  19. Reconstructive methods in hearing disorders - surgical methods

    PubMed Central

    Zahnert, Thomas

    2005-01-01

    Restoration of hearing is associated in many cases with resocialisation of those affected and therefore occupies an important place in a society where communication is becoming ever faster. Not all problems can be solved surgically. Even 50 years after the introduction of tympanoplasty, the hearing results are unsatisfactory and often do not reach the threshold for social hearing. The cause of this can in most cases be regarded as incomplete restoration of the mucosal function of the middle ear and tube, which leads to ventilation disorders of the ear and does not allow real vibration of the reconstructed middle ear. However, a few are also caused by the biomechanics of the reconstructed ossicular chain. There has been progress in reconstructive middle ear surgery, which applies particularly to the development of implants. Implants made of titanium, which are distinguished by outstanding biocompatibility, delicate design and by biomechanical possibilities in the reconstruction of chain function, can be regarded as a new generation. Metal implants for the first time allow a controlled close fit with the remainder of the chain and integration of micromechanical functions in the implant. Moreover, there has also been progress in microsurgery itself. This applies particularly to the operative procedures for auditory canal atresia, the restoration of the tympanic membrane and the coupling of implants. This paper gives a summary of the current state of reconstructive microsurgery paying attention to the acousto-mechanical rules. PMID:22073050

  20. Subsequent Surgery after Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Ding, David; Group, Mars

    2016-01-01

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

  1. Surgical treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament: functional result☆

    PubMed Central

    Barros, Marcos Alexandre; Cervone, Gabriel Lopes de Faria; Costa, André Luis Serigatti

    2015-01-01

    Objective To objectively and subjectively evaluate the functional result from before to after surgery among patients with a diagnosis of an isolated avulsion fracture of the posterior cruciate ligament who were treated surgically. Method Five patients were evaluated by means of reviewing the medical files, applying the Lysholm questionnaire, physical examination and radiological examination. For the statistical analysis, a significance level of 0.10 and 95% confidence interval were used. Results According to the Lysholm criteria, all the patients were classified as poor (<64 points) before the operation and evolved to a mean of 96 points six months after the operation. We observed that 100% of the posterior drawer cases became negative, taking values less than 5 mm to be negative. Conclusion Surgical methods with stable fixation for treating avulsion fractures at the tibial insertion of the posterior cruciate ligament produce acceptable functional results from the surgical and radiological points of view, with a significance level of 0.042.

  2. COMPLICATIONS OF THE SCREW/WASHER TIBIAL FIXATION TECHNIQUE FOR KNEE LIGAMENT RECONSTRUCTION

    PubMed Central

    Almeida, Alexandre; Roveda, Gilberto; Valin, Márcio Rangel; Almeida, Nayvaldo Couto de; Sartor, Vanderlei; Alves, Soraya Melina

    2015-01-01

    To evaluate the presence of pain at the site of the surgical incision and the need to remove the tibial fixation screw in anterior cruciate ligament (ACL) reconstruction, in relation to sex and body mass index (BMI). Methods: A group of 265 patients who underwent ACL reconstruction with ipsilateral flexor tendon grafts from the thigh in which the tibial fixation technique consisted of using a cortical screw and metal washer, between July 2000 and November 2007, were evaluated. Results: 176 patients were evaluated for an average of 33.3 ± 19.5 months; median of 29.5 months; IIQ: 17-45 months; minimum of 8 and maximum of 87 months. There was no statistical difference regarding complaints of pain at the site of the screw (p = 0.272) and the need to remove the tibial screw (p = 0.633) between sexes. There was no statistical difference regarding complaints of pain at the site of the screw (p = 0.08) and the need to remove the tibial screw (p = 0.379) according to BMI. Conclusion: The pain complaint rate at the screw site from the screw and metal washer method used for tibial fixation in ACL reconstruction was of the order of 25%, and the screw had to be removed in 10.8% of the cases. There was no predominance of pain complaints at the surgical wound between the sexes. There was a greater tendency to complain about pain among patients with BMI < 25. There was no predominance of screw and washer removal between the sexes or between individuals with different BMIs. PMID:27022587

  3. Anatomical considerations in hamstring tendon harvesting for anterior cruciate ligament reconstruction

    PubMed Central

    Charalambous, Charalambos Panayiotou; Kwaees, Tariq Adam

    2012-01-01

    Summary Hamstring tendons are widely used for anterior cruciate ligament (ACL) reconstruction of the knee. Certain anatomical considerations must be taken into account when harvesting the hamstring tendons to be used in ACL reconstruction. These anatomical considerations are discussed in this review article. PMID:23738306

  4. Interface and biocompatibility of polyethylene terephthalate knee ligament prostheses. A histological and ultrastructural device retrieval analysis in failed synthetic implants used for surgical repair of anterior cruciate ligaments.

    PubMed

    Kock, H J; Stürmer, K M; Letsch, R; Schmit-Neuerburg, K P

    1994-01-01

    In a prospective clinical study of 54 patients with acute anterior cruciate ligament instability, 56 artificial ligaments made of polyethylene terephthalate (Trevira hochfest) were implanted to restore knee stability. The average follow-up of these artificial knee ligaments was 40.2 (12-79) months; five implants (10%) had to be explanted due to failure after an average of 17.8 (6-50) months. All explants were examined by histological and ultrastructural methods in a device retrieval analysis. With regard to short- and medium-term artificial ligament failure in the human knee joint, a non-isometric surgical implantation technique, inappropriate strain during rehabilitation and implant fatigue and wear were responsible for ligament failures. PMID:7696041

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  8. Anterior cruciate ligament reconstruction as a day case with extended recovery.

    PubMed

    Haug; Sørensen; Dichmann

    2000-10-01

    The aim of this study was to describe the procedures and the postoperative outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction when carried out a day case with extended recovery. Between December 1995 and September 1998, 91 patients underwent surgery using bone-patellatendon-bone autografts and interference screw fixation. Additional surgical procedures were performed on 35 of the patients. The patient records were evaluated for a mean of 17 months (1-33 months) postoperatively. The course of treatment was. (1) Evaluation and KLT-arthrometer test 14 days preoperatively. (2) Surgery, cryocuff, bupivacain, paracetamol, NSAID and ketobemidon for postoperative pain control. (3) Discharge from hospital within 24 h. (4) Physiotherapy after 14 days. (5) Follow-up after 6 weeks with bandage removal and after 6 months. Eight patients required one further day of hospitalisation due to pain (four), nausea (one), haematoma (two) and prolonged anaesthesia (one). Five patients were readmitted to hospital for a mean of 8 (3-16) days postoperatively. Three patients underwent re-surgery due to haematoma/rupture of the scar. No deep infections were found. We concluded that this effective method of ACL-reconstruction can be carried out safely as a day case procedure with extended recovery to the benefit of the patients. PMID:11063947

  9. Baseline Predictors of Health-Related Quality of Life After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Dunn, Warren R.; Wolf, Brian R.; Harrell, Frank E.; Reinke, Emily K.; Huston, Laura J.; Spindler, Kurt P.; Nwosu, Samuel K.; Kaeding, Christopher C.; Parker, Richard D.; Wright, Rick W.; Andrish, Jack T.; McCarty, Eric C.; Amendola, Annunziato; Marx, Robert G.; Wolcott, Michelle L.; Liu, Zhouwen; Alvarez, JoAnn M.

    2015-01-01

    Background: Limited information exists regarding predictors of general quality of life following anterior cruciate ligament (ACL) reconstruction with up to six-year follow-up. We hypothesized that certain variables evaluated at the time of ACL reconstruction will predict the general quality of life as measured by the Short Form-36 (SF-36). Methods: All unilateral ACL reconstructions from 2002 to 2004 in patients currently enrolled in a prospective multicenter cohort were evaluated. Patients preoperatively completed the SF-36 validated outcome instrument. Surgeons documented intra-articular pathological conditions and treatment, as well as the ACL reconstruction surgical technique. At baseline and at a minimum of two and six years postoperatively, patients completed the SF-36. Longitudinal analysis was performed for the two-year and six-year end points. Results: Of the initial 1512 subjects, at least one follow-up questionnaire was obtained from 1411 subjects (93%). The cohort was 44% female, and the median patient age at enrollment was twenty-three years. The mean scores were 41.9 points for the Physical Component Summary (PCS) and 51.7 points for the Mental Component Summary (MCS) at baseline, 53.6 points for the PCS and 52.0 points for the MCS at two years, and 54.0 points for the PCS and 52.4 points for the MCS at six years. Significant predictors of a higher PCS score were a higher baseline PCS score, younger age, lower baseline body mass index, having >50% of the lateral meniscus excised, or having no treatment done on a lateral meniscal tear. In contrast, significant predictors of a lower PCS score were a shorter follow-up time since surgery, revision ACL reconstruction, smoking at baseline, fewer years of education, and chondromalacia of the lateral tibial plateau. The mean utility gained at six years after ACL reconstruction was 5.3 quality-adjusted life years (QALYs). Conclusions: Large improvements in the PCS (with an effect size of 1.2) were noted at two

  10. Arthroscopic single-bundle posterior cruciate ligament reconstruction: retrospective review of hamstring tendon graft versus LARS artificial ligament

    PubMed Central

    Li, Bin; Wen, Yu; Qian, Qirong; Wu, Yuli; Lin, Xiangbo

    2008-01-01

    Our objective was to compare the results of reconstruction of isolated chronic posterior cruciate ligament (PCL) injury using a four-strand hamstring graft (4SHG) and a LARS artificial ligament. Thirty-six patients were divided into a 4SHG group (n = 15) and a LARS group (n = 21). The minimum follow-up time was two years. The outcome measures used were KT-1000 measurements, the International Knee Documentation Committee (IKDC) scoring system, Lysholm knee scoring scale and Tegner activity rating. Both groups improved significantly between the preoperative and postoperative assessment in terms of the knee laxity and functional examination (P < 0.01). Meanwhile, knee stability was significantly improved in the LARS group when compared with the 4SHG group (P < 0.05); this was also the case for the Lysholm, Tegner and IKDC scores (P < 0.05). Our study indicates that using a LARS ligament for PCL reconstruction was clinically more useful than using a 4SHG in the treatment of the PCL-deficient knee. PMID:18654776

  11. RISKS AND CONSEQUENCES OF USING THE TRANSPORTAL TECHNIQUE IN RECONSTRUCTING THE ANTERIOR CRUCIATE LIGAMENT: RELATIONSHIPS BETWEEN THE FEMORAL TUNNEL, LATERAL SUPERIOR GENICULAR ARTERY AND LATERAL EPICONDYLE OF THE FEMORAL CONDYLE

    PubMed Central

    Astur, Diego Costa; Aleluia, Vinicius; Santos, Ciro Veronese; Arliani, Gustavo Gonçalves; Badra, Ricardo; Oliveira, Saulo Gomes; Kaleka, Camila Cohen; Cohen, Moisés

    2015-01-01

    Objective: Define a security zone to avoid possibles vascular and ligamentar complications during anterior cruciate ligament reconstruction. Methods: Arthroscopic reconstruction using the transtibial and transportal technique in cadaver knees was performed followed by dissection and measurement of the distance between the femoral tunnel and the proximal attachment of the lateral collateral ligament and the femoral tunnel and the lateral superior genicular artery. Results: The measure of the analysed distances show us an aproximation between the major branch of the lateral superior genicular artery and the femoral insertion of the colateral lateral ligament and the femoral tunnel during the transportal technique. Conclusion: We realize that the use of technical ship it to arthroscopic ACL reconstruction has a higher probability of injury to the lateral geniculate artery and insertion of the lateral collateral ligament, promoting post-surgical complications such as instability of the knee, osteonecrosis of the femoral condyle and ligamentização graft. PMID:27047873

  12. The Clinical Outcomes of Anterior Cruciate Ligament Reconstruction Surgery Based on Iatrogenic Damage

    PubMed Central

    Korkmaz, Murat; Erkoç, Mustafa Fatih; Karaaslan, Fatih; Mermerkaya, Musa Uğur

    2014-01-01

    Objectives: To examine the degenerative changes of adjacent cartilage and bony structure, after anterior cruciate ligament reconstruction surgery. Methods: 27 subjects, who had anterior cruciate ligament reconstruction surgery due to various reasons at least 12 months ago, were admitted to study. MRI data of patients were acquired retrospectively. Pre-operative and post-operative MRI images were compared according to retropatellar cartilage thickness, evidence of any new osteophytes formation or any signal intensity change on bony elements. Paired statistical analysis was applied. Results: The MRI revelation showed that; there were 14 patients with decrement of retropatellar cartilage thickness, 9 patients with new osteophytes formation and 21 patients with abnormal signal intensity change on bony elements; which were statistically significant (P<0.001). Conclusion: These results provide basic information about the degenerative effect of anterior cruciate ligament reconstruction surgery, on adjacent cartilage and bony structure.

  13. Scapholunate interosseus ligament reconstruction on a cadaver: A technique

    PubMed Central

    Arenas-Prat, Joan

    2014-01-01

    Background: Acute rupture of the scapholunate interosseus ligament is a relatively frequent occurrence which can be repaired primarily by direct suturing. However, patients are often seen a few weeks after injury when most of the ligament fibers have degenerated. This poses a challenge because direct repair can be difficult and long term results have not been satisfying. In the present study, a technique is presented to address this problem and its possible advantages are discussed. Materials and Methods: A fresh frozen wrist cadaver specimen, thawed to room temperature, was used to carry out the procedure. The scapholunate joint was exposed through a dorsal approach and stabilized using two percutaneous Kirschner wires. Using a U shaped chisel, a groove along the scapholunate articular margin was created to accommodate a strip from the extensor retinaculum as a ligament plasty. This has been secured using six anchor sutures and several pictures taken during the procedure to expose the key steps. Results: The ligamentoplasty presented in this article preserves most of the articular surface of proximal carpus and at the same time stabilizes the scapholunate joint. However, more in vivo research should be carried out to validate this treatment. Conclusion: The technique suggests a possible way to repair a ruptured scapholunate interosseus ligament that cannot be repaired primarily. Because osteointegration of the ligament strips is not possible in the present experiment, biomechanics of the construct cannot be fully tested. PMID:25298562

  14. Autograft Versus Nonirradiated Allograft Tissue for Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Mariscalco, Michael W.; Magnussen, Robert A.; Mehta, Divyesh; Hewett, Timothy E.; Flanigan, David C.; Kaeding, Christopher C.

    2014-01-01

    Background An autograft has traditionally been the gold standard for anterior cruciate ligament reconstruction (ACLR), but the use of allograft tissue has increased in recent years. While numerous studies have demonstrated that irradiated allografts are associated with increased failure rates, some report excellent results after ACLR with nonirradiated allografts. The purpose of this systematic review was to determine whether the use of nonirradiated allograft tissue is associated with poorer outcomes when compared with autografts. Hypothesis Patients undergoing ACLR with autografts versus nonirradiated allografts will demonstrate no significant differences in graft failure risk, laxity on postoperative physical examination, or differences in patient-oriented outcome scores. Study Design Systematic review. Methods A systematic review was performed to identify prospective or retrospective comparative studies (evidence level 1, 2, or 3) of autografts versus nonirradiated allografts for ACLR. Outcome data included graft failure based on clinical findings and instrumented laxity, postoperative laxity on physical examination, and patient-reported outcome scores. Studies were excluded if they did not specify whether the allograft had been irradiated. Quality assessment and data extraction were performed by 2 examiners. Results Nine studies comparing autografts and nonirradiated allografts were included. Six of the 9 studies compared bone– patellar tendon–bone (BPTB) autografts with BPTB allografts. Two studies compared hamstring tendon autografts to hamstring tendon allografts, and 1 study compared hamstring tendon autografts to tibialis anterior allografts. The mean patient age in 7 of 9 studies ranged from 24.5 to 32 years, with 1 study including only patients older than 40 years and another not reporting patient age. The mean follow-up duration was 24 to 94 months. Six of 9 studies reported clinical graft failure rates, 8 of 9 reported postoperative instrumented

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

    NASA Astrophysics Data System (ADS)

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

    2008-09-01

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

  16. Arthroscopic-Assisted Management of Unstable Distal-Third Clavicle Fractures: Conoid Ligament Reconstruction and Fracture Cerclage With Sutures.

    PubMed

    Cisneros, Luis Natera; Reiriz, Juan Sarasquete

    2015-12-01

    Surgical treatment is usually indicated for the management of Neer type IIB fractures of the distal third of the clavicle. These unstable injuries have shown a rate of nonunion that oscillates around 30% to 45% when managed conservatively, and surgical strategies often require a second operation for implant removal. We describe an arthroscopic-assisted technique for the treatment of Neer type IIB unstable distal-third clavicle fractures that overcomes the issues related to open surgery, metal hardware, and implant irritation. This technique increases the load to failure of the construct by means of adding a synthetic conoid ligament reconstruction with a nonrigid suspension device, and it allows the diagnosis and treatment of associated glenohumeral injuries. Our technique incorporates a fracture interfragmentary fixation with sutures, thus avoiding a second operation for implant removal. PMID:26870642

  17. Arthroscopic-Assisted Management of Unstable Distal-Third Clavicle Fractures: Conoid Ligament Reconstruction and Fracture Cerclage With Sutures

    PubMed Central

    Cisneros, Luis Natera; Reiriz, Juan Sarasquete

    2015-01-01

    Surgical treatment is usually indicated for the management of Neer type IIB fractures of the distal third of the clavicle. These unstable injuries have shown a rate of nonunion that oscillates around 30% to 45% when managed conservatively, and surgical strategies often require a second operation for implant removal. We describe an arthroscopic-assisted technique for the treatment of Neer type IIB unstable distal-third clavicle fractures that overcomes the issues related to open surgery, metal hardware, and implant irritation. This technique increases the load to failure of the construct by means of adding a synthetic conoid ligament reconstruction with a nonrigid suspension device, and it allows the diagnosis and treatment of associated glenohumeral injuries. Our technique incorporates a fracture interfragmentary fixation with sutures, thus avoiding a second operation for implant removal. PMID:26870642

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

    PubMed Central

    Lynch, T. Sean; Parker, Richard D.; Patel, Ronak M.; Andrish, Jack T.; Spindler, Kurt P.

    2015-01-01

    With an estimated 200,000 anterior cruciate ligament reconstructions performed annually in the United States, there is an emphasis on determining patient-specific information to help educate patients on expected clinically relevant outcomes. The Multicenter Orthopaedic Outcomes Network consortium was created in 2002 to enroll and longitudinally follow a large population cohort of anterior cruciate ligament reconstructions. The study group has enrolled >4,400 anterior cruciate ligament reconstructions from seven institutions to establish the large level I prospective anterior cruciate ligament reconstruction outcomes cohort. The group has become more than a database with information regarding anterior cruciate ligament injuries; it has helped to establish a new benchmark for conducting multicenter, multisurgeon orthopaedic research. The changes in anterior cruciate ligament reconstruction practice resulting from the group include the use of autograft for high school, college, and competitive athletes in their primary anterior cruciate ligament reconstructions. Other modifications include treatment options for meniscus and cartilage injuries, as well as lifestyle choices made after anterior cruciate ligament reconstruction. PMID:25667401

  19. Annular Ligament Reconstruction With Triceps Autograft for Chronic Radial Head Instability.

    PubMed

    Marinello, Patrick G; Wagner, Timothy; Styron, Joseph; Maschke, Steven; Evans, Peter J

    2016-03-01

    We present a modification and revisit of the Bell Tawse technique for annular ligament reconstruction with triceps autograft for chronic radial head instability. In patients with instability stemming from an incompetent annular ligament, this technique has proved successful to restore stability to the proximal radial capitellar joint as an augment after ensuring normal boney anatomy. Through a lateral Kocher approach, an approximately 10 cm × 4 mm strip of lateral triceps tendon is harvested as a free graft for the reconstruction. Following passing of the triceps autograft around the radial neck, it is sutured to a mini-Mitek suture anchor and is placed into a decorticated portion of the proximal ulna to recreate the annular ligament. Finally, we present 2 case illustrations where this technique was successfully used for chronic radial head instability. PMID:26709571

  20. The Lateral Meniscus as a Guide to Anatomical Tibial Tunnel Placement During Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kassam, A.M.; Tillotson, L.; Schranz, P.J.; Mandalia, V.I.

    2015-01-01

    Purpose: The aim of the study is to show, on an MRI scan, that the posterior border of the anterior horn of the lateral meniscus (AHLM) could guide tibial tunnel position in the sagittal plane and provide anatomical graft position. Method: One hundred MRI scans were analysed with normal cruciate ligaments and no evidence of meniscal injury. We measured the distance between the posterior border of the AHLM and the midpoint of the ACL by superimposing sagittal images. Results: The mean distance between the posterior border of the AHLM and the ACL midpoint was -0.1mm (i.e. 0.1mm posterior to the ACL midpoint). The range was 5mm to -4.6mm. The median value was 0.0mm. 95% confidence interval was from -0.5 to 0.3mm. A normal, parametric distribution was observed and Intra- and inter-observer variability showed significant correlation (p<0.05) using Pearsons Correlation test (intra-observer) and Interclass correlation (inter-observer). Conclusion: Using the posterior border of the AHLM is a reproducible and anatomical marker for the midpoint of the ACL footprint in the majority of cases. It can be used intra-operatively as a guide for tibial tunnel insertion and graft placement allowing anatomical reconstruction. There will inevitably be some anatomical variation. Pre-operative MRI assessment of the relationship between AHLM and ACL footprint is advised to improve surgical planning. Level of Evidence: Level 4. PMID:26962379

  1. Partial arthroscopic trapeziectomy with ligament reconstruction to treat primary thumb basal joint osteoarthritis.

    PubMed

    Desmoineaux, P; Delaroche, C; Beaufils, P

    2012-11-01

    Since the outcome of partial trapeziectomy is not always satisfactory, we proposed using arthroscopy to perform partial trapeziectomy and to perform ligament reconstruction with the abductor pollicis longus tendon. A tendon strip was left intact at its insertion at the base of the first metacarpal and then slipped into the trapeziectomy space. It was fixed into a blind tunnel at the base of the second metacarpal with a bioabsorbable interference screw. Forty-nine patients were surgically treated between 2006 and 2009. With an average follow-up of 3.6 years, 83.5% of patients were satisfied with the procedure; 96% of thumbs were stable and 74% were pain free. The average recovery time was 4.5 months. There were four cases of radial nerve branch irritation and one case of flexor carpi radialis tendinitis; there were no cases of complex regional pain syndrome. This minimally-invasive technique is a less-aggressive treatment approach for thumb carpometacarpal joint arthritis, which simplify postoperative recovery. PMID:23098774

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

    PubMed

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

    2015-06-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  5. Neural Excitability Alterations After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Pietrosimone, Brian G.; Lepley, Adam S.; Ericksen, Hayley M.; Clements, Amy; Sohn, David H.; Gribble, Phillip A.

    2015-01-01

    Context Neuromuscular dysfunction is common after anterior cruciate ligament reconstruction (ACL-R). However, little is known about quadriceps spinal-reflex and descending corticomotor excitability after ACL-R. Understanding the effects of ACL-R on spinal-reflex and corticomotor excitability will help elucidate the origins of neuromuscular dysfunction. Objective To determine whether spinal-reflex excitability and corticomotor excitability differed between the injured and uninjured limbs of patients with unilateral ACL-R and between these limbs and the matched limbs of healthy participants. Design Case-control study. Setting Laboratory. Patients or Other Participants A total of 28 patients with unilateral ACL-R (9 men, 19 women; age = 21.28 ± 3.79 years, height = 170.95 ± 10.04 cm, mass = 73.18 ± 18.02 kg, time after surgery = 48.10 ± 36.17 months) and 29 participants serving as healthy controls (9 men, 20 women; age = 21.55 ± 2.70 years, height = 170.59 ± 8.93 cm, mass = 71.89 ± 12.70 kg) volunteered. Main Outcome Measure(s) Active motor thresholds (AMTs) were collected from the vastus medialis (VM) using transcranial magnetic stimulation. We evaluated VM spinal reflexes using the Hoffmann reflex normalized to maximal muscle responses (H : M ratio). Voluntary quadriceps activation was measured with the superimposed-burst technique and calculated using the central activation ratio (CAR). We also evaluated whether ACL-R patients with high or low voluntary activation had different outcomes. Results The AMT was higher in the injured than in the uninjured limb in the ACL-R group (t27 = 3.32, P = .003) and in the matched limb of the control group (t55 = 2.05, P = .04). The H : M ratio was bilaterally higher in the ACL-R than the control group (F1,55 = 5.17, P = .03). The quadriceps CAR was bilaterally lower in the ACL-R compared with the control group (F1,55 = 10.5, P = .002). The ACL-R group with low voluntary activation (CAR < 0.95) had higher AMT than

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

    ERIC Educational Resources Information Center

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

    2001-01-01

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

  7. A Retrospective Review of Anterior Cruciate Ligament Reconstruction Using Patellar Tendon

    PubMed Central

    Chahal, Jaskarndip; Lee, Andrew; Heard, Wendell; Bach, Bernard R.

    2013-01-01

    Background: The comparative data in the literature regarding rates of reoperation, revision ligament surgery, and contralateral surgery following anterior cruciate ligament reconstruction (ACLR) are variable and are often derived from studies with multiple surgeons, multiple centers, different surgical techniques, and a wide variety of graft choices. Purpose: To describe and analyze a single surgeon’s experience with ACLR using bone–patellar tendon–bone (BPTB) as the primary graft choice over a 25-year period. Study Design: Retrospective case series. Methods: All patients who underwent ACLR from 1986 to 2012 were identified from a prospectively maintained database. Traditional follow-up was only for patients who sought subsequent surgery with the index surgeon or presented with contralateral ACL injury. Covariates of interest included age, sex, time, and graft selection. Outcomes of interest included reoperation rates after primary/revision ACLR, rate of revision ACLR, success of meniscal repair with concomitant ACLR, and the proportion of patients undergoing contralateral surgery. Results: A total of 1981 patients (mean age, 29 years; 49% male) were identified. Of patients undergoing primary ACLR (n = 1809), 74% had BPTB autograft and 26% had a central third BPTB allograft. The mean age of patients undergoing autograft and allograft ACLR was 26 and 36 years, respectively (P < .05). Allograft tissue usage increased over time (P < .05). The rate of personal ACLR revision surgery was 1.7% (n = 30) for primary cases and 3.5% (n = 6) for revision cases. There were no significant differences in revision rates between primary autograft (1.6%) and allograft (2.0%) ACLR. With allograft use, the method of sterilization did not affect revision rates. The overall reoperation rate following primary ACLR was 10%; the 5-year reoperation rate was 7.7%. The reoperation rate was lower for primary cases reconstructed with allograft versus autograft (5% vs 12%) (P < .0001

  8. Results of meniscectomy and meniscal repair in anterior cruciate ligament reconstruction

    PubMed Central

    DELEDDA, DAVIDE; ROSSO, FEDERICA; COTTINO, UMBERTO; BONASIA, DAVIDE EDOARDO; ROSSI, ROBERTO

    2015-01-01

    Meniscal tears are commonly associated with anterior cruciate ligament (ACL) injuries. A deficient medial meniscus results in knee instability and could lead to higher stress forces on the ACL reconstruction. Comparison of results in meniscectomy and meniscal repairs revealed worse clinical outcomes in meniscectomy, but higher re-operation rates in meniscal repairs. Our aim was to review the results of ACL reconstruction associated with meniscectomy or meniscal repair. PMID:26889472

  9. EVALUATION OF THE RESULTS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING FLEXOR TENDONS AND RIGID GUIDE TRANSVERSE SCREW

    PubMed Central

    de Castro, Renato Luiz Bevilacqua; Acras, Sandor Dosa

    2015-01-01

    Objective: The aim of this study was to analyze the results of ACL (anterior cruciate ligament) reconstruction using quadruple flexor tendons as grafts, with ligament fixation in the femur using a rigid guide transverse screw and in the tibia, using a cancellous screw with a fixing washer. Methods: 173 knees (166 from males and seven from females) that had undergone surgery with ACL reconstruction using this technique between December 2002 and February 2007 were evaluated. The mean age was 30 years (from 13 to 56 years), and the mean follow-up time was 30 months (6-55 months). We divided the knees into three groups, which were assessed using the Lysholm scale: Group A with six months of follow-up; Group B with 12 months of follow-up; and Group C with 24 months of follow-up. Results: We evaluated the results, and groups A, B and C received 94, 95 and 95 points respectively on the Lysholm scale. Conclusions: The surgical technique proved to be safe and easy to perform, with good results and a low complication rate. Also, its results were maintained throughout the study period of 24 months. PMID:27027002

  10. Symmetric limb overgrowth following anterior cruciate ligament reconstruction in a skeletally immature patient.

    PubMed

    Zimmerman, Lance J; Jauregui, Julio J; Riis, Jacob F; Tuten, Hans Robert

    2015-11-01

    This report describes a case of symmetric femoral and tibial overgrowth of 2.8 cm in a 13-year-old patient after undergoing reconstruction surgery for his torn right anterior cruciate ligament. A literature review of previous cases is also provided. Following a pediatric anterior cruciate ligament tear, delaying surgery until the patient approaches skeletal maturity may avoid long-term growth disturbances, however, delaying this procedure may increase the probability of further joint damage. This growth disturbance was managed with a percutaneous epiphysiodesis that corrected the limb length deformity. PMID:25919804

  11. Early failure of coracoclavicular ligament reconstruction using TightRope system.

    PubMed

    Singh, Bijayendra; Mohanlal, Paras; Bawale, Rajesh

    2016-03-01

    This prospective study reports the results of early failure of coracoclavicular (CC) ligament reconstruction using TightRope. Nine consecutive patients who had CC ligament reconstruction using TightRope or GraftRope were assessed for radiological and functional outcomes using DASH and Oxford Shoulder scores. With an average age of 38.4 (21-70) years, four patients had type III injuries, two type IV and two type V injuries. The mean follow-up was 22.8 (12-42) months. In 7 out of 9 patients, secondary progressive loss of reduction was observed at an average of 3.1 (1-7) months. Three patients underwent revision. The mean DASH score at latest follow-up was 27.45 (19.6-35) & Oxford shoulder score was 30.5 (20-43). Coraco-clavicular reconstruction with TightRope or GraftRope appears to result in failure with progressive AC joint subluxation perhaps due to 'windscreen wiper' micromotion. Surgeons should be wary of this potential problem whilst choosing this method of -reconstruction for CC ligament reconstructions. PMID:26984664

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

    PubMed Central

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

    2016-01-01

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

  13. The Effect of Graft Strength on Knee Laxity and Graft In-Situ Forces after Posterior Cruciate Ligament Reconstruction

    PubMed Central

    Lai, Yu-Shu; Chen, Wen-Chuan; Huang, Chang-Hung; Cheng, Cheng-Kung; Chan, Kam-Kong; Chang, Ting-Kuo

    2015-01-01

    Surgical reconstruction is generally recommended for posterior cruciate ligament (PCL) injuries; however, the use of grafts is still a controversial problem. In this study, a three-dimensional finite element model of the human tibiofemoral joint with articular cartilage layers, menisci, and four main ligaments was constructed to investigate the effects of graft strengths on knee kinematics and in-situ forces of PCL grafts. Nine different graft strengths with stiffness ranging from 0% (PCL rupture) to 200%, in increments of 25%, of an intact PCL’s strength were used to simulate the PCL reconstruction. A 100 N posterior tibial drawer load was applied to the knee joint at full extension. Results revealed that the maximum posterior translation of the PCL rupture model (0% stiffness) was 6.77 mm in the medial compartment, which resulted in tibial internal rotation of about 3.01°. After PCL reconstruction with any graft strength, the laxity of the medial tibial compartment was noticeably improved. Tibial translation and rotation were similar to the intact knee after PCL reconstruction with graft strengths ranging from 75% to 125% of an intact PCL. When the graft’s strength surpassed 150%, the medial tibia moved forward and external tibial rotation greatly increased. The in-situ forces generated in the PCL grafts ranged from 13.15 N to 75.82 N, depending on the stiffness. In conclusion, the strength of PCL grafts have has a noticeable effect on anterior-posterior translation of the medial tibial compartment and its in-situ force. Similar kinematic response may happen in the models when the PCL graft’s strength lies between 75% and 125% of an intact PCL. PMID:26001045

  14. [Implant-free anterior cruciate ligament reconstruction with the patella ligament and press-fit double bundle technique].

    PubMed

    Hertel, P; Behrend, H

    2010-07-01

    Anterior cruciate ligament (ACL) reconstruction using autologous tendons (BTB patellar tendon, hamstrings, quadriceps tendon) in an implant-free fixation technique is becoming more and more popular due to biological and economical reasons. In 1987 an implant-free press-fit fixation technique of a BTB graft from the medial side of the patellar tendon (via mini-arthrotomy) was introduced and first published during the 4th ESKA Conference 1990 in Stockholm. Special emphasis is given to the anatomical orientation of the BTB graft. During the inside-out femoral press-fit fixation the bone-ligament margin of the graft is placed directly into the femoral insertion line of the natural ACL adapting its double-bundle structure. The graft is fixed by press-fit within the tibial metaphysis and its ligamentous part is secured in the metaphysis by harvested cancellous bone blocks driven into the joint line from the outside. The postoperative regime includes weight-bearing as tolerated and free motion. Out of 159 patients 95 could be seen for follow-up after an average of 10.7 years. The final IKDC knee score revealed 22.1% in group A (very good) and 62.1% in group B (good). The Tegner activity level was 6.8 preinjury and 6.0 postoperatively. The average KT 1,000 side-to-side difference was 1.8 mm. Subjectively no patient complained of instability and 99% of the patients could kneel on hard ground with minimal or no complaints. ACL revision surgery due to graft failure was not necessary in any of the patients. Advantages of the described procedure are a narrow anatomical orientation including the double bundle structure of the ACL, rapid graft incorporation by bone-to-bone healing, lack of bone resorption at the graft-host interface, decreased donor site morbidity, cost-effectiveness and ease of possible revision surgery. PMID:20607510

  15. Pseudogout: A Rare Cause of Acute Arthritis Following Arthroscopic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Zaman, Mahvash; Sabir, Numaera; Charalambous, Charalambos P.

    2015-01-01

    We report a case of an acute pseudogout attack following single-bundle anterior cruciate ligament (ACL) reconstruction in a 35-year-old man. At the initial reconstruction surgery, he was found to have early degenerative changes mainly in the lateral compartment. He presented with acute onset pain and swelling following reconstruction of the ACL. Arthroscopic irrigation was performed and the synovial fluid was positive for calcium pyrophosphate crystals. A pseudogout attack must be considered in the differential diagnosis in cases of acute onset pain and swelling after arthroscopic surgery, especially with the background of degenerative knee changes, and this may signify a poorer long-term outcome. PMID:26389074

  16. Anatomical reconstruction of the spring ligament using peroneus longus tendon graft.

    PubMed

    Choi, Kyungjin; Lee, Samuel; Otis, James C; Deland, Jonathan T

    2003-05-01

    Posterior tibial tendon insufficiency is often associated with failure of the spring ligament and flatfoot deformity. Arch correction procedures involving bony realignment, such as lateral column lengthening or joint fusions, can predispose to arthritis. Soft tissue reconstruction may provide a more anatomical correction without these complications. The purpose of this investigation was to compare the ability of three different spring ligament reconstruction procedures to correct flatfoot deformity. A deformity model of 5 degrees - 15 degrees talonavicular abduction was created in 10 cadaver foot-ankle specimens. Three reconstructions utilizing the peroneus longus tendon were evaluated for their ability to correct talonavicular abduction and subtalar eversion under 357 N vertical GRF load. A superomedial/plantar passage of the tendon through the calcaneus and navicular was shown to be more effective than either of the other two approaches, correcting the talonavicular joint from 9.1 degrees +/- 8.1 degrees abducted to 1.0 degree +/- 6.8 degrees adducted, and the subtalar joint from 3.1 degrees +/- 3.3 degrees everted to 0.4 degrees +/- 4.2 degrees inverted. Thus, an anatomical reconstruction of a model of a failed spring ligament was demonstrated to be effective in the correction of a flatfoot deformity produced in cadaver foot-ankle specimens. PMID:12801201

  17. EFFECT OF THE GRAFTING SECTION AREA ON ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION SURGERY – HISTOLOGICAL STUDY ON DOGS

    PubMed Central

    Pereira, Ricardo Violante; Müller, Sérgio Swain; Vannini, Rodrigo; Felisbino, Sérgio Luiz; Curcelli, Emilio Carlos; Pereira, Gilberto José Caçdo; de Almeida Silvares, Paulo Roberto

    2015-01-01

    Objective: To correlate the initial grafting section area with the outcomes from anterior cruciate ligament (ACL) reconstruction surgery. Eight dogs underwent operations, divided into two groups according to graft size: Group A, 25% and Group B, 40% of the patellar ligament (PL) width. Methods: After eight months, the dogs were sacrificed for macroscopic and histological analysis on the reconstructed ligaments. Each dog's contralateral knee was used as a control. Results: In both groups, all the reconstructed ligaments were seen to be viable and hypertrophied. The morphology of the PL grafting had changed, which was observed by measuring the crimp and cellularity, and it resembled that of the ACL. Conclusion: The grafting section area did not influence the histological outcomes from ACL reconstruction surgery in dogs. PMID:27047857

  18. Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction With Remnant Preservation Using Outside-In Technique

    PubMed Central

    Lee, Byung-Ill; Kwon, Sai-Won; Choi, Hyung-Suk; Chun, Dong-Il; Kim, Yong-Beom; Kim, Byoung-Min

    2015-01-01

    This report describes a modified anatomic single-bundle anterior cruciate ligament (ACL) reconstruction technique using the FlipCutter guide pin (Arthrex, Naples, FL) as a retrograde drill and a cortical suspensory fixation device (TightRope; Arthrex) with an adjustable graft loop length. Preservation of the ACL remnant as a biological sleeve for the graft is an important issue from the viewpoints of acceleration of revascularization and ligamentization, preservation of the proprioceptive nerve fibers, enhancement of the biological environment for healing, and maintenance of the anchor point at the native tibial attachment, in addition to yielding a lower incidence of tibial bone tunnel enlargement. The goal of our technique is to obtain some advantages of the remnant-preserving technique through an anatomic single-bundle ACL reconstruction, which is performed to minimize damage to the ACL tibial remnant. PMID:26759771

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

    PubMed

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

    2016-07-01

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

  20. Newly developed anatomical and functional ligament reconstruction for the Lisfranc joint fracture dislocations: a case report.

    PubMed

    Hirano, Takaaki; Niki, Hisateru; Beppu, Moroe

    2014-09-01

    A 15-year-old male complained of pain in the left foot that occurred when changing direction while running and at presentation, he had difficulty in walking due to pain and swelling. Plain X-ray of the foot revealed a Myerson Type B2 Lisfranc fracture dislocation, and 3-D computed tomography (CT) revealed proximal fractures of the 2nd-4th metatarsals. The Lisfranc ligament was anatomically reconstructed using a graft of the gracilis tendon. During aftercare, partial weight bearing was permitted at 6 weeks postoperatively and full weight bearing at 8 weeks postoperatively. The patient resumed sporting activities 3 months postoperatively. A plain X-ray taken 12 months postoperatively showed favorable joint congruency, and the patient scored 100 points on the Japanese Society for Surgery of the Foot standard rating system midfoot scale. Our anatomical ligament reconstruction is a useful new method of anatomical reduction and maintenance, and it shortens the duration of aftercare. PMID:25103712

  1. Long-term interventions effects of robotic training on patients after anterior cruciate ligament reconstruction

    PubMed Central

    Hu, Chunying; Huang, Qiuchen; Yu, Lili; Zhou, Yue; Gu, Rui; Ye, Miao; Ge, Meng; Xu, Yanfeng; Liu, Jianfeng

    2016-01-01

    [Purpose] The aim of this study was to examine the long-term interventions effects of robot-assisted therapy rehabilitation on functional activity levels after anterior cruciate ligament reconstruction. [Subjects and Methods] The subjects were 8 patients (6 males and 2 females) who received anterior cruciate ligament reconstruction. The subjects participated in robot-assisted therapy lasting for one month. The Timed Up-and-Go test, 10-Meter Walk test, Functional Reach Test, surface electromyography of the vastus lateralis and vastus medialis, and extensor strength of isokinetic movement of the knee joint were evaluated before and after the intervention. [Results] The average value of the of vastus medialis EMG, Functional Reach Test, and the maximum and average extensor strength of the knee joint isokinetic movement increased significantly, and the time of the 10-Meter Walk test decreased significantly. [Conclusion] These results suggest that walking ability and muscle strength can be improved by robotic walking training as a long-term intervention.

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

    PubMed Central

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

    2016-01-01

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

  3. Sex Influences the Biomechanical Outcomes of Anterior Cruciate Ligament Reconstruction in a Pre-Clinical Large Animal Model

    PubMed Central

    Kiapour, Ata M.; Fleming, Braden C.; Proffen, Benedikt L.; Murray, Martha M.

    2015-01-01

    Background The risk of anterior cruciate ligament (ACL) injury is 2-10 times greater in women than men. While the role of sex on injury risk is well established, its effects on surgical outcomes remain controversial. Purpose To investigate whether the biomechanical outcomes of ACL reconstruction are affected by sex using an established porcine model that displays similar sex-specific differences in knee anatomy and ligament structural properties to humans. We hypothesized there are sex differences in ACL reconstruction outcomes with regards to the graft structural properties, knee laxity and cartilage damage. Study Design Controlled Laboratory Study. Methods A total of 41 (23 M, 18 F) adolescent Yucatan minipigs underwent unilateral ACL transection and ACL reconstruction using sex-matched bone-patellar tendon-bone allografts (with or without additional bio-enhancement). Graft biomechanical and histological properties, knee laxity and cartilage damage were assessed after 15 weeks. A two-factor ANOVA was used to investigate the effect of sex on all the measured outcomes after adjusting for the treatment effect. Results After 15 weeks of healing, female pigs had a significantly lower mean normalized graft yield load (by 18.5±7.7%; p=0.023) and linear stiffness (by 11.9±5.6%; p=0.043), compared to males. Female pigs had a significantly greater side-to-side differences in AP knee laxity at 30° (by 1.4±0.6 mm; p=0.028) and 90° (by 1.8±0.8 mm; p=0.032). Female pigs had a lower graft vascular density (by 0.8±0.3 [analog scoring];p=0.021) with similar cellular and collagen-based histologic scores in both sexes (p>0.6). Female pigs also had a significantly larger area of cartilage damage (by 43.3±14.8 mm2; p=0.014) after conventional ACL reconstruction than their male counterparts. Conclusion Female pigs had significantly worse outcomes (i.e., graft structural properties, knee laxity and cartilage damage) compared to males in this translational model after 15 weeks

  4. Tibial Tunnel Cyst Formation after Anterior Cruciate Ligament Reconstruction Using a Non-Bioabsorbable Interference Screw

    PubMed Central

    Joshi, Yogesh V.; Phaltankar, Padmanabh M.; Charalambous, Charalambos P.

    2015-01-01

    Tibial cyst formation following the use of bioabsorbable interference screws in anterior cruciate ligament (ACL) reconstruction is well-described; however, cyst formation after the use of metallic interference screws is not well-documented. We describe a case of osteolytic lesion of the proximal tibia presenting to us 20 years after ACL reconstruction using an autologous bone-tendon-bone graft. The original graft fixation technique was interference fixation with a metal screw in the tibial and femoral tunnels. A two-stage revision reconstruction of the ACL was undertaken with curettage and bone grafting of the tibial lesion in the first stage and reconstruction using a four-strand hamstring tendon in the second stage. The patient recovered satisfactorily with complete healing of the cyst and returned to pre-injury level of activities. We have reviewed case reports and case series that describe the aetiology of intra-osseous cyst formation following ACL reconstruction. PMID:26673117

  5. Tibial Tunnel Cyst Formation after Anterior Cruciate Ligament Reconstruction Using a Non-Bioabsorbable Interference Screw.

    PubMed

    Joshi, Yogesh V; Bhaskar, Deepu; Phaltankar, Padmanabh M; Charalambous, Charalambos P

    2015-12-01

    Tibial cyst formation following the use of bioabsorbable interference screws in anterior cruciate ligament (ACL) reconstruction is well-described; however, cyst formation after the use of metallic interference screws is not well-documented. We describe a case of osteolytic lesion of the proximal tibia presenting to us 20 years after ACL reconstruction using an autologous bone-tendon-bone graft. The original graft fixation technique was interference fixation with a metal screw in the tibial and femoral tunnels. A two-stage revision reconstruction of the ACL was undertaken with curettage and bone grafting of the tibial lesion in the first stage and reconstruction using a four-strand hamstring tendon in the second stage. The patient recovered satisfactorily with complete healing of the cyst and returned to pre-injury level of activities. We have reviewed case reports and case series that describe the aetiology of intra-osseous cyst formation following ACL reconstruction. PMID:26673117

  6. Bicruciate Ligament Reconstruction in a Professional Rugby Player: Clinical Presentation and Literature Review

    PubMed Central

    Bohu, Yoann; Klouche, Shahnaz; Herman, Serge; Gerometta, Antoine; Lefevre, Nicolas

    2015-01-01

    The association of an anterior cruciate ligament (ACL) tear and a posterior cruciate ligament (PCL) injury is rare in athletes, and to our knowledge it has never been described in a professional rugby player. We report the case of a 27-year-old international professional rugby player who presented with an ACL tear associated with chronic posterior laxity on a former PCL tear. The procedure associated arthroscopic ACL and PCL reconstruction in a one-stage operation with two autografts, bone-patellar tendon-bone and hamstring tendon, respectively. At 7 months postoperatively, the patient had returned to playing rugby at the same level of play. The therapeutic strategy successfully met the established goals of returning to sports at the same level of play with excellent functional results after 2 years of follow-up. A literature review was performed via PubMed. The inclusion criteria were the studies in English language, assessing the return-to-sport after bicruciate ligament reconstruction in athletes. Eight studies were included in analysis. Only one study has focused on the return-to-sport in 24 competitive athletes and two other studies have included 1 professional athlete each. The overall rate of the return-to-sport after bicruciate reconstruction varied between 100% and 50%. PMID:26491590

  7. Effect of Femoral Tunnel Placement for Reconstruction of the Anterior Cruciate Ligament on Tibial Rotation

    PubMed Central

    Ristanis, Stavros; Stergiou, Nicholas; Siarava, Eleftheria; Ntoulia, Aikaterini; Mitsionis, Grigorios; Georgoulis, Anastasios D.

    2009-01-01

    Background: Rotational knee movement after reconstruction of the anterior cruciate ligament has been difficult to quantify. The purpose of this study was to identify in vivo whether a more horizontal placement of the femoral tunnel (in the ten o'clock position rather than in the eleven o'clock position) can restore rotational kinematics, during highly demanding dynamic activities, in a knee in which a bone-patellar tendon-bone graft had been used to reconstruct the anterior cruciate ligament. Methods: We evaluated ten patients in whom a bone-patellar tendon-bone graft had been used to reconstruct the anterior cruciate ligament with the femoral tunnel in the eleven o'clock position, ten patients who had had the same procedure with the femoral tunnel in the ten o'clock position, and ten healthy controls. Kinematic data were collected while the subjects (1) descended from a stairway, made foot contact, and then pivoted 90° on the landing lower limb and (2) jumped from a platform, landed with both feet on the ground, and pivoted 90° on the right or left lower limb. The dependent variable that we examined was tibial rotation during pivoting. Results: The results demonstrated that reconstruction of the anterior cruciate ligament with the femoral tunnel in either the ten or the eleven o'clock position successfully restored anterior tibial translation. However, both techniques resulted in tibial rotation values, during the dynamic activities evaluated, that were significantly larger than those in the intact contralateral lower limbs and those in the healthy controls. Tibial rotation did not differ significantly between the two reconstruction groups or between the healthy controls and the intact contralateral lower limbs. However, we noticed that positioning the tunnel at ten o'clock resulted in slightly decreased rotation values that may have clinical relevance but not statistical significance. Conclusions: Regardless of which of the two tested positions was utilized to

  8. Visualization of postoperative anterior cruciate ligament reconstruction bone tunnels

    PubMed Central

    2011-01-01

    Background and purpose Non-anatomic bone tunnel placement is the most common cause of a failed ACL reconstruction. Accurate and reproducible methods to visualize and document bone tunnel placement are therefore important. We evaluated the reliability of standard radiographs, CT scans, and a 3-dimensional (3D) virtual reality (VR) approach in visualizing and measuring ACL reconstruction bone tunnel placement. Methods 50 consecutive patients who underwent single-bundle ACL reconstructions were evaluated postoperatively by standard radiographs, CT scans, and 3D VR images. Tibial and femoral tunnel positions were measured by 2 observers using the traditional methods of Amis, Aglietti, Hoser, Stäubli, and the method of Benereau for the VR approach. Results The tunnel was visualized in 50–82% of the standard radiographs and in 100% of the CT scans and 3D VR images. Using the intraclass correlation coefficient (ICC), the inter- and intraobserver agreement was between 0.39 and 0.83 for the standard femoral and tibial radiographs. CT scans showed an ICC range of 0.49–0.76 for the inter- and intraobserver agreement. The agreement in 3D VR was almost perfect, with an ICC of 0.83 for the femur and 0.95 for the tibia. Interpretation CT scans and 3D VR images are more reliable in assessing postoperative bone tunnel placement following ACL reconstruction than standard radiographs. PMID:21999625

  9. Injury to the Anterior Tibial Artery during Bicortical Tibial Drilling in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kim, Sang Bum; Lim, Jin Woo; Seo, Jeong Gook

    2016-01-01

    Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. The patient had a vague pain which led to delayed diagnosis of compartment syndrome and delayed treatment with fasciotomy. All surgeons should be aware of these rare but critical complications because the results may be disastrous like muscle necrosis as in this case. PMID:26929808

  10. Injury to the Anterior Tibial Artery during Bicortical Tibial Drilling in Anterior Cruciate Ligament Reconstruction.

    PubMed

    Kim, Sang Bum; Lim, Jin Woo; Seo, Jeong Gook; Ha, Jeong Ku

    2016-03-01

    Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. The patient had a vague pain which led to delayed diagnosis of compartment syndrome and delayed treatment with fasciotomy. All surgeons should be aware of these rare but critical complications because the results may be disastrous like muscle necrosis as in this case. PMID:26929808

  11. Editorial: Functional testing in the assessment of return to sports after anterior cruciate ligament reconstruction

    PubMed Central

    Sun, Luning; Fan, Jing; Gill, Thomas J.

    2015-01-01

    The paper entitled “Functional testing differences in anterior cruciate ligament (ACL) reconstruction patients released versus not released to return to sport” published in the American Journal of Sports Medicine (AJSM) assessed Functional Movement Screen (FMS) and the Lower Quarter Y Balance Test (YBT-LQ) as possible objective tools for evaluating a patient’s readiness to return to sports after ACL reconstruction. The results suggest that many patients clinically cleared continue to have measurable function deficits and that both FMS and YBT-LQ may be used as additional tools for return to sports clearance. PMID:26539442

  12. Medial Patellofemoral Ligament Reconstruction: A Technique With a “V”-Shaped Patellar Tunnel

    PubMed Central

    Ahmad, Riaz; Jayasekera, Narlaka; Schranz, Peter; Mandalia, Vipul

    2014-01-01

    Patellofemoral dislocation is a common problem affecting the young and active population. The medial patellofemoral ligament (MPFL) is torn when the patella dislocates as it acts as a checkrein to lateral displacement. This leads to patellar instability, and MPFL reconstruction is required if the dislocation recurs after a trial of rehabilitation. We describe a “V”-shaped patellar tunnel technique to reconstruct the MPFL using an autologous gracilis graft. This modification of the patellar tunnel does not breach the lateral cortex of the patella, and it allows a broader attachment of the tendon graft to the patella, which mimics the normal anatomic attachment of the MPFL to the patella. PMID:25473612

  13. Stable Meniscal Tears Left In Situ at the Time of Arthroscopic Anterior Cruciate Ligament Reconstruction: A Systematic Review.

    PubMed

    Rothermich, Marcus A; Cohen, Jared A; Wright, Rick

    2016-04-01

    Meniscal tears can be incidentally encountered at the time of anterior cruciate ligament (ACL) reconstruction. In these cases, the surgeon has several treatment options that include benign neglect, debridement, trephination, and repair. The authors performed a systematic review of the literature studying the various treatment options for meniscal tears discovered at the time of ACL reconstruction. This systematic review included eight articles that had relevant data regarding benign neglect compared with debridement, trephination, or repair of incidentally encountered meniscal tears. Combined data from these studies resulted in a total of 646 meniscal tears treated with benign neglect with follow-up information available. Importantly, there were differences in reoperation rates between medial and lateral meniscal tears left in situ. However, stable medial and lateral meniscal tears treated with benign neglect did not have different subjective or objective outcomes than those treated with surgical intervention. This systematic review concludes that when stable meniscal tears are encountered at the time of arthroscopic ACL reconstruction, benign neglect can be used for a successful outcome. PMID:25927355

  14. Biomechanical Analysis of Simulated Clinical Testing and Reconstruction of the Anterolateral Ligament of the Knee

    PubMed Central

    Spencer, Luke; Burkhart, Timothy A.; Tran, Michael N.; Rezansoff, Alex James; Deo, Shaneel; Caterine, Scott; Getgood, Alan M

    2016-01-01

    Background: Anatomic anterolateral ligament (ALL) reconstruction has been proposed to assist anterior cruciate ligament (ACL) reconstruction in controlling anterolateral rotational laxity of the knee. However, the biomechanical effects have not been reported. Purpose: (1) To investigate the effect of ALL transection on rotational knee kinematics and (2) to determine the effect on knee biomechanics of ALL reconstruction procedures compared with lateral extra-articular tenodesis (LET). Study Design: Controlled laboratory study. Methods: A total of 12 cadaveric knee specimens were tested in the following sequence: (1) ACLintact, (2) anteromedial bundle of ACL sectioned (ACLamb), (3) complete ACL sectioned (ACLfull), (4) ALL sectioned (ALLsec), (5) anatomic ALL reconstruction (ALLanat), and (6) LET. Biomechanical anterior drawer and Lachman tests were performed in which a 90-N load was applied to the posterior tibia, and anterior translation was measured. A combined load to simulate the early phase of the pivot-shift test was executed in which a 5-N·m internal rotation moment was applied to a fully extended knee; anterior translation and internal rotation were measured. Results: Anterior translation increased across conditions for the biomechanical tests. Internal rotation during the simulated early-phase pivot-shift test was significantly different between ACLfull and ALLsec. Anatomic ALL reconstruction did not significantly reduce internal rotation or anterior translation during the simulated early-phase pivot-shift test. After LET, a significant decrease in anterior translation was found. There was no evidence of over-constraint of the knee with either anatomic ALL reconstruction or LET. Conclusion: The ALL demonstrated a role in controlling anterolateral laxity. LET had a composite effect in governing both anterior and rotational laxity. Anatomic ALL reconstruction did not reduce anterolateral rotational laxity. Clinical Relevance: Profiling the biomechanical

  15. Thoracoscopic tracheal reconstruction without surgical field intubation

    PubMed Central

    Zhao, Kejia; Mei, Jiandong; Hai, Yang; Liu, Chengwu; Ma, Lin

    2016-01-01

    Abstract A cross‐filed endotracheal intubation is usually applied to maintain single lung ventilation during both open and thoracoscopic tracheal resection and reconstruction. Herein, we report a case of thoracoscopic tracheal resection and reconstruction with interrupted ventilation via transoral endotracheal intubation in a patient with thoracic tracheal adenocarcinoma. Tracheal anastomosis was accomplished using a running suture with a 3‐0 Prolene stitch. PMID:27385994

  16. Adult acquired flatfoot deformity at the talonavicular joint: reconstruction of the spring ligament in an in vitro model.

    PubMed

    Deland, J T; Arnoczky, S P; Thompson, F M

    1992-01-01

    The mobile unilateral flatfoot deformity of chronic posterior tibial tendon insufficiency has been difficult to correct by soft tissue procedures. The procedures can decrease pain, but they do not always correct the longitudinal arch or relieve all the symptoms. Using 10 fresh frozen cadaveric specimens and a rig for stimulation of weightbearing, the deformity associated with chronic posterior tibial tendon insufficiency was produced by multiple ligamentous release and documented by AP and lateral radiographs. Reconstruction of the spring ligament using a ligament bone autograft from the superficial deltoid ligament was then performed and tested under load. The mean correction was within 2.5 degrees of normal (over or undercorrection) on both the AP and lateral radiographs with the specimens under load. Clinical Relevance. In posterior tibial tendon insufficiency, it may be possible to address the ligament as well as tendon insufficiency to gain a corrected arch. The success of such a procedure will depend upon adequate tendon and ligament reconstruction in a fully mobile deformity. Questions remain as to the adequacy of this ligament graft, and a stronger free ligament graft, as well as correction of any bony malalignment, may be required. PMID:1398361

  17. Biomechanical Measures During Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury After Anterior Cruciate Ligament Reconstruction and Return to Sport

    PubMed Central

    Paterno, Mark V.; Schmitt, Laura C.; Ford, Kevin R.; Rauh, Mitchell J.; Myer, Gregory D.; Huang, Bin; Hewett, Timothy E.

    2016-01-01

    Background Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non–anterior cruciate ligament–injured athletes. Hypotheses Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury. Study Design Cohort study (prognosis); Level of evidence, 2. Methods Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury. Results Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81). Conclusion Altered neuromuscular control of the hip and knee during a dynamic landing task

  18. Effectiveness of cryotherapy after anterior cruciate ligament reconstruction

    PubMed Central

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

    2012-01-01

    Objective The purpose of this study was to evaluate cryotherapy effectiveness in the immediate postoperative period of ACL reconstruction to improve pain and range of motion (ROM) of the knee. Methods This is a pilot study of a prospective and randomized clinical trial. Patients (n=25) were divided into two groups: Intervention (A) group (n=10): patients were submitted to an inpatient physical therapy protocol and received ice compress for 20 minutes, twice a day; Control (B) group (n=9): patients had the same protocol, twice a day. The pain intensity was evaluated with the visual analogic scale (VAS) and range of motion was measured with a goniometer. Results The Intervention (A) group had important absolute and percentual improvement when compared with the Control (B) group regarding measures of pain and knee flexion/extension ROM. Conclusion Cryotherapy in the immediate postoperative period of ACL reconstruction was effective to improve pain and range of motion of the knee. Level of Evidence I, Randomized Clinical Trial. PMID:24453619

  19. ANATOMICAL RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT OF THE KNEE: DOUBLE BAND OR SINGLE BAND?

    PubMed Central

    Zanella, Luiz Antonio Zanotelli; Junior, Adair Bervig; Badotti, Augusto Alves; Michelin, Alexandre Froes; Algarve, Rodrigo Ilha; de Quadros Martins, Cesar Antonio

    2015-01-01

    Objective: To evaluate the double-band and single-band techniques for anatomical reconstruction of the anterior cruciate ligament of the knee and demonstrate that the double-band technique not only provides greater anterior stability but also causes less pain and a better subjective patient response. Methods: We selected 42 patients who underwent anterior cruciate ligament reconstruction, by means of either the single-band anatomical reconstruction technique, using flexor tendon grafts with two tunnels, or the double-band anatomical reconstruction technique, using four tunnels and grafts from the semitendinosus and gracilis tendons. All fixations were performed using interference screws. There was no variation in the sample. Before the operation, the objective and subjective IKDC scores, Lysholm score and length of time with the injury were evaluated. All these variables were reassessed six months later, and the KT-1000 correlation with the contralateral knee was also evaluated. Results: There was no significant difference between the two groups in subjective evaluations, but the single-band group showed better results in relation to range of motion and objective evaluations including KT-1000 (with statistical significance). Conclusion: Our study demonstrated that there was no difference between the two groups in subjective evaluations, but better results were found using the single-band anatomical technique, in relation to objective evaluations. PMID:27042621

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

    NASA Astrophysics Data System (ADS)

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

    2014-04-01

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

  1. Comparative Study on Anterior Cruciate Ligament Reconstruction: Determination of Isometric Points with and Without Navigation

    PubMed Central

    Angelini, Fabio J.; Albuquerque, Roberto F. M.; Sasaki, Sandra U.; Camanho, Gilberto L.; Hernandez, Arnaldo J.

    2010-01-01

    OBJECTIVES: To compare the accuracy of tunnel placement and graft isometry for anterior cruciate ligament reconstruction performed using a computer-assisted navigation system (Orthopilot) and using traditional instruments. METHODS: The anterior cruciate ligament was removed intact from 36 pairs of human cadaver knees. From each pair, one knee was randomized to Group 1 (conventional) and the other to Group 2 (Orthopilot). An inelastic suture was then passed through the central points of the tibial and femoral tunnels. Neither of the tunnels was drilled. All knees were then dissected, and six parameters were obtained: distances from the tibial tunnel center to the 1) posterior cruciate ligament, 2) anterior horn of the lateral meniscus and 3) medial tibial spine; 4) distance from the femoral tunnel center to the posterior femoral cortex; 5) femoral tunnel coronal angle; and 6) variation of the distance from the femoral to the tibial tunnel with the knee extended and at 90 degrees of flexion. RESULTS: The variation of the distance from the femoral to the tibial tunnel during flexion and extension was smaller in the Orthopilot group (better isometry) compared to the conventional group. There were no statistical differences in any other parameters between the groups, and all tunnels were considered to be in satisfactory positions. DISCUSSION: The results obtained for anterior cruciate ligament reconstruction depend on precise isometric point positioning, and a navigation system is a precision tool that can assist surgeons in tunnel positioning. CONCLUSION: No differences in tunnel position were observed between the groups. Nonetheless, better isometry was achieved in the Orthopilot group than with conventional instruments. PMID:20668625

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

    PubMed Central

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

    2016-01-01

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

  3. Bilateral Medial Tibial Plateau Fracture after Arthroscopic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Cho, Chul Hyun; Lee, Kyung Jae; Jeon, Jong Hyuk

    2015-01-01

    Tibial plateau fractures after arthroscopic anterior cruciate ligament (ACL) reconstruction are rare, and only isolated cases have been reported. The authors describe a case of bilateral medial tibial plateau fracture following a minor motorcycle accident in a patient who underwent arthroscopic ACL reconstruction in the past. Two years and four months before the accident, the patient underwent an arthroscopically assisted ACL reconstruction using double-bundle technique on his left knee at a hospital. He had the same surgery using single-bundle technique on his right knee about eight months ago at another hospital. The fractures in his both involved knees occurred through the tibial tunnel and required open reduction with internal fixation. At three weeks after fixation, a second-look arthroscopy revealed intact ACLs in both knees. At five months follow-up, he was able to walk without instability on physical examination. Follow-up radiographs of the patient showed callus formations with healed fractures. PMID:26060613

  4. PERI-INCISIONAL DYSESTHESIA FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING CENTRAL THIRD OF PATELLAR TENDON

    PubMed Central

    de Carvalho Júnior, Lúcio Honório; Machado, Soares Luiz Fernando; Gonçalves, Matheus Braga Jacques; Júnior, Paulo Randal Pires; Baumfeld, Daniel Soares; Pereira, Marcelo Lobo; Lessa, Rodrigo Rosa; Costa, Lincoln Paiva; Bisinoto, Henrique Barra

    2015-01-01

    Objective: To evaluate the prevalence and type of dysesthesia around the incision used to obtain the patellar tendon for anterior cruciate ligament (ACL) reconstruction surgery. Methods: Out of a population of 1368 ACL reconstructions using the central third of the patellar tendon, 102 patients (111 knees) were evaluated by means of telephone interview. Results: The mean follow-up was 52 months (ranging from 12 to 88 months). The patients' ages ranged from 16 to 58 years (mean: 34.7 years). There was some degree of peri-incisional dysesthesia in 66 knees (59.46%). In 40.54% of the knees, this condition was not found. In all the cases of dysesthesia, the type encountered was Highet's type II. Conclusion: Peri-incisional dysesthesia following ACL reconstruction using the central third of the patellar tendon is highly prevalent. It affected more than half of the cases in this series. PMID:27026983

  5. Cranial cruciate ligament rupture in the dog--a retrospective study comparing surgical techniques.

    PubMed

    Moore, K W; Read, R A

    1995-08-01

    Three surgical techniques, grouped as intra-articular techniques, extracapsular techniques and fibular head transposition, were used for repair of the cranial cruciate ligament (CCL)-deficient stifle in 113 dogs over a 4 year 4 month period. The clinical outcome of the techniques were compared using information provided by the owners and physical examination. Regardless of surgical technique, 85.7 to 91.0% of dogs showed clinical improvement after surgery. However, less than 50% of dogs became clinically sound on the operated leg and 9.0 to 14.3% of dogs remained persistently lame on the operated leg. No statistical association was found between result after surgery and age, body weight, sex, duration of injury before surgery, association with injury, tibial plateau angle, degree of radiographic osteoarthritis before surgery or the presence of concurrent medial meniscal injury. On physical examination, extra-capsular techniques appeared superior to the fibular head transposition in terms of joint stability and limb function. Concurrent medial meniscal injury necessitating meniscectomy existed in 48.0% of cases. Twenty-two percent of dogs ruptured their contralateral CCL at an average of 14 months after the first. PMID:8579557

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

    PubMed

    Deo, Shaneel; Getgood, Alan

    2015-06-01

    This report describes superficial medial collateral ligament reconstruction of the knee using a novel method of graft fixation with the ACL Tightrope RT (Arthrex, Naples, FL). After tibial fixation with either a standard interference screw or staple, femoral fixation of the semitendinosus tendon is performed with the adjustable-loop suspensory fixation device, which allows for both initial graft tensioning and re-tensioning after cyclical knee range of motion. This provides the ability for the graft to accommodate for resultant soft-tissue creep and stress relaxation, thereby allowing for optimal soft-tissue tension and reduction in laxity at the end of the procedure. PMID:26258041

  7. Brucella arthritis of the knee, 1 year after revision of anterior cruciate ligament reconstruction.

    PubMed

    Papastergiou, S G; Koukoulias, N E; Koumis, P; Kyparlis, D; Santas, R

    2011-01-01

    Brucellosis is a zoonotic infection with a broad spectrum of clinical manifestations. The authors report the first case in the literature of septic arthritis of the knee 1 year after revision of anterior cruciate ligament reconstruction. Brucella melitensis biotype 3 was found in both synovial fluid and blood cultures. The patient was treated initially with arthroscopic debridement. After the diagnosis was confirmed, a second arthroscopic lavage and metal work removal was applied leaving the graft in place. Antimicrobial chemotherapy was prescribed for 3 months. The infection was fully eradicated and the patient is still asymptomatic, 4 years after the treatment. PMID:22700607

  8. Brucella arthritis of the knee, 1 year after revision of anterior cruciate ligament reconstruction

    PubMed Central

    Papastergiou, S G; Koukoulias, N E; Koumis, P; Kyparlis, D; Santas, R

    2011-01-01

    Brucellosis is a zoonotic infection with a broad spectrum of clinical manifestations. The authors report the first case in the literature of septic arthritis of the knee 1 year after revision of anterior cruciate ligament reconstruction. Brucella melitensis biotype 3 was found in both synovial fluid and blood cultures. The patient was treated initially with arthroscopic debridement. After the diagnosis was confirmed, a second arthroscopic lavage and metal work removal was applied leaving the graft in place. Antimicrobial chemotherapy was prescribed for 3 months. The infection was fully eradicated and the patient is still asymptomatic, 4 years after the treatment. PMID:22700607

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

    PubMed Central

    Deo, Shaneel; Getgood, Alan

    2015-01-01

    This report describes superficial medial collateral ligament reconstruction of the knee using a novel method of graft fixation with the ACL Tightrope RT (Arthrex, Naples, FL). After tibial fixation with either a standard interference screw or staple, femoral fixation of the semitendinosus tendon is performed with the adjustable-loop suspensory fixation device, which allows for both initial graft tensioning and re-tensioning after cyclical knee range of motion. This provides the ability for the graft to accommodate for resultant soft-tissue creep and stress relaxation, thereby allowing for optimal soft-tissue tension and reduction in laxity at the end of the procedure. PMID:26258041

  10. Effect of culture complex of BMSCs and sodium hydroxide- and GRGDSPC-treated PET on the reconstruction of injured anterior cruciate ligament in a rabbit model.

    PubMed

    Huang, Jianming; Chen, Fengrong; Jian, Guojian; Ye, Zhiyang; Wang, Zimin; Liu, Haoyuan; Kang, Yifan

    2015-01-01

    Ligament reconstruction is an effective therapy for anterior cruciate ligament (ACL) rupture. Polyethylene terephthalate (PET) artificial ligaments have recently gained popularity in clinical ACL reconstruction for its advantage in the improvement of keen function. However, the application of PET in clinical treatment is limited by its poor bioactivity and biocompatibility. Recently, bone marrow-derived mesenchymal stem cells (BMSCs) have been widely studied in regenerative medical therapy due to their multi-lineage differentiation. Previous study also indicated that BMSCs may promote the healing of tendon-bone interface of injured ligament. We speculate that BMSCs may enhance the curative effect of PET artificial ligament on the tendon-bone-healing in ligament reconstruction. In this study, the PET materials were first modified with sodium hydroxide hydrolysis and GRGDSPC peptide which was able to improve its bioactivity and biocompatibility. Then, the effects of modified PET materials on the adhesion, proliferation and differentiation of BMSCs were examined. The in vitro co-culture of BMSCs and modified PET showed the modified PET promoted the adhesion, proliferation and differentiation of BMSCs. Further, the effect of culture complex of BMSCs and modified PET artificial ligament co-culture system on the injured ligament reconstruction was investigated in vivo. Results showed not only better growth and differentiation of BMSCs but also satisfactory healing of the injured ligament was observed after implantation of this culture complex into the injured ligament of rabbits. Our study provides a brand-new solution for ACL reconstruction. PMID:26221227

  11. “Basket weave technique” for medial patellofemoral ligament reconstruction: Clinical outcome of a prospective study

    PubMed Central

    Kodkani, Pranjal S

    2016-01-01

    Background: Bone tunneling and implants with rigid fixations for medial patellofemoral ligament (MPFL) reconstruction are known to compromise results and are avoidable, especially in skeletally immature subjects. This study was to assess if these deficiencies were overcome with the technique devised by the author which avoids implants and bone tunnels. Results were assessed for complication rate and outcome. Materials and Methods: Fifty six knees of recurrent lateral patellar dislocation were treated in the past 49 months by MPFL reconstruction. Thirty nine were female and 17 male knees. The mean age was 20.6 years (range 9-48 years). Mean followup was 26 months. Five knees had previously failed stabilization procedures. Thirty one cases had Dejours Type A or B and 12 had Type C trochlear dysplasia. Arthroscopy was performed for associated injuries and loose bodies. Seven knees required loose body removal. Five knees underwent lateral retinacular release. Four knees had tibial tuberosity transfer. One knee had an associated anterior cruciate ligament reconstruction. An anatomical MPFL reconstruction was performed using hamstring autograft without the need for intraoperative fluoroscopy. Only soft tissue fixation was necessary with this newly devised technique and suturing. A rapid rehabilitation protocol was implemented with monthly followup until normalcy and 6 monthly thereafter. Results: All achieved full range of motion and normal mediolateral stability. There was no recurrence of dislocation. No major surgery related complications. One patella fracture at 8 months was due to a fall developed terminal restriction of flexion. Those in sports could return to their sporting activities (Tegner 1–9). Cases with osteochondral fractures had occasional pain that subsided in 1 year. Mean Kujala score improved from 64.3 to 99.69 with KOOS score near normal in all. Conclusion: This new method of MPFL reconstruction gives excellent results. It avoids complications

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

    PubMed

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

    2016-01-01

    Gait pattern alterations were previously reported in association with objective patellar instability (OPI). Gait pattern comparison between a series of patients having undergone medial patellofemoral ligament (MPFL) reconstruction and a sample of control subjects. Thirty patients at 6 months postoperatively after MPFL reconstruction and thirty control subjects were enrolled in the study for a clinical and biomechanical assessment including gait analysis at three selected walking rates using the GAITRite(®) system. The mean raw IKDC score was 73 (± 19), and the mean Kujala knee function was 84 (± 17.5). The study of gait did not demonstrate any significant difference between the two groups at a normal and fast walking rate. At a 10 km/h running speed, the single-support phase was significantly shortened by a mean 2.33% (p < 0.05), the swing phase by a mean 2.64% (p < 0.05) and the double-support phase by a mean 3.49% (p < 0.05) on the operated side. MPFL reconstruction reported good midterm functional and clinical results in the management of OPI. At 6 months postoperatively, the patient gait pattern was similar to that observed in healthy subjects at a normal and fast walking speed. However, our study revealed persistent gait abnormalities at a 10 km/h running speed. These gait alterations seemed to be related to the ligament reconstruction in itself due to the higher strain applied on the reconstructed MPFL during running cycle (10 km/h). Level of evidence IV. PMID:25274090

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

    PubMed

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

    2009-09-01

    Although there are numerous reports of septic pyogenic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction, there is limited information regarding the outcomes of fungal infection. We determined the outcomes of six patients with mycotic infection after regular ACL reconstruction. There were four males and two females with a mean age of 33 years. We determined the number of procedures performed, bone loss originating to control infection, and final reconstruction in these patients. An average of five arthroscopic lavage procedures had been performed at the referring centers. Fungal infection was diagnosed based on pathologic samples; five infections were the result of mucormycosis and one was Candida. After final débridement, the mean segmental bone loss was 12.8 cm. All patients were treated with intravenous antifungal coverage and cement spacers before final reconstruction. At final followup, all patients were free of clinical infection. Three had reconstruction with an allograft-prosthesis composite, two with hemicylindrical allografts, and one with an intercalary allograft arthrodesis. Despite the extremely unusual presentation of this complication, surgeons should be aware of potential and catastrophic consequences of this severe complication after ACL reconstruction. PMID:19190972

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

    PubMed

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

    2012-11-01

    We investigated the in vivo cartilage contact biomechanics of the tibiofemoral joint in patients after reconstruction of a ruptured anterior cruciate ligament (ACL). A dual fluoroscopic and MR imaging technique was used to investigate the cartilage contact biomechanics of the tibiofemoral joint during in vivo weight-bearing flexion of the knee in eight patients 6 months following clinically successful reconstruction of an acute isolated ACL rupture. The location of tibiofemoral cartilage contact, size of the contact area, cartilage thickness at the contact area, and magnitude of the cartilage contact deformation of the ACL-reconstructed knees were compared with those previously measured in intact (contralateral) knees and ACL-deficient knees of the same subjects. Contact biomechanics of the tibiofemoral cartilage after ACL reconstruction were similar to those measured in intact knees. However, at lower flexion, the abnormal posterior and lateral shift of cartilage contact location to smaller regions of thinner tibial cartilage that has been described in ACL-deficient knees persisted in ACL-reconstructed knees, resulting in an increase of the magnitude of cartilage contact deformation at those flexion angles. Reconstruction of the ACL restored some of the in vivo cartilage contact biomechanics of the tibiofemoral joint to normal. Clinically, recovering anterior knee stability might be insufficient to prevent post-operative cartilage degeneration due to lack of restoration of in vivo cartilage contact biomechanics. PMID:22528687

  15. Biomechanical Evaluation of Posterior Cruciate Ligament Reconstruction With Quadriceps Versus Achilles Tendon Bone Block Allograft

    PubMed Central

    Forsythe, Brian; Haro, Marc S.; Bogunovic, Ljiljana; Collins, Michael J.; Arns, Thomas A.; Trella, Katie J.; Shewman, Elizabeth F.; Verma, Nikhil N.; Bach, Bernard R.

    2016-01-01

    Background: Long-term studies of posterior cruciate ligament (PCL) reconstruction suggest that normal stability is not restored in the majority of patients. The Achilles tendon allograft is frequently utilized, although recently, the quadriceps tendon has been introduced as an alternative option due to its size and high patellar bone density. Purpose/Hypothesis: The purpose of this study was to compare the biomechanical strength of PCL reconstructions using a quadriceps versus an Achilles allograft. The hypothesis was that quadriceps bone block allograft has comparable mechanical properties to those of Achilles bone block allograft. Study Design: Controlled laboratory study. Methods: Twenty-nine fresh-frozen cadaveric knees were assigned to 1 of 3 groups: (1) intact PCL, (2) PCL reconstruction with Achilles tendon allograft, or (3) PCL reconstruction with quadriceps tendon allograft. After reconstruction, all supporting capsular and ligamentous tissues were removed. Posterior tibial translation was measured at neutral and 20° external rotation. Each specimen underwent a preload, 2 cyclic loading protocols of 500 cycles, then load to failure. Results: Construct creep deformation was significantly lower in the intact group compared with both Achilles and quadriceps allograft (P = .008). The intact specimens reached the greatest ultimate load compared with both reconstructions (1974 ± 752 N, P = .0001). The difference in ultimate load for quadriceps versus Achilles allograft was significant (P = .048), with the quadriceps group having greater maximum force during failure testing. No significant differences were noted between quadriceps versus Achilles allograft for differences in crosshead excursion during cyclic testing (peak-valley [P-V] extension stretch), creep deformation, or stiffness. Construct stiffness measured during the failure test was greatest in the intact group (117 ± 9 N/mm, P = .0001) compared with the Achilles (43 ± 11 N/mm) and quadriceps (43

  16. Increased Compliance With Supervised Rehabilitation Improves Functional Outcome and Return to Sport After Anterior Cruciate Ligament Reconstruction in Recreational Athletes

    PubMed Central

    Han, Fucai; Banerjee, Anirban; Shen, Liang; Krishna, Lingaraj

    2015-01-01

    Background: Successful return to sport is an important outcome measure after anterior cruciate ligament (ACL) reconstruction and a reason for patients’ decisions to elect surgery. Rehabilitation programs supervised by physical therapists are routinely prescribed after ACL reconstruction surgery. However, the added advantage of supervised physical therapy after ACL reconstruction is still debatable. Hypothesis: Attending more supervised physical therapy sessions after arthroscopic ACL reconstruction in recreational athletes increases their chance of successful return to sport. Study Design: Cohort study; Level of evidence, 3. Methods: The authors analyzed 93 recreational athletes who underwent arthroscopic ACL reconstruction. After arthroscopic single-bundle ACL reconstruction, patients were advised to attend 20 supervised physical therapy sessions. Patients’ demographics, surgical details, and outcome measures (Knee injury and Osteoarthritis Outcome Score [KOOS], Lysholm scale, and Short Form–36 Health Survey [SF-36]) were recorded presurgery and at 1-year follow-up. Ability to return to sports was documented through patients’ self-report. The attendance at physical therapy by each patient was obtained by examining database records and assessed as fully compliant (>15 sessions), moderately compliant (6-15 sessions), or noncompliant (<6 sessions). Results: Patients in the fully compliant group had significantly greater odds (odds ratio [OR], 18.5; 95% CI, 1.9-184.5; P = .013) of a successful return to sport as compared with the noncompliant group. Patients in the moderately compliant group also had greater odds of returning to sport as compared with the noncompliant group (OR, 4.2; 95% CI, 1.0-16.6; P = .043). Patients in the fully compliant group had significantly greater scores on the Lysholm (P < .001), KOOS Sports and Recreation subscale (P = .021), KOOS Symptoms subscale (P = .040), and SF-36 physical component summary (PCS) (P = .012) as compared with

  17. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING THE DOUBLE-BUNDLE TECHNIQUE – EVALUATION IN THE BIOMECHANICS LABORATORY

    PubMed Central

    D'Elia, Caio Oliveira; Bitar, Alexandre Carneiro; Castropil, Wagner; Garofo, Antônio Guilherme Padovani; Cantuária, Anita Lopes; Orselli, Maria Isabel Veras; Luques, Isabela Ugo; Duarte, Marcos

    2015-01-01

    Objective: The objective of this study was to describe the methodology of knee rotation analysis using biomechanics laboratory instruments and to present the preliminary results from a comparative study on patients who underwent anterior cruciate ligament (ACL) reconstruction using the double-bundle technique. Methods: The protocol currently used in our laboratory was described. Three-dimensional kinematic analysis was performed and knee rotation amplitude was measured on eight normal patients (control group) and 12 patients who were operated using the double-bundle technique, by means of three tasks in the biomechanics laboratory. Results: No significant differences between operated and non-operated sides were shown in relation to the mean amplitudes of gait, gait with change in direction or gait with change in direction when going down stairs (p > 0.13). Conclusion: The preliminary results did not show any difference in the double-bundle ACL reconstruction technique in relation to the contralateral side and the control group. PMID:27027003

  18. Anterior cruciate ligament reconstruction best practice: A review of graft choice

    PubMed Central

    Shaerf, Daniel A; Pastides, Philip S; Sarraf, Khaled M; Willis-Owen, Charles A

    2014-01-01

    There is much literature about differing grafts used in anterior cruciate ligament (ACL) reconstruction. Much of this is of poor quality and of a low evidence base. We review and summarise the literature looking at the four main classes of grafts used in ACL reconstruction; bone-patella tendon-bone, hamstrings, allograft and synthetic grafts. Each graft has the evidence for its use reviewed and then compared, where possible, to the others. We conclude that although there is no clear “best” graft, there are clear differences between the differing graft choices. Surgeon’s need to be aware of the evidence behind these differences, in order to have appropriate discussions with their patients, so as to come to an informed choice of graft type to best suit each individual patient and their requirements. PMID:24649411

  19. Type I collagen and polyvinyl alcohol blend fiber scaffold for anterior cruciate ligament reconstruction.

    PubMed

    Cai, Changbin; Chen, Cheng; Chen, Guangxing; Wang, Fuyou; Guo, Lin; Yin, Li; Feng, Dehong; Yang, Liu

    2013-06-01

    The aim of this study was to perform an evaluation of a braided fiber scaffold for anterior cruciate ligament (ACL) reconstruction. The scaffold was composed of 50% type I collagen (Col-I) and 50% polyvinyl alcohol (PVA). First, the biocompatibility and in vitro weight loss of the scaffold were tested. Then, the scaffolds were used to reconstruct the ACL in China Bama mimi pigs. At 24 weeks post-operation, the mechanical properties and histology of the regenerated ACL were analyzed. The maximum load and tensile strength were 472.43± 15.2 N and 29.71± 0.96 MPa, respectively; both were ~75% of those of native ACL and ~90% of those of fiber scaffold. This indicated that the scaffold maintained a large portion of native ACL's mechanical properties, and tissue formation on the scaffold compensated most of the tensile strength loss caused by scaffold degradation. Histology and immunohistology analysis showed the morphology and major extracellular matrix components of the regenerated ligament resembled the native ACL. Thus, the Col-I/PVA blend fiber ACL scaffold showed good potential for clinical applications. PMID:23531980

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

    PubMed Central

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

    2015-01-01

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

  1. Neuromuscular Fatigue Alters Postural Control and Sagittal Plane Hip Biomechanics in Active Females With Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Frank, Barnett S.; Gilsdorf, Christine M.; Goerger, Benjamin M.; Prentice, William E.; Padua, Darin A.

    2014-01-01

    Background: Females with history of anterior cruciate ligament (ACL) injury and subsequent ligament reconstruction are at high risk for future ACL injury. Fatigue may influence the increased risk of future injury in females by altering lower extremity biomechanics and postural control. Hypothesis: Fatigue will promote lower extremity biomechanics and postural control deficits associated with ACL injury. Study Design: Descriptive laboratory study. Methods: Fourteen physically active females with ACL reconstruction (mean age, 19.64 ± 1.5 years; mean height, 163.52 ± 6.18 cm; mean mass, 62.6 ± 13.97 kg) volunteered for this study. Postural control and lower extremity biomechanics were assessed in the surgical limb during single-leg balance and jump-landing tasks before and after a fatigue protocol. Main outcome measures were 3-dimensional hip and knee joint angles at initial contact, peak angles, joint angular displacements and peak net joint moments, anterior tibial shear force, and vertical ground reaction force during the first 50% of the loading phase of the jump-landing task. During the single-leg stance task, the main outcome measure was center of pressure sway speed. Results: Initial contact hip flexion angle decreased (t = −2.82, P = 0.01; prefatigue, 40.98° ± 9.79°; postfatigue, 36.75° ± 8.61°) from pre- to postfatigue. Hip flexion displacement (t = 2.23, P = 0.04; prefatigue, 45.19° ± 14.1°; postfatigue, 47.48° ± 14.21°) and center of pressure sway speed (t = 3.95, P < 0.05; prefatigue, 5.18 ± 0.96 cm/s; postfatigue, 6.20 ± 1.72 cm/s) increased from pre- to postfatigue. There was a trending increase in hip flexion moment (t = 2.14, P = 0.05; prefatigue, 1.66 ± 0.68 Nm/kg/m; postfatigue, 1.91 ± 0.62 Nm/kg/m) from pre- to postfatigue. Conclusion: Fatigue may induce lower extremity biomechanics and postural control deficits that may be associated with ACL injury in physically active females with ACL reconstruction. Clinical Relevance

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

    PubMed Central

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

    2016-01-01

    Purpose The purpose of this study was to compare the clinical outcomes of arthroscopic anatomical double bundle (DB) anterior cruciate ligament (ACL) reconstruction with either selective anteromedial (AM) or posterolateral (PL) bundle reconstruction while preserving a relatively healthy ACL bundle. Materials and Methods The authors evaluated 98 patients with a mean follow-up of 30.8±4.0 months who had undergone DB or selective bundle ACL reconstructions. Of these, 34 cases underwent DB ACL reconstruction (group A), 34 underwent selective AM bundle reconstruction (group B), and 30 underwent selective PL bundle reconstructions (group C). These groups were compared with respect to Lysholm and International Knee Documentation Committee (IKDC) score, side-to-side differences of anterior laxity measured by KT-2000 arthrometer at 30 lbs, and stress radiography and Lachman and pivot shift test results. Pre- and post-operative data were objectively evaluated using a statistical approach. Results The preoperative anterior instability measured by manual stress radiography at 90° of knee flexion in group A was significantly greater than that in groups B and C (all p<0.001). At last follow-up, mean side-to-side instrumented laxities measured by the KT-2000 and manual stress radiography were significantly improved from preoperative data in all groups (all p<0.001). There were no significant differences between the three groups in anterior instability measured by KT-2000 arthrometer, pivot shift, or functional scores. Conclusion Selective bundle reconstruction in partial ACL tears offers comparable clinical results to DB reconstruction in complete ACL tears. PMID:27401652

  3. RANDOMIZED PROSPECTIVE STUDY ON TRAUMATIC PATELLAR DISLOCATION: CONSERVATIVE TREATMENT VERSUS RECONSTRUCTION OF THE MEDIAL PATELLOFEMORAL LIGAMENT USING THE PATELLAR TENDON, WITH A MINIMUM OF TWO YEARS OF FOLLOW-UP

    PubMed Central

    Bitar, Alexandre Carneiro; D'Elia, Caio Oliveira; Demange, Marco Kawamura; Viegas, Alexandre Christo; Camanho, Gilberto Luis

    2015-01-01

    Objective: The aim of this study was to compare the surgical results from reconstruction of the medial patellofemoral ligament (MPFL) with non-operative treatment of primary patellar dislocation. Methods: Thirty-nine patients (41 knees) with patellar dislocation were randomized into two groups. One group was treated conservatively (immobilization and physiotherapy) and other was treated surgically with reconstruction of the MPFL, and the results were evaluated with a minimum follow-up of two years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrences were evaluated. Pearson's chi-square test and Fisher's exact test were used in the statistical evaluation. Results: The statistical analysis showed that the mean Kujala score was significantly lower in the conservative group (70.8), compared with the mean value in the surgical group (88.9), with p = 0.001. The surgical group presented a higher percentage of “good/excellent” Kujala score results (71.43%) than in the conservative group (25.0%), with p = 0.003. The conservative group presented a greater number of recurrences (35% of the cases), while in the surgical group there were no reports of recurrences and/or subluxation. Conclusions: Treatment with reconstruction of the medial patellofemoral ligament using the patellar tendon produced better results, based on the analysis of post-treatment recurrences and the better final results from the Kujala questionnaire after a minimum follow-up period of two years. PMID:27027072

  4. Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine.

    PubMed

    An, Howard S; Al-Shihabi, Laith; Kurd, Mark

    2014-07-01

    Although classically associated with patients of East Asian origin, ossification of the posterior longitudinal ligament (OPLL) may cause myelopathy in patients of any ethnic origin. Degeneration of the PLL is followed by endochondral ossification, resulting in spinal cord compression. Specific genetic polymorphisms and medical comorbidities have been implicated in the development of OPLL. Patients should be evaluated with a full history and neurologic examination, along with cervical radiographs. Advanced imaging with CT and MRI allows three-dimensional evaluation of OPLL. Minimally symptomatic patients can be treated nonsurgically, but patients with myelopathy or severe stenosis are best treated with surgical decompression. OPLL can be treated via an anterior (ie, corpectomy and fusion) or posterior (ie, laminectomy and fusion or laminoplasty) approach, or both. The optimal approach is dictated by the classification and extent of OPLL, cervical spine sagittal alignment, severity of stenosis, and history of previous surgery. Anterior surgery is associated with superior outcomes when OPLL occupies >50% to 60% of the canal, despite increased technical difficulty and higher complication rates. Posterior surgery is technically easier and allows decompression of the entire cervical spine, but patients may experience late deterioration because of disease progression. PMID:24966248

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

    PubMed Central

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

    2016-01-01

    The Ligament Advanced Reinforcement System has recently been widely used as the primary graft of choice in anterior cruciate ligament (ACL) reconstruction. But the biological graft–bone healing still remains a problem. Previous studies have shown that simvastatin (SIM) stimulates bone formation. The objective of this study was to investigate whether surface coating with collagen containing low-dose SIM microsphere could enhance the surface biocompatibility of polyethylene terephthalate (PET) artificial ligaments to accelerate graft-to-bone healing. The in vitro studies demonstrated that bone marrow stromal cells on the collagen-coated PET scaffolds (COL/PET) and simvastatin/collagen-coated PET scaffolds (SIM/COL/PET) proliferated vigorously. Compared with the PET group and the COL/PET group, SIM could induce bone marrow stromal cells’ osteoblastic differentiation, high alkaline phosphatase activity, more mineralization deposition, and more expression of osteoblast-related genes, such as osteocalcin, runt-related transcription factor 2, bone morphogenetic protein-2, and vascular endothelial growth factor, in the SIM/COL/PET group. In vivo, rabbits received ACL reconstruction with different scaffolds. Histological analysis demonstrated that graft–bone healing was significantly greater with angiogenesis and osteogenesis in the SIM/COL/PET group than the other groups. In addition, biomechanical testing at the eighth week demonstrated a significant increase in the ultimate failure load and stiffness in the SIM/COL/PET group. The low dose of SIM-sustained release from SIM/COL/PET promoted the graft–bone healing via its effect on both angiogenesis and osteogenesis. This study suggested that collagen containing low-dose SIM microsphere coating on the surface of PET artificial ligaments could be potentially applied for ACL reconstruction. PMID:26869789

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

    PubMed

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

    2016-01-01

    The Ligament Advanced Reinforcement System has recently been widely used as the primary graft of choice in anterior cruciate ligament (ACL) reconstruction. But the biological graft-bone healing still remains a problem. Previous studies have shown that simvastatin (SIM) stimulates bone formation. The objective of this study was to investigate whether surface coating with collagen containing low-dose SIM microsphere could enhance the surface biocompatibility of polyethylene terephthalate (PET) artificial ligaments to accelerate graft-to-bone healing. The in vitro studies demonstrated that bone marrow stromal cells on the collagen-coated PET scaffolds (COL/PET) and simvastatin/collagen-coated PET scaffolds (SIM/COL/PET) proliferated vigorously. Compared with the PET group and the COL/PET group, SIM could induce bone marrow stromal cells' osteoblastic differentiation, high alkaline phosphatase activity, more mineralization deposition, and more expression of osteoblast-related genes, such as osteocalcin, runt-related transcription factor 2, bone morphogenetic protein-2, and vascular endothelial growth factor, in the SIM/COL/PET group. In vivo, rabbits received ACL reconstruction with different scaffolds. Histological analysis demonstrated that graft-bone healing was significantly greater with angiogenesis and osteogenesis in the SIM/COL/PET group than the other groups. In addition, biomechanical testing at the eighth week demonstrated a significant increase in the ultimate failure load and stiffness in the SIM/COL/PET group. The low dose of SIM-sustained release from SIM/COL/PET promoted the graft-bone healing via its effect on both angiogenesis and osteogenesis. This study suggested that collagen containing low-dose SIM microsphere coating on the surface of PET artificial ligaments could be potentially applied for ACL reconstruction. PMID:26869789

  7. Evaluating degenerative changes in the wrist after surgical treatment for scaphoid pseudarthrosis using a corticocancellous graft for anatomical reconstruction.

    PubMed

    Markowicz, Agnieszka; Baczkowski, Bogusław; Lorczyński, Adam; Sawicka, Joanna; Siwicka, Karolina

    2006-10-31

    Background. Pseudoarthrosis of the scaphoid results in the development of carpal instability and severe posttraumatic osteoarthritis. Modern methods of treatment focus on reconstruction of the anatomical shape and length of the scaphoid. The purpose of our study was to determine the occurrence of carpal osteoarthritis after surgical treatment of scaphoid pseudoarthrosis using a cortico-cancellous bone grafting technique. Material and methods. 48 patients who had undergone surgical treatment for scaphoid union failure were examined. The surgical method included the anatomical reconstruction of the scaphoid bone, which resulted in normal ligament tension and carpal stability. The clinical examination included pain evaluation, return to work, range of wrist motion, and grip strength. On comparative x-rays of both wrists we evaluated union, the length and shape of the scaphoid bone, the scapho-lunate angle, the carpal height ratio, and the carpal ulnar shift. Results. Union was obtained in 42 cases. In 26 patients there were no signs of osteoarthritis, while 11 patients had slight degenerative changes in the radio-scaphoid joint. Conclusions. According to our analysis, cortico-cancellous bone grafting is an effective surgical procedure, useful not only in obtaining union, but also in reconstructing the shape and length of the scaphoid and preventing posttraumatic carpal asteoarthritis. PMID:17589397

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

    PubMed Central

    Jia, Yu-Hua; Sun, Peng-Fei

    2015-01-01

    Background: Hamstring (HS) autograft and bone-patellar tendon-bone allograft are the most common choice for reconstruction of anterior cruciate ligament (ACL). There was a little report about the clinical outcome and difference of arthroscopic ACL reconstruction using allograft and autograft. This study aimed to compare the clinical outcome of autograft and allograft reconstruction for ACL tears. Methods: A total of 106 patients who underwent surgery because of ACL tear were included in this study. The patients were randomly divided into two groups, including 53 patients in each group. The patients in group I underwent standard ACL reconstruction with HS tendon autografts, while others in group II underwent reconstruction with bone-patellar tendon-bone allograft. All the patients were followed up and analyzed; the mean follow-up was 81 months (range: 28–86 months). Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC), Lysholm scores, physical instability tests, and patient satisfaction questionnaires. The complication rates of both groups were compared. Tibial and femoral tunnel widening were assessed using lateral and anteroposterior radiographs. Results: At the end of follow-up, no significant differences were found between the groups in terms of IKDC, Lysholm scores, physical instability tests, patient satisfaction questionnaires, and incidences of arthrofibrosis. Tibial and femoral tunnel widening was less in the HS tendon autografts. This difference was more significant on the tibial side. Conclusions: In the repair of ACL tears, allograft reconstruction is as effective as the autograft reconstruction, but the allograft can lead to more tunnel widening evidently in the tibial tunnel, particularly. PMID:26612290

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

    PubMed Central

    Devgan, Ashish; Singh, Amanpreet; Gogna, Paritosh; Singla, Rohit; Magu, Narender Kumar; Mukhopadhyay, Reetadyuti

    2015-01-01

    Background: Single bundle anterior cruciate ligament (ACL) reconstruction has been the current standard of treatment for ACL deficiency. However, a significant subset of patients continue to report residual symptoms of instability with a poor pivot control. Cadaveric biomechanical studies have shown double bundle (DB) ACL reconstructions to restore the knee kinematics better. This study evaluates the outcome of DB ACL reconstruction. Materials and Methods: 30 consecutive patients who underwent anatomic DB ACL reconstruction were included in this prospective longitudinal study. There were all males with a mean age of 25 ± 7.45 years. All patients were prospectively evaluated using GeNouRoB (GNRB) arthrometer, functional knee scores (International Knee Documentation Committee [IKDC] and Lysholm) and postoperative magnetic resonance imaging (MRI) for comparing the graft orientation and footprint of the reconstructed ACL with that of the normal knee. Results: The average followup was 36.2 months. At the time of final followup the mean Lysholm score was 93.13 ± 3.31. As per the objective IKDC score, 26 patients (86.6%) were in Group A while 4 patients (13.3%) were in Group B. The mean differential anterior tibial translation by GNRB, arthrometer was 1.07 ± 0.8 mm (range 0.1-2.3 mm). All cases had a negative pivot shift test. MRI scans of operated and the contralateral normal knee showed the mean sagittal ACL tibial angle coronal ACL tibial angle and tibial ACL footprint to be in accordance with the values of the contralateral, normal knee. Conclusion: The study demonstrates that DB ACL reconstruction restores the ACL anatomically in terms of size and angle of orientation. However, long term studies are needed to further substantiate its role in decreasing the incidence of early osteoarthritic changes compared to the conventional single bundle reconstructions. PMID:26015600

  10. Surgical Predictors of Clinical Outcome following Revision ACL Reconstruction

    PubMed Central

    Wright, Rick W.

    2016-01-01

    Objectives: Revision ACL reconstruction has been documented to have worse outcomes compared with primary ACL reconstructions. The reasons why remain unknown. The purpose of this study was to determine either previous or current surgical factors noted at the time of ACL revision reconstruction predicts activity level, sports function, and OA symptoms at two year follow-up. Methods: Revision ACL reconstruction patients were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, and a series of validated patient reported outcome instruments (IKDC, KOOS, WOMAC, and Marx activity rating score). Patients were followed up for 2 years, and asked to complete the identical set of outcome instruments. Regression analysis was used to control for age, gender, BMI, activity level, baseline outcome scores, revision number, time since last ACLR, and a variety of previous and current surgical variables, in order to assess the surgical risk factors for clinical outcomes 2 years after revision ACL reconstruction. Results: 1205 patients met the inclusion criteria and were successfully enrolled. 697 (58%) were males, with a median cohort age of 26 years. The median time since their last ACL reconstruction was 3.4 years. Baseline characteristics of the cohort are summarized in Table 1. At 2 years, follow-up was obtained on 82% (989/1205). Both previous as well as current surgical factors were found to be significant drivers of poorer outcomes at 2 years (Table 2). The most consistent surgical factors driving outcome in revision patients were prior surgical technique, prior tibial tunnel position, current femoral fixation and having a notchplasty. Having a previous arthrotomy compared to the one incision technique resulted in significantly poorer outcomes on the IKDC (odds ratio=0.41; 95% CI=0.17-0.95; p=0.037) and KOOS pain, sports/rec, and QOL subscales (OR range=0.23-0.42; 95% CI=0.10-0.97; p<0

  11. Inside-Out Antegrade Tibial Tunnel Drilling Through the Posterolateral Portal Using a Flexible Reamer in Posterior Cruciate Ligament Reconstruction

    PubMed Central

    Alentorn-Geli, Eduard; Stuart, Joseph J.; Choi, J.H. James; Toth, Alison P.; Moorman, Claude T.; Taylor, Dean C.

    2015-01-01

    Posterior cruciate ligament (PCL) reconstruction using the transtibial drilling or arthroscopic tibial-inlay technique has a risk of injury to the popliteal neurovascular bundle because a pin is drilled anterior to posterior. Intraoperative fluoroscopy is used to decrease the risk of neurovascular injury. In addition, graft passage in the transtibial technique may be problematic because of a sharp turn when placing the graft into the tibial tunnel, which may damage graft fibers. In the surgical technique described in this report, the posteromedial portal is used for visualization and the posterolateral portal is used for debridement of the PCL tibial footprint and the synovial fold closest to the PCL. A curved guide is placed from the posterolateral portal to the tibial footprint, and a flexible pin is drilled across the tibia. The tibial tunnel is then created using a flexible reamer under direct visualization up to the desired length, and a graft can be positioned in the tibial tunnel through the posterolateral portal. This technique has the potential advantages of decreasing the risk of injury to the popliteal neurovascular bundle (use of anteriorly directed, inside-out drilling), avoiding a sharp turn during graft passage, and allowing accurate and anatomic tibial tunnel placement without intraoperative fluoroscopy. PMID:26900551

  12. Inside-Out Antegrade Tibial Tunnel Drilling Through the Posterolateral Portal Using a Flexible Reamer in Posterior Cruciate Ligament Reconstruction.

    PubMed

    Alentorn-Geli, Eduard; Stuart, Joseph J; Choi, J H James; Toth, Alison P; Moorman, Claude T; Taylor, Dean C

    2015-10-01

    Posterior cruciate ligament (PCL) reconstruction using the transtibial drilling or arthroscopic tibial-inlay technique has a risk of injury to the popliteal neurovascular bundle because a pin is drilled anterior to posterior. Intraoperative fluoroscopy is used to decrease the risk of neurovascular injury. In addition, graft passage in the transtibial technique may be problematic because of a sharp turn when placing the graft into the tibial tunnel, which may damage graft fibers. In the surgical technique described in this report, the posteromedial portal is used for visualization and the posterolateral portal is used for debridement of the PCL tibial footprint and the synovial fold closest to the PCL. A curved guide is placed from the posterolateral portal to the tibial footprint, and a flexible pin is drilled across the tibia. The tibial tunnel is then created using a flexible reamer under direct visualization up to the desired length, and a graft can be positioned in the tibial tunnel through the posterolateral portal. This technique has the potential advantages of decreasing the risk of injury to the popliteal neurovascular bundle (use of anteriorly directed, inside-out drilling), avoiding a sharp turn during graft passage, and allowing accurate and anatomic tibial tunnel placement without intraoperative fluoroscopy. PMID:26900551

  13. Assessment of functional impairment after knee anterior cruciate ligament reconstruction using cardiorespiratory parameters: a cross-sectional study

    PubMed Central

    2014-01-01

    Background A dynamic sub-maximum exercise with the same absolute intensity, performed with different muscle groups, may present exacerbated cardiorespiratory responses. Therefore, cardiorespiratory responses to unilateral exercise may identify bilateral differences. The purpose of this study was to verify whether the cardiorespiratory responses to lower limb exercise display counter-lateral differences, and if they could be used to assist athletes and health professionals involved in rehabilitation. Methods Nine individuals participated in this cross-sectional study. They had been treated in a private rehabilitation clinic and submitted to intra-articular reconstruction of the anterior cruciate ligament. The cycling exercise with the same sub-maximal intensity and with one lower limb was used to gather data. Cardiorespiratory responses to exercise were compared between exercises performed with the involved and uninvolved limb after five minutes of exercise. Results Cardiorespiratory responses to exercise performed with the involved limb presented higher values after five minutes of cycling: oxygen uptake (+7%), carbon dioxide production (+10%), minute ventilation (+20%), breathing frequency (+19%), ventilatory equivalent for oxygen (+14%), end-tidal pressure of O2 oxygen (+4%), end-tidal pressure of O2 carbon dioxide (-9%) and heart rate (+9%). Conclusions The exacerbated responses, including increase of the ventilatory equivalent and decrease of end-tidal pressure of carbon dioxide, indicate that this exercise protocol may be useful in the characterization of the functional deficit of the surgical limb during rehabilitation. PMID:24885115

  14. Medial ulnar collateral ligament reconstruction of the elbow in major league baseball players: Where do we stand?

    PubMed Central

    Erickson, Brandon J; Bach Jr, Bernard R; Bush-Joseph, Charles A; Verma, Nikhil N; Romeo, Anthony A

    2016-01-01

    The ulnar collateral ligament (UCL) is a vital structure to the overhead athlete, especially the baseball pitcher. For reasons not completely understood, UCL injuries have become increasingly more common in major league baseball (MLB) pitchers over the past 10 years. UCL reconstruction (UCLR) is the current gold standard of treatment for these injuries in MLB pitchers who wish to return to sport (RTS) at a high level and who have failed a course of non-operative treatment. Results following UCLR in MLB pitchers have been encouraging, with multiple RTS rates now cited at greater than 80%. Unfortunately, with the rising number of UCLR, there has also been a spike in the number of revision UCLR in MLB pitchers. Similar to primary UCLR, the etiology of the increase in revision UCLR, aside from an increase in the number of pitchers who have undergone a primary UCLR, remains elusive. The current literature has attempted to address several questions including those surrounding surgical technique (method of exposure, graft choice, management of the ulnar nerve, concomitant elbow arthroscopy, etc.), post-operative rehabilitation strategies, and timing of RTS following UCLR. While some questions have been answered, many remain unknown. The literature surrounding UCLR in MLB pitchers will be reviewed, and future directions regarding this injury in these high level athletes will be discussed. PMID:27335810

  15. Medial ulnar collateral ligament reconstruction of the elbow in major league baseball players: Where do we stand?

    PubMed

    Erickson, Brandon J; Bach, Bernard R; Bush-Joseph, Charles A; Verma, Nikhil N; Romeo, Anthony A

    2016-06-18

    The ulnar collateral ligament (UCL) is a vital structure to the overhead athlete, especially the baseball pitcher. For reasons not completely understood, UCL injuries have become increasingly more common in major league baseball (MLB) pitchers over the past 10 years. UCL reconstruction (UCLR) is the current gold standard of treatment for these injuries in MLB pitchers who wish to return to sport (RTS) at a high level and who have failed a course of non-operative treatment. Results following UCLR in MLB pitchers have been encouraging, with multiple RTS rates now cited at greater than 80%. Unfortunately, with the rising number of UCLR, there has also been a spike in the number of revision UCLR in MLB pitchers. Similar to primary UCLR, the etiology of the increase in revision UCLR, aside from an increase in the number of pitchers who have undergone a primary UCLR, remains elusive. The current literature has attempted to address several questions including those surrounding surgical technique (method of exposure, graft choice, management of the ulnar nerve, concomitant elbow arthroscopy, etc.), post-operative rehabilitation strategies, and timing of RTS following UCLR. While some questions have been answered, many remain unknown. The literature surrounding UCLR in MLB pitchers will be reviewed, and future directions regarding this injury in these high level athletes will be discussed. PMID:27335810

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

    PubMed Central

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

    2016-01-01

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

  17. Factors affecting isokinetic muscle strength before and after anterior cruciate ligament reconstruction.

    PubMed

    Yüksel, Halil Yalçin; Erkan, Serkan; Uzun, Macit

    2011-06-01

    The purpose of this study was to evaluate the factors affecting muscle strength of ACL-deficient knees before and after ACL reconstruction. The study included 122 male patients who underwent primary ACL reconstruction with a bone-patellar tendon-bone autograft. Preoperative loss and change in muscle strength in both extensor and flexor muscle groups after ACL reconstruction were calculated separately at 60 degrees/sec and 180 degrees/sec angular velocities. We evaluated the effect of surgical delay on the preoperative deficit and on its change after surgery. Muscle strength change after ACL reconstruction was also evaluated in relation to patient compliance to treatment. The longer the delay of ACL reconstruction the more the muscle strength deficit of flexor and extensor muscles increased. In the ACL deficient knees with high strength deficit, improvement in muscle strength was higher after ACL reconstruction for both muscle groups. When delay of ACL reconstruction was short and the patient was compliant to treatment, flexor muscle strength recovery was early. Shortening the delay to reconstruction had a positive influence on muscle strength after ACL reconstruction when preoperative muscle strength deficit was high. PMID:21846002

  18. Sex differences in knee strength deficit 1 year after anterior cruciate ligament reconstruction

    PubMed Central

    Kim, Do Kyung; Park, Won Hah

    2015-01-01

    [Purpose] Little is known about the outcome differences between men and women after anterior cruciate ligament (ACL) reconstruction. Therefore, the present study aimed to compare knee muscle strength between men and women 1 year after ACL reconstruction. [Subjects and Methods] Retrospective and outcome study. Between 2012 and 2015, 35 males (mean age, 29.7 ± 010.7 years) and 35 females (mean age, 28.2 ± 11.3 years) who had undergone primary ACL reconstruction were recruited from Samsung medical centers. We assessed the strength deficit in the quadriceps (extensor) and hamstrings (flexor) at 60°/sec and 180°/sec with isokinetic testing equipment. Statistical analysis was conducted with a t-test to determine if sex differences existed in knee strength deficit. [Results] Significant differences were noted between men and women with respect to extensor muscle strength deficit. Women reported less extensor muscle strength than men did, at the angular velocities 60°/sec and 180°/sec. However, no significant sex differences were found at either velocity with respect to the strength deficit of the knee flexor muscles. [Conclusion] Compared to male patients, female patients reported significantly less extensor muscle strength and less improvement 1 year after reconstruction. PMID:26834366

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

    PubMed Central

    Dhinsa, Baljinder S; Nawaz, Syed Z; Gallagher, Kieran R; Skinner, John; Briggs, Tim; Bentley, George

    2015-01-01

    Background: Instability of the knee joint, after anterior cruciate ligament (ACL) injury, is contraindication to osteochondral defect repair. This prospective study is to investigate the role of combined autologous chondrocyte implantation (ACI) with ACL reconstruction. Materials and Methods: Three independent groups of patients with previous ACL injuries undergoing ACI were identified and prospectively followed up. The first group had ACI in combination with ACL reconstruction (combined group); the 2nd group consisted of individuals who had an ACI procedure having had a previously successful ACL reconstruction (ACL first group); and the third group included patients who had an ACI procedure to a clinically stable knee with documented nonreconstructed ACL disruption (No ACL group). Their outcomes were assessed using the modified cincinnati rating system, the Bentley functional (BF) rating system (BF) and a visual analog scale (VAS). Results: At a mean followup of 64.24 months for the ACL first group, 63 months for combined group and 78.33 months for the No ACL group; 60% of ACL first patients, 72.73% of combined group and 83.33% of the No ACL group felt their outcome was better following surgery. There was no significant difference demonstrated in BF and VAS between the combined and ACL first groups. Results revealed a significant affect of osteochondral defect size on outcome measures. Conclusion: The study confirms that ACI in combination with ACL reconstruction is a viable option with similar outcomes as those patients who have had the procedures staged. PMID:26015603

  20. Assessment of the quality and content of information on anterior cruciate ligament reconstruction on the internet.

    PubMed

    Bruce-Brand, Robert A; Baker, Joseph F; Byrne, Damien P; Hogan, Niall A; McCarthy, Tom

    2013-06-01

    The Internet has become a major source of health information for the public. However, there are concerns regarding the quality, accuracy, and currency of medical information available online. We assessed the quality of information about anterior cruciate ligament (ACL) reconstruction on the first 60 websites returned by the 4 most popular search engines. Each site was categorized by type and assessed for quality and validity using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and a novel ACL reconstruction-specific content score. The presence of the Health On the Net Code (HONcode), a purported quality assurance marker, was noted. The quality of information on ACL reconstruction available online is variable, with many websites omitting basic information regarding treatment options, risks, and prognosis. Commercial websites predominate. Academic and allied health professional websites attained the highest DISCERN and JAMA benchmark scores, whereas physician sites achieved the highest content scores. Sites that bore the HONcode seal obtained higher DISCERN and ACL reconstruction content scores than those without this certification. The HONcode seal is a reliable indicator of website quality, and we can confidently advise our patients to search for this marker. PMID:23582738

  1. Posterior Tibial Tendoscopy: Endoscopic Synovectomy and Assessment of the Spring (Calcaneonavicular) Ligament.

    PubMed

    Lui, Tun Hing

    2015-12-01

    A tear of the spring ligament is frequently associated with posterior tibial tendon dysfunction. Repair of the damaged spring ligament is an important component of surgical reconstruction in the treatment of posterior tibial tendon dysfunction because it is a major anatomic contributor to the integrity of the medial longitudinal arch, particularly if the dynamic support of the posterior tibial tendon is compromised. Extensive dissection is required for exposure and repair of the ligament because it is a deep-seated structure. It is beneficial to confirm the presence of ligament tears before surgical exploration to avoid unnecessary dissection. Preoperative magnetic resonance imaging and ultrasound studies have moderate sensitivity in the detection of these tears. We report an arthroscopic technique for assessment of the integrity of the spring ligament during endoscopic or open reconstruction of the posterior tibial tendon. This allows the surgeon to confirm the presence of a ligament tear before additional dissection to explore and repair the ligament. PMID:27284518

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

    PubMed

    Group, Mars

    2016-08-01

    It has not been known what drives revision anterior cruciate ligament (ACL) reconstruction graft choice in the past. We undertook this study to utilize the Multicenter ACL Revision Study (MARS) group and propensity score statistical analysis to determine the drivers of revision ACL reconstruction graft choice. We hypothesized that propensity analysis would demonstrate that individual surgeons still have significant impact on revision ACL reconstruction. Twelve hundred patients were enrolled in this longitudinal revision cohort by 83 surgeons at 52 sites. The median age was 26 years and 505 (42%) were females. One thousand forty-nine (87%) patients were undergoing their first ACL revision. Graft choice for revision ACL reconstruction for these patients was 48% autograft, 49% allograft, and 3% combination. The independent variables of this model included gender, age, ethnicity, body mass index, smoking status, sport, activity level, previous graft, revision number, surgeon, surgeon's opinion of failure, previous technical aspects, etc. Surgeons were defined as those who contributed more than 15 patients during the enrollment period. . We calculated a propensity score for graft type based on the predicted probability of receiving an allograft from a logistic regression model. Propensity scores demonstrated that surgeon, prior graft choice, and patient age each had significant influence on which graft type was chosen for the revision ACL reconstruction (p  < 0.0001). The revising surgeon had the largest impact upon graft choice: ∼ 5 times that of the second-most important factor (prior graft). If the prior graft type was an autograft, then an allograft was 3.6 times more likely to be chosen for the revision. This current study demonstrates that the individual surgeon is ultimately the most important factor in revision ACL reconstruction graft choice. Additional statistically significant influences of graft choice included age, gender, previous graft choice, ACL

  3. A proposal for a new tibial guide system for posterior cruciate ligament reconstruction.

    PubMed

    Abdalla, Rene Jorge; Pacagnan, André Valente; Loyola, Hugo Alexandre Guimarães; Cohen, Moisés; Camanho, Gilberto Luís; Forgas, Andrea

    2007-07-01

    Posterior cruciate ligament reconstruction is always a challenge to the orthopaedic surgeon. It is difficult when the anterior cruciate ligament (ACL) is intact. We propose a new guide system through the posteromedial portal, avoiding ACL damage. The arthroscope is inserted anteromedially (30 degrees), and anterolateral portals are used for instruments to confirm the diagnosis and inspect the joint to search for and treat associated lesions that may appear eventually. The posteromedial portal is located posterior to the collateral medial ligament superficially, adjacent to a portion of the posteromedial femoral condyle, which is located 1 cm proximal to the posteromedial tibial plate (where a skin marker must be used before insufflation of the knee). Our system is designed with an articular end in the form of a rasp, which helps prepare the area of the posterior tibia to be stripped before the tibial tunnel is drilled while being protected by the drill guide; this simplifies the preparation and creation of the tibial tunnel via a single device, which can be done with a 30 degrees arthroscope but is easier with a 70 degree arthroscope. The guide system through the posteromedial portal is used to determine a fixed 40 degrees angle of approach to the tibia in the anteroposterior direction to drill the tibial tunnel; this approach is particularly helpful in the presence of an intact ACL. The graft into the femoral tunnel is fixed with a bioabsorbable interference screw whose size must fit the graft and the tunnel walls. Before tibial graft fixation, it is necessary to reduce the posterior drawer. In the tibia the bundle corresponding to the anterolateral portion is tensioned and fixed under flexion, followed by the posteromedial portion in extension, by means of a Bottom Fix system (Smith & Nephew, Mayfield, MA) placed near the exit of the tibial tunnel. PMID:17637420

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

    PubMed Central

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

    2015-01-01

    Background In the present study, we aimed to compare clinical and radiographic outcomes between hook plate fixation and coracoclavicular (CC) ligament reconstruction for the treatment of acute unstable acromioclavicular (AC) joint dislocation. Methods Forty-two patients who underwent surgery for an unstable acute dislocation of the AC joint were included. We divided them into two groups according to the treatment modality: internal fixation with a hook plate (group I, 24 cases) or CC ligament reconstruction (group II, 18 cases). We evaluated the clinical outcomes using a visual analog scale (VAS) for pain and Constant-Murley score, and assessed the radiographic outcomes based on the reduction and loss of CC distance on preoperative, postoperative, and final follow-up plain radiographs. Results The mean VAS scores at the final follow-up were 1.6 ± 1.5 and 1.3 ± 1.3 in groups I and II, respectively, which were not significantly different. The mean Constant-Murley scores were 90.2 ± 9.9 and 89.2 ± 3.5 in groups I and II, respectively, which were also not significantly different. The AC joints were well reduced in both groups, whereas CC distance improved from a mean of 215.7% ± 50.9% preoperatively to 106.1% ± 10.2% at the final follow-up in group I, and from 239.9% ± 59.2% preoperatively to 133.6% ± 36.7% at the final follow-up in group II. The improvement in group I was significantly superior to that in group II (p < 0.001). Furthermore, subluxation was not observed in any case in group I, but was noted in six cases (33%) in group II. Erosions of the acromion undersurface were observed in 9 cases in group I. Conclusions In cases of acute unstable AC joint dislocation, hook plate fixation and CC ligament reconstruction yield comparable satisfactory clinical outcomes. However, radiographic outcomes based on the maintenance of reduction indicate that hook plate fixation is a better treatment option. PMID:25729525

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

    PubMed Central

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

    2010-01-01

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

  6. Coracoclavicular ligament reconstruction: biomechanical comparison of tendon graft repairs to a synthetic double bundle augmentation.

    PubMed

    Wellmann, Mathias; Kempka, Jan P; Schanz, Steffen; Zantop, Thore; Waizy, Hazibullah; Raschke, Michael J; Petersen, Wolf

    2009-05-01

    For currently presented anatomical coracoclavicular ligament repairs issues such as autologous tendon graft versus synthetic suture augmentation and the optimum fixation strategies for both types of reconstruction are not solved. The purpose of the study was to compare the biomechanical properties of different tendon graft repairs to the characteristics of a synthetic polyester augmentation. Four anatomical coracoclavicular ligament repairs were biomechanically tested: 5 mm coracoclavicular tendon loop with suture fixation, tendon loop with flip button fixation, tendon loop with interference screw fixation versus a double 1.0-mm polyester repair with flip button fixation. The biomechanical testing included cyclic superio-inferior loading and a subsequent load to failure protocol. The ultimate failure loads were significantly higher for the double polyester/flip button repair (927 N) compared to all tendon repair techniques (maximum 640 N). In contrast the stiffness level was higher for the tendon repairs compared to the polyester/flip button repair (68.7 N/mm) but strongly dependent on the fixation technique (interference screw 97.2 N/mm, flip button 84.9 N/mm, side to side suture 60.9 N/mm). A synthetic coracoclavicular augmentation using a polyester suture provides adequate structural properties compared to a tendon repair. Therefore the decision for a tendon graft should be made by the necessity of a biologic substrate rather than by the assumption of a biomechanical advantage. PMID:19225755

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

    PubMed Central

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

    2016-01-01

    Background: Anterior cruciate ligament (ACL) reconstruction with hamstring autografts less than 8.5 mm in diameter is associated with worse patient-reported outcome scores and increased risk of revision surgery compared with reconstructions performed with larger grafts. One proposed solution to small autograft harvest is to create a hybrid graft by augmenting autografts with allograft tissue to increase graft diameter. Purpose: To compare hybrid autograft/allograft ACL reconstruction to autograft ACL reconstruction, specifically analyzing the patient-reported outcome scores and the risk of revision surgery at 2 years postoperative. Study Design: Cohort study; Level of evidence, 3. Methods: From the years 2002 to 2009, a total of 34 patients were identified from a prospectively collected database as having undergone hybrid ACL reconstruction. Twenty-seven of 34 (79.4%) patients had a 2-year follow-up. These 27 patients were matched by age (within 1 year) and sex to 27 patients who underwent hamstring autograft ACL reconstruction during the same period. At the 2-year mark, revision surgery risk and patient-reported outcome scores were compared between the 2 groups. Results: The mean age for the hybrid and matched groups (±SD) was 20.9 ± 7.0 years. Both the hybrid and control groups had 17 males and 10 females. There was no significant difference in preoperative patient-reported outcome scores, meniscus tears, or cartilage lesions between the 2 groups. Graft size was larger in the hybrid group (9.5 ± 0.6 mm) than in the autograft group (8.4 ± 0.9 mm) (P < .001). At 2 years postoperative, patient-reported outcome scores were similar between the hybrid and autograft groups. Revision surgery was required in 5 (18.5%) patients who underwent hybrid reconstruction compared with 2 (7.4%) of those who underwent autograft reconstruction (P = .26). Conclusion: Patients who undergo ACL reconstruction with hybrid hamstring grafts and hamstring autografts report similar

  8. Trapeziectomy With Ligament Reconstruction and Tendon Interposition Arthroplasty With the Entire Width of the Flexor Carpi Radialis Tendon.

    PubMed

    Marenghi, Letizia; Paterlini, Marco; Tocco, Silvio; Corradi, Maurizio

    2016-06-01

    The original Burton-Pellegrini technique used to treat trapeziometacarpal joint osteoarthritis suggests the use of half of the flexor carpi radialis (FCR) width to reconstruct the ligament and perform the tendon interposition arthroplasty. In our study, unlike the original technique, we used the full thickness of the FCR and evaluated a sample of 100 thumbs (95 patients) preoperatively and postoperatively, with a mean follow-up of 36 months. According to the Eaton classification, 1 thumb was grade II, 81 were grade III, and 18 were grade IV. The mean patient age at the time of surgery was 62.4 years. The finger-tip pinch improved by 46.3%, the key pinch improved by 34.5%, the grip strength improved by 50.8%, and the Kapandji test improved by 7.4%. Pain measured with visual analog score improved by 78.8%. The self-administrated questionnaires DASH and PRWHE were completed postoperatively from 2006 to 2012, because the Italian version of PRWHE was not yet validated: the postoperative DASH and PRWHE were, respectively, 9.9 and 10.5. No complications such as metacarpal subluxation of the thumb, impingement, fracture of the first metacarpal base, or a decrease in the wrist function were found in our population after surgical treatment. Therefore, according to our series, this variation of the original Burton-Pellegini surgical technique provides pain relief, stability, and mobility of the thumb without any morbidity caused by the full harvest of the FCR tendon. PMID:27015407

  9. Unsuccessful regeneration of the semitendinosus tendon harvested for anterior cruciate ligament reconstruction: report of two cases.

    PubMed

    Nakamae, A; Ochi, M; Deie, M; Adachi, N

    2012-12-01

    Recent magnetic resonance imaging (MRI) and three-dimensional (3D) computed tomography (CT) analyses have demonstrated that semitendinosus tendon can regenerate at a high rate following harvesting the tendon for anterior cruciate ligament (ACL) reconstruction. Although it is known that the regeneration of the semitendinosus tendon does not occur in all the patients, the reason for this unsuccessful regeneration of the tendon in certain patients remains unknown. We recently encountered two cases in which regeneration of the semitendinosus tendon was unsuccessful because of apparent reasons. These patients experienced a sudden sharp pain in the posterior aspect of their thighs when their hamstring muscles were subjected to aggressive load at 3 and 4 weeks after surgery. At the follow-up examination conducted after 12 months, 3D CT imaging revealed unsuccessful regeneration of the semitendinosus tendons in both cases. Severe proximal retraction of the semitendinosus muscle belly was also confirmed. PMID:23123037

  10. Factors affecting return to play after anterior cruciate ligament reconstruction: a review of the current literature.

    PubMed

    Bauer, Matthew; Feeley, Brian T; Wawrzyniak, John R; Pinkowsky, Gregory; Gallo, Robert A

    2014-11-01

    Anterior cruciate ligament reconstruction has been reported to produce normal or near-normal knee results in > 90% of patients. A recent meta-analysis suggested that, despite normal or near-normal knees, many athletes do not return to sports. Rates and timing of return to competitive athletics are quite variable depending on the graft type, the age of the patient, the sport, and the level of play. Even when athletes do return to play, often they do not return to their previous level. Graft failure, subjective physical factors, and psychological factors, including fear of reinjury and lack of motivation, appear to play a large role in patients' ability to return to sporting activities. PMID:25419890