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Sample records for acl reconstruction patients

  1. Transphyseal ACL Reconstruction in Skeletally Immature Patients

    PubMed Central

    Cruz, Aristides I.; Lakomkin, Nikita; Fabricant, Peter D.; Lawrence, J. Todd R.

    2016-01-01

    Background: Most studies examining the safety and efficacy of transphyseal anterior cruciate ligament (ACL) reconstruction for skeletally immature patients utilize transtibial drilling. Independent femoral tunnel drilling may impart a different pattern of distal femoral physeal involvement. Purpose: To radiographically assess differences in distal femoral physeal disruption between transtibial and independent femoral tunnel drilling. We hypothesized that more oblique tunnels associated with independent drilling involve a significantly larger area of physeal disruption compared with vertically oriented tunnels. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We analyzed skeletally immature patients aged between 10 and 15 years who underwent transphyseal ACL reconstruction utilizing an independent femoral tunnel drilling technique between January 1, 2008, and March 31, 2011. These patients were matched with a transtibial technique cohort based on age and sex. Radiographic measurements were recorded from preoperative magnetic resonance imaging and postoperative radiographs. Results: Ten patients in each group were analyzed. There were significant differences between independent drilling and transtibial drilling cohorts in the estimated area of physeal disruption (1.64 vs 0.74 cm2; P < .001), femoral tunnel angles (32.1° vs 72.8°; P < .001), and medial/lateral location of the femoral tunnel (24.2 vs 36.1 mm from lateral cortex; P = .001), respectively. There was a significant inverse correlation between femoral tunnel angle and estimated area of distal femoral physeal disruption (r = –0.8255, P = .003). Conclusion: Femoral tunnels created with an independent tunnel drilling technique disrupt a larger area of the distal femoral physis and create more eccentric tunnels compared with a transtibial technique. Clinical Relevance: As most studies noting the safety of transphyseal ACL reconstruction have utilized a central, vertical femoral tunnel

  2. Physeal Disruption During ACL Reconstruction in Skeletally Immature Patients

    PubMed Central

    Cruz, Aristides Ignacio; Lakomkin, Nikita; Fabricant, Peter D.; Lawrence, John Todd R.

    2016-01-01

    Objectives: The purpose of this study was to radiographically assess differences in distal femoral physeal disruption between transtibial and independent femoral tunnel drilling techniques following ACL reconstruction in skeletally immature patients. Methods: A retrospective, matched comparative cohort study was performed of skeletally immature patients who underwent transphyseal ACL reconstruction between January 1, 2008 and March 31, 2011. All skeletally immature patients between ten and fifteen years old who underwent independent femoral tunnel drilling and had adequate baseline and post-operative radiographs were analyzed. These patients were matched with a transtibial technique cohort based on age and sex. Demographic characteristics and peri-operative metrics were collected. Radiographic measurements were recorded from pre-operative MRI and post-operative plain radiographs. Results: Twenty patients were analyzed. Between groups, there were significant differences between independent tunnel drilling and transtibial tunnel drilling in the estimated area of physeal disruption (1.64 cm2 vs. 0.74 cm2, P<0.001), femoral (32.1º vs. 72.8º, P<0.001) and tibial (50.1º vs. 60.5º, P=0.003) tunnel angles, medial/lateral location of the femoral tunnel (24.2 mm vs. 36.1 mm from lateral cortex, P=0.001), and distance from the lateral aspect of the distal femoral physis and the femoral tunnel exit (4.7 mm vs. 26.7 mm from the perichondrial ring, P<0.001), respectively. All patients who underwent femoral tunnel drilling at an angle of less than 25º from the transverse axis experienced a greater than 6% disruption of physeal area. There was a significant inverse correlation between femoral tunnel angle and estimated area of femoral physeal involvement (r=-0.8255, P=0.003). Conclusion: With femoral tunnel drilling techniques that create more oblique tunnels, the area of distal femoral physeal damage is larger, more eccentric and closer to the perichondrial ring. Since most

  3. Predicting success in ACL reconstruction.

    PubMed

    Shalvoy, Robert M

    2014-11-03

    Anterior Cruciate Ligament (ACL) injury and ACL reconstruction is common in the United States. However, when compared to the standards of other orthopedics procedures today, ACL reconstruction is NOT predictably successful in restoring patients to their pre-injury state. Only 60-70% of reconstructed patients resume their previous level of activity and many patients experience some degree of osteoarthritis. The reasons for such limitations of success are many. A recent renewal of interest in the many variables affecting ACL reconstruction and the understanding of the varying needs of patients with ACL injury holds promise for improving success even today as well as ultimately providing a normal knee for patients after ACL reconstruction.

  4. Evidence-Based ACL Reconstruction

    PubMed Central

    Rodriguez-Merchan, E. Carlos

    2015-01-01

    There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL) reconstruction. The purpose of this article is to answer the following questions: 1) Bone-patellar tendon-bone reconstruction (BPTB-R) or hamstrimg reconstruction (H-R); 2) Double bundle or single bundle; 3) Allograft or authograft; 4) Early or late reconstruction; 5) Rate of return to sports after ACL reconstruction; 6) Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE) search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analyses focused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II) of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years. PMID:25692162

  5. Evidence-Based ACL Reconstruction.

    PubMed

    Rodriguez-Merchan, E Carlos

    2015-01-01

    There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL) reconstruction. The purpose of this article is to answer the following questions: 1) Bone-patellar tendon-bone reconstruction (BPTB-R) or hamstrimg reconstruction (H-R); 2) Double bundle or single bundle; 3) Allograft or authograft; 4) Early or late reconstruction; 5) Rate of return to sports after ACL reconstruction; 6) Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE) search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analyses focused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II) of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years. PMID:25692162

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

    PubMed

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

    2004-06-01

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

  7. Functional Performance Testing and Patient Reported Outcomes following ACL Reconstruction: A Systematic Scoping Review.

    PubMed

    Almangoush, Adel; Herrington, Lee

    2014-01-01

    Objective. A systematic scoping review of the literature to identify functional performance tests and patient reported outcomes for patients who undergo anterior cruciate ligament (ACL) reconstruction and rehabilitation that are used in clinical practice and research during the last decade. Methods. A literature search was conducted. Electronic databases used included Medline, PubMed, Cochrane Library, EMBASE, CINAHL, SPORTDiscus, PEDro, and AMED. The inclusion criteria were English language, publication between April 2004 and April 2014, and primary ACL reconstruction with objective and/or subjective outcomes used. Two authors screened the selected papers for title, abstract, and full-text in accordance with predefined inclusion and exclusion criteria. The methodological quality of all papers was assessed by a checklist of the Critical Appraisal Skills Programme (CASP). Results. A total of 16 papers were included with full-text. Different authors used different study designs for functional performance testing which led to different outcomes that could not be compared. All papers used a measurement for quantity of functional performance except one study which used both quantity and quality outcomes. Several functional performance tests and patient reported outcomes were identified in this review. Conclusion. No extensive research has been carried out over the past 10 years to measure the quality of functional performance testing and control stability of patients following ACL reconstruction. However this study found that the measurement of functional performance following ACL reconstruction consisting of a one-leg hop for a set distance or a combination of different hops using limb symmetry index (LSI) was a main outcome parameter of several studies. A more extensive series of tests is suggested to measure both the quantitative and qualitative aspects of functional performance after the ACL reconstruction. The KOOS and the IKDC questionnaires are both measures that

  8. Functional Performance Testing and Patient Reported Outcomes following ACL Reconstruction: A Systematic Scoping Review

    PubMed Central

    Herrington, Lee

    2014-01-01

    Objective. A systematic scoping review of the literature to identify functional performance tests and patient reported outcomes for patients who undergo anterior cruciate ligament (ACL) reconstruction and rehabilitation that are used in clinical practice and research during the last decade. Methods. A literature search was conducted. Electronic databases used included Medline, PubMed, Cochrane Library, EMBASE, CINAHL, SPORTDiscus, PEDro, and AMED. The inclusion criteria were English language, publication between April 2004 and April 2014, and primary ACL reconstruction with objective and/or subjective outcomes used. Two authors screened the selected papers for title, abstract, and full-text in accordance with predefined inclusion and exclusion criteria. The methodological quality of all papers was assessed by a checklist of the Critical Appraisal Skills Programme (CASP). Results. A total of 16 papers were included with full-text. Different authors used different study designs for functional performance testing which led to different outcomes that could not be compared. All papers used a measurement for quantity of functional performance except one study which used both quantity and quality outcomes. Several functional performance tests and patient reported outcomes were identified in this review. Conclusion. No extensive research has been carried out over the past 10 years to measure the quality of functional performance testing and control stability of patients following ACL reconstruction. However this study found that the measurement of functional performance following ACL reconstruction consisting of a one-leg hop for a set distance or a combination of different hops using limb symmetry index (LSI) was a main outcome parameter of several studies. A more extensive series of tests is suggested to measure both the quantitative and qualitative aspects of functional performance after the ACL reconstruction. The KOOS and the IKDC questionnaires are both measures that

  9. Cross-cultural comparison of patients undergoing ACL reconstruction in the United States and Norway.

    PubMed

    Magnussen, Robert A; Granan, Lars-Petter; Dunn, Warren R; Amendola, Annunziato; Andrish, Jack T; Brophy, Robert; Carey, James L; Flanigan, David; Huston, Laura J; Jones, Morgan; Kaeding, Christopher C; McCarty, Eric C; Marx, Robert G; Matava, Matthew J; Parker, Richard D; Vidal, Armando; Wolcott, Michelle; Wolf, Brian R; Wright, Rick W; Spindler, Kurt P; Engebretsen, Lars

    2010-01-01

    Data from large prospectively collected anterior cruciate ligament (ACL) cohorts are being utilized to address clinical questions regarding ACL injury demographics and outcomes of ACL reconstruction. These data are affected by patient and injury factors as well as surgical factors associated with the site of data collection. The aim of this article is to compare primary ACL reconstruction data from patient cohorts in the United States and Norway, demonstrating the similarities and differences between two large cohorts. Primary ACL reconstruction data from the Multicenter Orthopaedic Outcomes Network (MOON) in the United States and the Norwegian National Knee Ligament Registry (NKLR) were compared to identify similarities and differences in patient demographics, activity at injury, preoperative Knee injury and Osteoarthritis Outcome Score (KOOS), time to reconstruction, intraarticular pathology, and graft choice. Seven hundred and thirteen patients from the MOON cohort were compared with 4,928 patients from the NKLR. A higher percentage of males (NKLR 57%, MOON 52%; P < 0.01) and increased patient age (NKLR 27 years, MOON 23 years; P\\0.001) were noted in the NKLR population. The most common sports associated with injury in the MOON cohort were basketball (20%), soccer (17%), and American football (14%); while soccer (42%), handball (26%), and downhill skiing (10%) were most common in the NKLR. Median time to reconstruction was 2.4 (Interquartile range [IQR] 1.2-7.2) months in the MOON cohort and 7.9 (IQR 4.2-17.8) months in the NKLR cohort (P < 0.001). Both meniscal tears (MOON 65%, NKLR 48%; P < 0.001) and articular cartilage defects (MOON 46%, NKLR 26%; P < 0.001) were more common in the MOON cohort. Hamstring autografts (MOON 44%, NKLR 63%) and patellar tendon autografts (MOON 42%, NKLR 37%) were commonly utilized in both cohorts. Allografts were much more frequently utilized in the MOON cohort (MOON 13%, NKLR 0.04%; P < 0.001). Significant diversity in patient

  10. PATIENT-SPECIFIC AND SURGERY-SPECIFIC FACTORS THAT AFFECT RETURN TO SPORT AFTER ACL RECONSTRUCTION

    PubMed Central

    Lynch, Andrew; Rabuck, Stephen; Lynch, Brittany; Davin, Sarah; Irrgang, James

    2016-01-01

    Context Anterior cruciate ligament (ACL) reconstruction is frequently performed to allow individuals to return to their pre-injury levels of sports participation, however, return to pre-injury level of sport is poor and re-injury rates are unacceptably high. Re-injury is likely associated with the timeframe and guidelines for return to sport (RTS). It is imperative for clinicians to recognize risk factors for re-injury and to ensure that modifiable risk factors are addressed prior to RTS. The purpose of this commentary is to summarize the current literature on the outcomes following return to sport after ACL reconstruction and to outline the biologic and patient-specific factors that should be considered when counseling an athlete on their progression through rehabilitation. Evidence Acquisition A comprehensive literature search was performed to identify RTS criteria and RTS rates after ACL reconstruction with consideration paid to graft healing, anatomic reconstruction, and risk factors for re-injury and revision. Results were screened for relevant original research articles and review articles, from which results were summarized. Study Design Clinical Review of the Literature Results Variable RTS rates are presented in the literature due to variable definitions of RTS ranging from a high threshold (return to competition) to low threshold (physician clearance for return to play). Re-injury and contralateral injury rates are greater than the risk for primary ACL injury, which may be related to insufficient RTS guidelines based on time from surgery, which do not allow for proper healing or resolution of post-operative impairments and elimination of risk factors associated with both primary and secondary ACL injuries. Conclusions RTS rates to pre-injury level of activity after ACLR are poor and the risk for graft injury or contralateral injury requiring an additional surgery is substantial. Resolving impairments while eliminating movement patterns associated with

  11. Gait analysis in patients undergoing ACL reconstruction according to Kenneth Jones' technique.

    PubMed

    Bacchini, Massimo; Cademartiri, Carola; Soncini, Giovanni

    2009-08-01

    The anterior cruciate ligament is essential for knee stability, and its injury, both acute and in the case of chronic knee instability, promotes meniscal degenerative alterations, as well as the onset and progression of gonarthrosis. In this retrospective study, young adults engaged in nonprofessional sportive activities undergoing ACL reconstruction by the Kenneth-Jones technique were assessed clinically and with gait analysis, to detect any deficits persisting even after rehabilitation at a follow- up of approximately 6 months. Eight patients who had undergone elective ligament reconstruction by Kenneth-Jones were assessed between the 5th and 7th month postsurgery with clinical-anamnestic investigation, including the Hughston Clinic subjective knee questionnaire and by gait analysis with the EL.I.Te. system. Gait analysis showed a reduction of ACL protection mechanisms during initial stance; furthermore, the operated limb globally exhibited greater difficulty in muscle recruitment. Residual deficits in muscle recruitment, exposing the reconstructed ligament to possible injuries, persist after a rehabilitation program and after resuming ofpre-surgery activities, thus adjustment of the rehabilitative program on the basis of these findings is recommended.

  12. Abnormal landing strategies after ACL reconstruction.

    PubMed

    Gokeler, A; Hof, A L; Arnold, M P; Dijkstra, P U; Postema, K; Otten, E

    2010-02-01

    The objective was to analyze muscle activity and movement patterns during landing of a single leg hop for distance after anterior cruciate ligament (ACL) reconstruction. Nine (six males, three females) ACL-reconstructed patients 6 months after surgery and 11 (eight males, three females) healthy control subjects performed the hop task. Electromyographic signals from lower limb muscles were analyzed to determine onset time before landing. Biomechanical data were collected using an Optotrak Motion Analysis System and force plate. Matlab was used to calculate kinetics and joint kinematics. Side-to-side differences in ACL-reconstructed patients and healthy subjects as well as differences between the patients and control group were analyzed. In ACL-reconstructed limbs, significantly earlier onset times were found for all muscles, except vastus medialis, compared with the uninvolved side. The involved limbs had significantly reduced knee flexion during the take-off and increased plantarflexion at initial contact. The knee extension moment was significantly lower in the involved limb. In the control group, significantly earlier onset times were found for the semitendinosus, vastus lateralis and medial gastrocnemius of the non-dominant side compared with the dominant side. Muscle onset times are earlier and movement patterns are altered in the involved limb 6 months after ACL reconstruction.

  13. Graft Diameter matters in Hamstring ACL reconstruction

    PubMed Central

    Clatworthy, Mark

    2016-01-01

    Objective: Recently techniques have been developed to increase graft diameter in hamstring ACL reconstruction with the hope to decrease graft failure. To date there is limited evidence to show that a smaller graft diameter results in a higher ACL failure rate. Method: The factors for failure in 1480 consecutive single surgeon hamstring ACL reconstructions were evaluated prospectively. Patients were followed for 2-15 years. A multivariate analysis was performed which looked at graft size, age, sex, time to surgery, meniscal integrity, meniscal repair and ACL graft placement to determine whether graft diameter matters in determining the failure of hamstring ACL reconstruction. Results: Graft diameters ranged from 6-10 mm. The mean graft diameter for all patients was 7.75 mm. 83 ACL reconstructions failed. The mean size of graft failures was 7.55 mm ACL reconstructions that failed had a significantly smaller hamstring graft diameter p=0.001. The Hazard Ratio for a smaller diameter graft is 0.517 p=<0.0001. For every 1 mm decrease in graft diameter there is a 48.3% higher chance of failure. The multivariate analysis showed a hazard ratio of 0.543 p=0.002. For every 1 mm decrease in graft diameter there is a 45.7% higher chance of failure. Conclusion: Smaller diameter hamstring grafts do have a higher failure rate. Grafts ≤ 7.5 mm had twice the failure rate of grafts ≥8 mm using a multivariate analysis for every 1 mm decrease in graft diameter there is a 45.7% higher chance of failure.

  14. Femoral tunnel malposition in ACL revision reconstruction.

    PubMed

    Morgan, Joseph A; Dahm, Diane; Levy, Bruce; Stuart, Michael J

    2012-11-01

    The Multicenter Anterior Cruciate Ligament (ACL) Revision Study (MARS) group was formed to study a large cohort of revision ACL reconstruction patients. The purpose of this subset analysis study of the MARS database is to describe specific details of femoral tunnel malposition and subsequent management strategies that surgeons chose in the revision setting. The design of this study is a case series. The multicenter MARS database is compiled from a questionnaire regarding 460 ACL reconstruction revision cases returned by 87 surgeons. This subset analysis described technical aspects and operative findings in specifically those cases in which femoral tunnel malposition was cited as the cause of primary ACL reconstruction failure. Of the 460 revisions included for study, 276 (60%) cases cited a specific "technical cause of failure." Femoral tunnel malposition was cited in 219 (47.6%) of 460 cases. Femoral tunnel malposition was cited as the only cause of failure in 117 cases (25.4%). Surgeons judged the femoral tunnel too vertical in 42 cases (35.9%), too anterior in 35 cases (29.9%), and too vertical and anterior in 31 cases (26.5%). Revision reconstruction involved the drilling of an entirely new femoral tunnel in 91 cases (82.1%). For primary reconstruction, autograft tissue was used in 82 cases (70.1%). For revision reconstruction, autograft tissue was used in 61 cases (52.1%) and allograft tissue in 56 cases (47.9%). Femoral tunnel malposition in primary ACL reconstruction was the most commonly cited reason for graft failure in this cohort. Graft selection is widely variable among surgeons.

  15. Femoral Tunnel Malposition in ACL Revision Reconstruction

    PubMed Central

    Morgan, Joseph A.; Dahm, Diane; Levy, Bruce; Stuart, Michael J.

    2013-01-01

    The Multicenter Anterior Cruciate Ligament (ACL) Revision Study (MARS) group was formed to study a large cohort of revision ACL reconstruction patients. The purpose of this subset analysis study of the MARS database is to describe specific details of femoral tunnel malposition and subsequent management strategies that surgeons chose in the revision setting. The design of this study is a case series. The multicenter MARS database is compiled from a questionnaire regarding 460 ACL reconstruction revision cases returned by 87 surgeons. This subset analysis described technical aspects and operative findings in specifically those cases in which femoral tunnel malposition was cited as the cause of primary ACL reconstruction failure. Of the 460 revisions included for study, 276 (60%) cases cited a specific “technical cause of failure.” Femoral tunnel malposition was cited in 219 (47.6%) of 460 cases. Femoral tunnel malposition was cited as the only cause of failure in 117 cases (25.4%). Surgeons judged the femoral tunnel too vertical in 42 cases (35.9%), too anterior in 35 cases (29.9%), and too vertical and anterior in 31 cases (26.5%). Revision reconstruction involved the drilling of an entirely new femoral tunnel in 91 cases (82.1%). For primary reconstruction, autograft tissue was used in 82 cases (70.1%). For revision reconstruction, autograft tissue was used in 61 cases (52.1%) and allograft tissue in 56 cases (47.9%). Femoral tunnel malposition in primary ACL reconstruction was the most commonly cited reason for graft failure in this cohort. Graft selection is widely variable among surgeons. PMID:23150344

  16. PRP Augmentation for ACL Reconstruction.

    PubMed

    Andriolo, Luca; Di Matteo, Berardo; Kon, Elizaveta; Filardo, Giuseppe; Venieri, Giulia; Marcacci, Maurilio

    2015-01-01

    Current research is investigating new methods to enhance tissue healing to speed up recovery time and decrease the risk of failure in Anterior Cruciate Ligament (ACL) reconstructive surgery. Biological augmentation is one of the most exploited strategies, in particular the application of Platelet Rich Plasma (PRP). Aim of the present paper is to systematically review all the preclinical and clinical papers dealing with the application of PRP as a biological enhancer during ACL reconstructive surgery. Thirty-two studies were included in the present review. The analysis of the preclinical evidence revealed that PRP was able to improve the healing potential of the tendinous graft both in terms of histological and biomechanical performance. Looking at the available clinical evidence, results were not univocal. PRP administration proved to be a safe procedure and there were some evidences that it could favor the donor site healing in case of ACL reconstruction with patellar tendon graft and positively contribute to graft maturation over time, whereas the majority of the papers did not show beneficial effects in terms of bony tunnels/graft area integration. Furthermore, PRP augmentation did not provide superior functional results at short term evaluation. PMID:26064903

  17. ACL Reconstruction With Autografts Weighing Performance Considerations and Postoperative Care.

    PubMed

    Grant, John A; Mohtadi, Nicholas G

    2003-04-01

    Anterior cruciate ligament (ACL) reconstruction is the treatment of choice for patients who experience episodes of instability and a decreased quality of life after ACL rupture. The bone-patellar tendon-bone and hamstring autografts are the current standards for ACL reconstruction. Primary care physicians, especially sports medicine clinicians, are the first-line providers of nonoperative care for patients who have ACL injuries. Care providers need to know the biologic and biomechanic properties of these grafts, clinical indications for each graft, and rehabilitation considerations to appropriately counsel their patients. PMID:20086463

  18. Selective anteromedial bundle reconstruction in partial ACL tears: a series of 36 patients with mean 24 months follow-up.

    PubMed

    Sonnery-Cottet, Bertrand; Lavoie, F; Ogassawara, R; Scussiato, R G; Kidder, J F; Chambat, P

    2010-01-01

    The purpose of this study was to describe an original technique of reconstruction of the anteromedial bundle preserving the posterolateral bundle and to report the results of a consecutive 36 patients series with mean 24 months follow-up. Our hypothesis is that this selective reconstruction of ACL partial tears could restore knee stability and function. In a consecutive series of 256, ACL reconstructions, 36 patients in which intact ACL fibers remained in the location corresponding to the posterolateral bundle were perioperatively diagnosed. These patients (21 women and 15 men) underwent isolated reconstruction of the anteromedial bundle while keeping the remaining fibers intact. AM bundle reconstructions were performed by the same surgeon using an outside-in technique. A quadrupled hamstring graft was used in 20 patients and a doubled semitendinosus graft in 16 patients. The mean age of the patients at the time of surgery was 32 years (min 15, max 53). The delay between injury and surgery was 6.6 months (min 2, max 35). Patients were assessed with the IKDC ligament evaluation form. Instrumented knee testing was performed with the Rolimeter arthrometer. Statistical analysis was performed to compare the preoperative and postoperative objective evaluation. Eleven concomitant meniscal lesions at the time of reconstruction were found. One patient who underwent a traumatic graft rupture at 4 months post surgery and two patients with previous contralateral ACL reconstruction were excluded, leaving 33 patients for final evaluation. Three reoperations were performed, including two arthrolysis for cyclops syndrome and one revision for a traumatic graft rupture. At last follow-up, 24 (73%) patients were graded A, 8 (24%) graded B and 1 C (3%) at IKDC objective evaluation. Mean side to side instrumented laxity was 4.8 mm (min 3, max 6) preoperatively and 0.8 mm (min 0, max 2) postoperatively. AM bundle reconstruction with an outside-in technique remains simple and

  19. Effect of 12 Weeks of Accelerated Rehabilitation Exercise on Muscle Function of Patients with ACL Reconstruction of the Knee Joint.

    PubMed

    Lee, Joong-Chul; Kim, Ji Youn; Park, Gi Duck

    2013-12-01

    [Purpose] To examine changes in the knee joint's isokinetic muscle functions following systematic and gradual rehabilitation exercises lasting for 12 weeks for male and female patients who underwent anterior cruciate ligament (ACL) reconstruction. Differences in muscle functions between the uninvolved side (US) and the involved side (IS) before surgery, differences in muscle functions between US and IS after rehabilitation exercises lasting for 12 weeks, and changes in muscle functions on US and IS between before and after surgery were analyzed to examine the effects of accelerated rehabilitation exercises after ACL reconstruction. [Subjects] The study subjects were 10 patients, five females and five males, who underwent ACL reconstruction performed by the same surgeon. [Methods] As a measuring tool, a Biodex Multi-joint system 3pro (USA), which is an isokinetic measuring device, was used to examine the flexion and extension forces of the knee joint. During isokinetic muscle strength evaluation, the ROM of US was set to be the same as that of IS for consistency of measurement. [Results] At 60°/s, the isokinetic muscle functions of the females did not show any significant change between before and after surgery in any of the variables on both US and IS. At 60°/s, the isokinetic muscle functions of the males did not show any significant change between before and after surgery in the peak torque, average power, and entire work done on US. In extension, peak torque on IS did not show any significant change.

  20. Update on rehabilitation following ACL reconstruction

    PubMed Central

    Nyland, John; Brand, Emily; Fisher, Brent

    2010-01-01

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

  1. ACL reconstruction: patellar tendon versus hamstring grafts--economical aspects.

    PubMed

    Forssblad, Magnus; Valentin, Anders; Engström, Björn; Werner, Suzanne

    2006-06-01

    The aim of the present investigation was to compare the costs for the use of patellar tendon versus hamstring tendons as grafts for anterior cruciate ligament (ACL) reconstruction including the different fixation methods. The background is that during recent years there has been a dramatic shift from patellar tendon to hamstring tendons in ACL reconstructions in Sweden. All our patients with ACL reconstructions performed during 1 year (2004) were included. Knee joints numbering 440 in 439 patients were primary ACL reconstructions. A hamstring graft was used in 345 knee joints (78.4%) and a patellar tendon graft in 95 (21.6%) of the patients (Table 2). On average 34 (SD 12.9; range 14-63) ACL reconstructions per surgeon were performed by a total of 14 surgeons. The average cost for patellar tendon procedure was 197 euros compared to 436 euros for the hamstring procedure. Mean time for surgery in primary reconstructions was 11.5 min shorter (P<0.001) for patellar tendon reconstructions (71.3+/-31 min) compared to hamstring reconstructions (83.2+/-27 min). This means a difference in cost of 90 euros. The total additional cost (fixation and surgery time) for the hamstring method compared to the patellar tendon method was on an average 329 euros. From a strict economic point of view we therefore recommend or at least consider the use of the patellar tendon as a graft in ACL reconstructions. PMID:16570193

  2. Stability Outcomes following Computer-Assisted ACL Reconstruction

    PubMed Central

    Christino, Melissa A.; Vopat, Bryan G.; Matson, Andrew P.; Reinert, Steven E.; Shalvoy, Robert M.

    2015-01-01

    Purpose. The purpose of this study was to determine whether intraoperative prereconstruction stability measurements and/or patient characteristics were associated with final knee stability after computer-assisted ACL reconstruction. Methods. This was a retrospective review of all patients who underwent computer-assisted single-bundle ACL reconstruction by a single surgeon. Prereconstruction intraoperative stability measurements were correlated with patient characteristics and postreconstruction stability measurements. 143 patients were included (87 male and 56 female). Average age was 29.8 years (SD ± 11.8). Results. Females were found to have significantly more pre- and postreconstruction internal rotation than males (P < 0.001 and P = 0.001, resp.). Patients with additional intra-articular injuries demonstrated more prereconstruction anterior instability than patients with isolated ACL tears (P < 0.001). After reconstruction, these patients also had higher residual anterior translation (P = 0.01). Among all patients with ACL reconstructions, the percent of correction of anterior translation was found to be significantly higher than the percent of correction for internal or external rotation (P < 0.001). Conclusion. Anterior translation was corrected the most using a single-bundle ACL reconstruction. Females had higher pre- and postoperative internal rotation. Patients with additional injuries had greater original anterior translation and less operative correction of anterior translation compared to patients with isolated ACL tears. PMID:25883804

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

    NASA Astrophysics Data System (ADS)

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

    2011-12-01

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

  4. Maximizing quadriceps strength after ACL reconstruction.

    PubMed

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

    2008-07-01

    The primary objectives of ACL surgery and rehabilitation are to restore knee function to preinjury levels and promote long-term joint health. Often these goals are not achieved, however. The quadriceps is critical to dynamic joint stability, and weakness of this muscle group is related to poor functional outcomes. Because of this, identifying strategies to minimize quadriceps weakness following ACL injury and reconstruction is of great clinical interest. This article reviews the current literature and critically discusses current rehabilitation approaches to restore quadriceps muscle function after ACL reconstruction.

  5. Cross-exercise on quadriceps deficit after ACL reconstruction.

    PubMed

    Papandreou, Maria; Billis, Evdokia; Papathanasiou, George; Spyropoulos, Panagiotis; Papaioannou, Nikos

    2013-02-01

    A few studies concerning the improvement of quadriceps muscle strength deficit (QD) at an early stage following anterior cruciate ligament (ACL) reconstruction have been conducted whereas, ACL rehabilitation protocols based on contralateral quadriceps strength (QS) do not exist. Given these, the goals of our study were (1) to evaluate the effects of cross-eccentric exercise (CEE) on QD on ACL reconstructed knees, and (2) to explore any changes in QD following CEE provided at the frequencies of 3 or 5 times per week. For this study, 42 ACL-reconstructed patients were randomly assigned into 3 groups, two experimental and one control and followed an 8-week rehabilitation program. Additionally, the experimental groups received CEE for 3 and 5 days per week for 8 weeks in their uninjured knees. QS was evaluated with an isokinetic/isometric test, at 60 degrees of knee flexion of both limbs before and after completion of CEE. Two-factor ANOVA showed a significant improvement of QD between groups (F = 5.16, p = 0.01) after CEE completion on ACL reconstructed knees. Statistically significant results arose from the 3 days per week (D = 18.60, p = 0.01) and 5 days per week (D = 15.12, p = 0.04) experimental groups, whereas the control group did not yield any statistically significant differences. CEE used as an adjunct to the ACL traditional rehabilitation program at the weekly frequencies of 3 and 5 times at the early stage of reconstruction significantly improved QD.

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

    PubMed

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

    2015-08-01

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

  7. ACL reconstructed patients with a BPTB graft present an impaired vastus lateralis neuromuscular response during high intensity running.

    PubMed

    Patras, Kostas; Ziogas, Giorgos; Ristanis, Stavros; Tsepis, Elias; Stergiou, Nicholas; Georgoulis, Anastasios D

    2010-11-01

    The purpose of the present study was to investigate whether the electromyographic response of the vastus lateralis (VL) muscle in the anterior cruciate ligament (ACL) reconstructed leg is similar to that of the intact contralateral leg and healthy controls, during moderate and high intensity running. Fourteen bone-patellar tendon-bone (BPTB) ACL reconstructed amateur soccer players and fourteen healthy control amateur soccer players volunteered to participate in the study. Electromyographic (EMG) traces from the vastus lateralis (VL) muscle were collected bilaterally, as athletes ran on a treadmill for 10 min on separate occasions, at moderate and high intensity. The dependent variable examined was the EMG amplitude during stance. During the moderate intensity running, EMG amplitude of the VL did not increase with time for any of the tested legs. During the high intensity running, the EMG amplitude of the VL increased significantly with time for the intact (F=6.747, p=0.001) and the control leg (F=4.258, p=0.008), but remained unchanged for the ACL reconstructed leg. During moderate intensity running, there was no difference in the neuromuscular response of the VL in the reconstructed leg compared to the intact and control leg. High intensity running resulted in an impaired neuromuscular response of the VL in the reconstructed leg compared to the intact and control leg. It seems that potential impairments of the neuromuscular response after ACL reconstruction should be tested under high rather than moderate intensity efforts.

  8. NFL Combine Athletic Performance after ACL Reconstruction

    PubMed Central

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

    2016-01-01

    Objectives: The purpose of this study was to determine the functional performance of NFL combine participants after ACL reconstruction compared with an age-, size-, and position-matched control group. The hypothesis was that there would be no difference between players after ACL reconstruction as compared with controls in functional athletic performance. Methods: A total of 98 NFL-caliber athletes who had undergone primary ACL reconstruction and participated in the NFL scouting combine between 2010 and 2014 were reviewed and compared with an age-, size-, and position-matched control group. Data recorded for each player included a 40-yard dash, vertical leap, broad jump, shuttle drill, and 3-cone drill. Results: With regard to speed and acceleration, the mean 40-yard dash time for ACL-reconstructed players was 4.74 seconds (range, 4.33-5.55 seconds) compared with controls at 4.74 seconds (range, 4.34-5.38 seconds; P = .96). Jumping performance was also similar, with a mean vertical leap for ACL-reconstructed players of 33.35 inches (range, 23-43 inches) and broad jump of 113.9 inches (range, 96-136 inches) compared with respective values for the controls of 33.22 inches (range, 23.5-43.5 inches; P = .84) and 113.9 inches (range, 92-134 inches; P = .99). Agility and quickness testing measures also did not show a statistically significantly difference, with ACL-reconstructed players performing the shuttle drill in 4.37 seconds (range, 4.02-4.84 seconds) and the 3-cone drill in 7.16 seconds (range, 6.45-8.14 seconds), respectively, compared with respective times for the controls of 4.37 seconds (range, 3.96-5.00 seconds; P = .91) and 7.18 seconds (range, 6.64-8.24 seconds; P = .75). Conclusion: This study suggests that after ACL reconstruction, high-caliber athletes can achieve equivalent levels of perfor- mance with no statistically significant differences compared with matched controls. This information is unique when advising high-level athletes on athletic

  9. Over the top or endobutton for ACL reconstruction?

    PubMed

    Verdano, Michele Arcangelo; Pedrabissi, Bianca; Lunini, Enricomaria; Pellegrini, Andrea; Ceccarelli, Francesco

    2012-08-01

    There are an estimated 80-100,000 ACL repairs in the US each year: most ACL tears occurs from noncontact injuries. The 3.9% of the knee ligament injuries undergoes surgery: in the 80% of these patients, this means ACL reconstruction. The purpose of this study is to compare two surgical techniques normally used for acl recustruction; the first one is the intra- extra articular technique with single bundle fixed with staples and the second one is the intra-articular technique with double bundle and endobutton post-fixation. We evaluate the clinical outcome of our patients at the time of 4 years follow up. From January 2006 to April 2009 40 patients underwent to ACL reconstruction, all operated by using hamstring tendons: 20 patients with an average age of 28,75 years (12 men and 8 women) underwent surgery using the intra-extra articular technique, whereas the remaining 20 patients with an average age of 34,5 years (11 men and 9 women) benefited the intra-articular technique with double bundle ligament and endobutton post-fixation. Our study shows no substancial difference between these'two technique, but clinical outcome measures (I.K.D.C., Lysholm and Tegner) estimated better results for the double bundle technique with Endobutton post-fixation. (www.actabiomedica.it).

  10. Risk Factors and Predictors Of Subsequent ACL Injury After ACL Reconstruction: Prospective Analysis Of 2801 Primary ACL Reconstructions

    PubMed Central

    Kaeding, Christopher C.; Pedroza, Angela; Reinke, Emily; Huston, Laura J.; Spindler, Kurt P.

    2014-01-01

    Objectives: Retear of an ACL after an ACL reconstruction (ACLR) is devastating for all involved. Understanding risk factors and predictors of subsequent ACL tear after an ACLR is vital for patient education of subsequent risk of injury and if a predictor is modifiable, to make adjustments to minimize the risk of repeat ACL tear. The objectives of this study were 1) to identify the risk factors and predictors for ispilateral and contralateral ACL tears after primary ACLR and 2) to compare retear risk between the 2002/03 and 2007/08 cohorts. This is the largest and most comprehensive prospective analysis of this kind in the literature. Methods: Data from the 2002-2008 MOON database was used to identify risk factors for ACL retear. Subjects who had a primary ACLR with no history of contralateral knee surgery and had 2 year follow-up data were included. Subjects who had multiligament surgery were excluded. Graft type (auto-BTB, auto-hamstring, allograft), age, Marx score at time of index surgery, sport played post ACLR, sex, smoking status, lateral meniscus tear at the time of ACLR, medial meniscus tear at the time of ACLR, BMI, and MOON site were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear. The analysis was repeated using the 2002/3 and 2007/8 cohort and included age, graft, sex, and Marx. An ANOVA with post-hoc analysis was performed to detect significant differences in age and Marx score by graft type over time. Results: A total of 2801 subjects met all inclusion/exclusion criteria. There were 165/2801 (5.89%) ipsilateral and 177/2801 (6.32%) contralateral ACL tears identified in the cohort at the two year follow-up. The odds of ipsilateral retear are 1.68 times greater for hamstring autograft (p=0.04) and 4.67 times greater for an allograft (p<0.001) compared to auto-BTB. The odds of ipsilateral retear decrease by 8% for every yearly increase in age (p < 0.001) and increases by 6% for every increased point on the

  11. ACL reconstruction in children: a transphyseal technique.

    PubMed

    Lemaitre, G; Salle de Chou, E; Pineau, V; Rochcongar, G; Delforge, S; Bronfen, C; Haumont, T; Hulet, C

    2014-06-01

    The annual incidence of ACL tears is increasing steadily in pediatric patients. Chronic anterior instability causes meniscal lesions at a frequency that increases significantly with the injury-to-surgery interval. Conservative therapy, simple suturing, and isolated extra-articular tendon reconstruction are associated with high failure rates. Intra-articular arthroscopy-assisted tendon reconstruction is a good treatment method, although several different techniques have been described. We used a transphyseal technique with a hamstring tendon graft to treat 14 knees in 13 patients with a mean age of 13 years and 7 months. Mean injury-to-surgery interval was 6 months. Strict compliance with technical rules is required when using this technique. Bone tunnel diameter must not exceed 8 mm. Bone tunnels must be as vertical and central as possible. The fixation material must not bridge the physis (at the femur, cortical fixation; and at the tibia, fixation using a resorbable screw no longer than 25 mm combined with a staple). Meniscal lesions were present in half the knees and meniscal preservation considered mandatory. Conservative treatment of concomitant lesions was performed routinely. After a mean follow-up of 15 months, no recurrent tears or revision procedures for meniscectomy had been recorded. The IKDC grade was A or B in 93% of knees. The mean subjective IKDC score was 83.3 and the Lysholm score was in the excellent or good range in 93% of knees. Of the 14 knees, 2 exhibited signs suggesting femoral epiphysiodesis, with 4° of valgus deformity compared to the contra-lateral knee and no clinical consequences. Transphyseal reconstruction with open physes conducted in strict compliance with technical rules can be performed to control the instability and preserve the menisci. Nevertheless, this technique carries a risk of epiphysiodesis, chiefly at the femur.

  12. In vivo bone tunnel remodeling in symptomatic patients after ACL reconstruction: a retrospective comparison of articular and extra-articular fixation

    PubMed Central

    Mathis, Dominic T.; Rasch, Helmut; Hirschmann, Michael T.

    2015-01-01

    Summary Background there is only a paucity of studies dealing with bone remodeling within the tunnels after anterior cruciate ligament (ACL) reconstruction. The objective of this study was to evaluate the influence of tendon graft type and surgical fixation technique on bone tunnel remodeling in patients with symptomatic knees after ACL reconstruction. Methods in a retrospective study 99mTc-HDP bone tracer uptake (BTU) in SPECT/CT of 57 knees with symptoms of pain and/or instability after ACL reconstruction was investigated. All 57 knees were subdivided according their anatomy (femur and tibia), fixation (articular versus extra-articular fixation) and graft types into eight groups: femoral-articular versus extra-articular fixation using bone-patellar tendon-bone (BPTB) and hamstring autografts; tibial-articular versus extra-articular fixation using patellar tendon and hamstring autografts; BTU grading for each area of the localisation scheme were recorded. Tunnel diameter and length was measured in the CT scans. Results BTU was higher for the articular fixation in the femur and for the extra-articular fixation in the tibial tunnel. Patellar tendon graft fixation showed a significantly higher BTU in the superior-lateral and posterior-central area of the tibia, meaning the areas of the tibial tunnel near the entrance into the joint. Tunnel enlargement correlated significantly with increased BTU (p<0.05). Conclusion assessment of in vivo bone tunnel remodelling in symptomatic patients after ACL reconstruction revealed different patterns of BTU with regards to graft and fixation method. PMID:26958543

  13. Rash After ACL Reconstruction: Asking the Right Questions.

    PubMed

    Smith, Andrew H; Bach, Bernard R

    2004-10-01

    A 40-year-old recreational athlete injured his left knee on a "moon bouncer" at his child's birthday party. Before the injury, he regularly went hiking and downhill skiing and played basketball and tennis. Because the injury caused persistent symptoms of knee instability, he elected to undergo an anterior cruciate ligament (ACL) reconstruction using allograft. At the time of surgery, the patient's skin examination was unremarkable, and no surgical complications were noted. The patient went home on the day of surgery.

  14. Rehabilitation Predictors of Clinical Outcome following Revision ACL Reconstruction

    PubMed Central

    Wright, Rick W.; Group, Mars

    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 whether rehabilitation-related factors prescribed at the time of ACL revision reconstruction significantly influence two year outcomes, as well as the incidence of incurring a subsequent re-operation. Our hypothesis was that immediate versus passive, active range of motion (ROM) and weightbearing will result in improved outcomes without incidence of subsequent surgery. Use of postoperative and functional return to sport braces will not improve return to sports function. Methods: Revision ACL reconstruction patients were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, prescribed post-op and rehabilitation instructions (ie. timing of weightbearing, timing of passive and active ROM, use of postoperative and return to sport braces) and a series of validated patient reported outcome instruments (IKDC, KOOS, and Marx activity rating score). Patients were followed up for 2 years, and asked to complete the identical set of outcome instruments. Because meniscal repair, meniscal transplants, HTOs, concurrent ligamentous reconstructions, and certain chondral treatments (ie. microfracture, abrasion arthroplasty, mosiacplasty, etc) are known to affect prescribed rehab treatments, patients with these pathologies were excluded from the analyses. Regression analysis was used to control for age, gender, activity level, baseline outcome scores, and the above-mentioned rehabilitation-related variables, in order to assess the risk factors for clinical outcomes 2 years after revision ACL reconstruction. Results: A total of 843 patients met the inclusion criteria and were successfully enrolled. 482 (57%) were males, with a median cohort age of 27 years. Baseline characteristics of the cohort are

  15. Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport

    PubMed Central

    Paterno, Mark V.; Rauh, Mitchell J.; Schmitt, Laura C.; Ford, Kevin R.; Hewett, Timothy E.

    2014-01-01

    Background The incidence of second anterior cruciate ligament (ACL) injuries in the first 12 months after ACL reconstruction (ACLR) and return to sport (RTS) in a young, active population has been reported to be 15 times greater than that in a previously uninjured cohort. There are no reported estimates of whether this high relative rate of injury continues beyond the first year after RTS and ACLR. Hypothesis The incidence rate of a subsequent ACL injury in the 2 years after ACLR and RTS would be less than the incidence rate reported within the first 12 months after RTS but greater than the ACL injury incidence rate in an uninjured cohort of young athletes. Study Design Cohort study; Level of evidence, 2. Methods Seventy-eight patients (mean age, 17.1 ± 3.1 years) who underwent ACLR and were ready to return to a pivoting/ cutting sport and 47 controls (mean age, 17.2 ± 2.6 years) who also participated in pivoting/cutting sports were prospectively enrolled. Each participant was followed for injury and athlete exposure (AE) data for a 24-month period after RTS. Twenty-three ACLR and 4 control participants suffered an ACL injury during this time. Incidence rate ratios (IRRs) were calculated to compare the rates (per 1000 AEs) of ACL injury in athletes in the ACLR and control groups. For the ACLR group, similar comparisons were conducted for side of injury by sex. Results The overall incidence rate of a second ACL injury within 24 months after ACLR and RTS (1.39/1000 AEs) was nearly 6 times greater (IRR, 5.71; 95% CI, 2.0–22.7; P = .0003) than that in healthy control participants (0.24/1000 AEs). The rate of injury within 24 months of RTS for female athletes in the ACLR group was almost 5 times greater (IRR, 4.51; 95% CI, 1.5–18.2; P = .0004) than that for female controls. Although only a trend was observed, female patients within the ACLR group were twice as likely (IRR, 2.43; 95% CI, 0.8–8.6) to suffer a contralateral injury (1.13/1000 AEs) than an

  16. Prognosis and Predictors of ACL Reconstructions using the MOON Cohort: A Model for Comparative Effectiveness Studies

    PubMed Central

    Spindler, Kurt P.; Parker, Richard D.; Andrish, Jack T.; Kaeding, Christopher C.; Wright, Rick W.; Marx, Robert G.; McCarty, Eric C.; Amendola, Annunziato; Dunn, Warren R.; Huston, Laura J.; Harrell, Frank E.

    2012-01-01

    Injury to the anterior cruciate ligament (ACL) threatens an active lifestyle and exposes the patient to risk of early osteoarthritis (OA). ACL reconstruction is typically chosen by individuals to allow a return to their previous work and sports activities. Primary ACL reconstruction (ACLR) has in general been effective at restoring functional stability, but patients’ modifiable predictors of both short- and long-term validated outcomes and OA are largely unknown. The Multicenter Orthopaedic Outcomes Network (MOON) consortium was established in 2002 to enroll and longitudinally follow a population cohort of ACL reconstructed patients. The objective was to establish patient-specific predictive models of clinically important outcomes. Over the past 10 years, the overarching aims of this NIAMS-funded prospective multicenter cohort of ACL reconstructions has been three-fold: 1) to identify both short- and long-term prognosis and predictors of sports function, activity level, and general health through validated patient-reported outcomes, 2) to identify the symptoms and signs of OA, and 3) to quantify the incidence of ACL reconstruction graft and/or contralateral ACL failures and additional surgical procedures. This manuscript summarizes the Kappa Delta Ann Doner Vaughan Award paper and presentation at the 2012 ORS/AAOS Annual Meeting. PMID:22912340

  17. The Potentially Positive Role of PRPs in Preventing Femoral Tunnel Widening in ACL Reconstruction Surgery Using Hamstrings: A Clinical Study in 51 Patients

    PubMed Central

    Starantzis, Konstantinos A.; Mastrokalos, Dimitrios; Koulalis, Dimitrios; Papakonstantinou, Olympia; Soucacos, Panayiotis N.; Papagelopoulos, Panayiotis J.

    2014-01-01

    Purpose. In this study, the early and midterm clinical and radiological results of the anterior cruciate ligament (ACL) reconstruction surgery with or without the use of platelet rich plasma (PRP) focusing on the tunnel-widening phenomenon are evaluated. Methods. This is a double blind, prospective randomized study. 51 patients have completed the assigned protocol. Recruited individuals were divided into two groups: a group with and a group without the use of PRPs. Patients were assessed on the basis of MRI scans, which were performed early postoperatively and repeated at least one-year postoperatively. The diameter was measured at the entrance, at the bottom, and at the mid distance of the femoral tunnel. Results. Our study confirmed the existence of tunnel widening as a phenomenon. The morphology of the dilated tunnels was conical in both groups. There was a statistical significant difference in the mid distance of the tunnels between the two groups. This finding may support the role of a biologic response secondary to mechanical triggers. Conclusions. The use of RPRs in ACL reconstruction surgery remains a safe option that could potentially eliminate the biologic triggers of tunnel enlargement. The role of mechanical factors, however, remains important. PMID:26464895

  18. PROPRIOCEPTION, BODY BALANCE AND FUNCTIONALITY IN INDIVIDUALS WITH ACL RECONSTRUCTION

    PubMed Central

    Furlanetto, Tássia Silveira; Peyré-Tartaruga, Leonardo Alexandre; do Pinho, Alexandre Severo; Bernardes, Emanuele da Silva; Zaro, Milton Antonio

    2016-01-01

    Objective : To evaluate and compare proprioception, body balance and knee functionality of individuals with or without unilateral anterior cruciate ligament (ACL) reconstruction. Methods : Forty individuals were divided in two groups: Experimental group, 20 individuals with ACL reconstruction at six months postoperative, and control group, 20 individuals with no history of lower limb pathologies. In the experimental group, we assessed lower limbs with reconstructed ACL and contralateral limb; in the control group the dominant and the non-dominant lower limbs were assessed. All subjects were submitted to joint position sense test to evaluate proprioception, postural control measure in single-limb, and step up and down (SUD) test for functional assessment. Results : There were no deficits in proprioception and postural control. In the SUD test, a 5% decrease in lift up force was found in reconstructed ACL lower limbs, however, a statistically not significant difference. The impact and step down force during the course of test were 30% greater in anatomic ACL than in control lower limbs. Conclusion : The individuals with ACL reconstruction at six months postoperative did not show changes in proprioception and postural control, but showed motor control changes, influencing knee functionality. Level of Evidence IV, Prognostic Studies. PMID:26981038

  19. Effects of ACL Reconstructive Surgery on Temporal Variations of Cytokine Levels in Synovial Fluid.

    PubMed

    Bigoni, Marco; Turati, Marco; Gandolla, Marta; Sacerdote, Paola; Piatti, Massimiliano; Castelnuovo, Alberto; Franchi, Silvia; Gorla, Massimo; Munegato, Daniele; Gaddi, Diego; Pedrocchi, Alessandra; Omeljaniuk, Robert J; Locatelli, Vittorio; Torsello, Antonio

    2016-01-01

    Anterior cruciate ligament (ACL) reconstruction restores knee stability but does not reduce the incidence of posttraumatic osteoarthritis induced by inflammatory cytokines. The aim of this research was to longitudinally measure IL-1β, IL-6, IL-8, IL-10, and TNF-α levels in patients subjected to ACL reconstruction using bone-patellar tendon-bone graft. Synovial fluid was collected within 24-72 hours of ACL rupture (acute), 1 month after injury immediately prior to surgery (presurgery), and 1 month thereafter (postsurgery). For comparison, a "control" group consisted of individuals presenting chronic ACL tears. Our results indicate that levels of IL-6, IL-8, and IL-10 vary significantly over time in reconstruction patients. In the acute phase, the levels of these cytokines in reconstruction patients were significantly greater than those in controls. In the presurgery phase, cytokine levels in reconstruction patients were reduced and comparable with those in controls. Finally, cytokine levels increased again with respect to control group in the postsurgery phase. The levels of IL-1β and TNF-α showed no temporal variation. Our data show that the history of an ACL injury, including trauma and reconstruction, has a significant impact on levels of IL-6, IL-8, and IL-10 in synovial fluid but does not affect levels of TNF-α and IL-1β. PMID:27313403

  20. Effects of ACL Reconstructive Surgery on Temporal Variations of Cytokine Levels in Synovial Fluid

    PubMed Central

    Bigoni, Marco; Gandolla, Marta; Sacerdote, Paola; Piatti, Massimiliano; Castelnuovo, Alberto; Franchi, Silvia; Gorla, Massimo; Munegato, Daniele; Gaddi, Diego; Pedrocchi, Alessandra; Omeljaniuk, Robert J.; Locatelli, Vittorio; Torsello, Antonio

    2016-01-01

    Anterior cruciate ligament (ACL) reconstruction restores knee stability but does not reduce the incidence of posttraumatic osteoarthritis induced by inflammatory cytokines. The aim of this research was to longitudinally measure IL-1β, IL-6, IL-8, IL-10, and TNF-α levels in patients subjected to ACL reconstruction using bone-patellar tendon-bone graft. Synovial fluid was collected within 24–72 hours of ACL rupture (acute), 1 month after injury immediately prior to surgery (presurgery), and 1 month thereafter (postsurgery). For comparison, a “control” group consisted of individuals presenting chronic ACL tears. Our results indicate that levels of IL-6, IL-8, and IL-10 vary significantly over time in reconstruction patients. In the acute phase, the levels of these cytokines in reconstruction patients were significantly greater than those in controls. In the presurgery phase, cytokine levels in reconstruction patients were reduced and comparable with those in controls. Finally, cytokine levels increased again with respect to control group in the postsurgery phase. The levels of IL-1β and TNF-α showed no temporal variation. Our data show that the history of an ACL injury, including trauma and reconstruction, has a significant impact on levels of IL-6, IL-8, and IL-10 in synovial fluid but does not affect levels of TNF-α and IL-1β. PMID:27313403

  1. Quality of Movement for Athletes Six Months Post ACL Reconstruction

    PubMed Central

    deMille, Polly; Nguyen, Joseph; Brown, Allison; Do, Huong; Selvaggio, Elizabeth; Chiaia, Theresa

    2016-01-01

    Objectives: Anterior cruciate ligament (ACL) injury prevention programs evaluate quality of movement (QM) to identify and correct high-risk movement patterns. However, return to play (RTP) decisions post-ACL reconstruction (ACLR) are often based on non-sport relatedquantitative measures such as isokinetic tests and/or time from surgery, with six months post-ACLR being a common expectation for RTP. The purpose of this study was to evaluate whether athletes are ready to RTP 6 months post ACLR using a QM assessment (QMA). Methods: A QMA including nine dynamic tasks (squat, single leg [SL] stance, step down, SL squat, jump in place, side to side jump, broad jump, hop to opposite, SL hop) progressing from double- to single-limb vertical and horizontal movements was administered to 136 athletes at five to seven months post-ACLR. Tasks were viewed from the frontal and sagittal planes by a physical therapist and performance specialist. Movements were evaluated live for risk factors associated with ACL injury (strategy, depth, control, symmetry, and alignment). The proportion of patients exhibiting risky movement patterns for each task was calculated. Fisher’s Exact test was used to determine if there were differences in movement patterns between males and females. Results: The proportion of patients demonstrating risky movement patterns for a task ranged from 48% to 100%. All 136 patients exhibited risky movement patterns for at least one task and 60% of patients displayed risky movement patterns in five or more of the nine tasks. Rates of risky movement patterns were not different between males and females for all tasks (P>0.1 for all tasks). Conclusion: Six months has been cited as a probable time for RTP post-ACLR; thus this is the expectation of the athlete. Our data show that athletes demonstrate multiple QM patterns associated with initial ACL injury, as well as 2nd injury at five to seven months post-operatively. Altered movement patterns evident in tasks as

  2. ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics.

    PubMed

    Herbort, Mirco; Lenschow, Simon; Fu, Freddie H; Petersen, Wolf; Zantop, Thore

    2010-11-01

    To evaluate the influence of tibial and femoral tunnel position in ACL reconstruction on knee kinematics, we compared ACL reconstruction with a tibial and femoral tunnel in anteromedial (AM-AM reconstruction) and in posterolateral footprint (PL-PL reconstruction) with a reconstruction technique with tibial posterolateral and femoral anteromedial tunnel placement (PL-AM reconstruction). In 9 fresh-frozen human cadaveric knees, the knee kinematics under simulated Lachman (134 N anterior tibial load) and a simulated pivot shift test (10 N/m valgus and 4 N/m internal tibial torque) were determined at 0°, 30°, 60°, and 90° of flexion. Kinematics were recorded for intact, ACL-deficient, and single-bundle ACL reconstructed knees using three different reconstruction strategies in randomized order: (1) PL-AM, (2) AM-AM and (3) PL-PL reconstructions. Under simulated Lachman test, single-bundle PL-AM reconstruction and PL-PL reconstructions both showed significantly increased anterior tibial translation (ATT) at 60° and 90° when compared to the intact knee. At all flexion angles, AM-AM reconstruction did not show any statistical significant differences in ATT compared to the intact knee. Under simulated pivot shift, PL-AM reconstruction resulted in significantly higher ATT at 0°, 30°, and 60° knee flexion and AM-AM reconstructions showed significantly higher ATT at 30° compared to the intact knee. PL-PL reconstructions did not show any significant differences to the intact knee. AM-AM reconstructions restore the intact knee kinematics more closely when compared to a PL-AM technique resembling a transtibial approach. PL-PL reconstructions showed increased ATT at higher flexion angles, however, secured the rotational stability at all flexion angles. Due to the independent tibial and femoral tunnel location, a medial portal technique may be superior to a transtibial approach. PMID:20461359

  3. USE OF SPATIOTEMPORAL GAIT PARAMETERS TO DETERMINE RETURN TO SPORTS AFTER ACL RECONSTRUCTION

    PubMed Central

    LEPORACE, GUSTAVO; METSAVAHT, LEONARDO; ZEITOUNE, GABRIEL; MARINHO, THIAGO; OLIVEIRA, TAINÁ; PEREIRA, GLAUBER RIBEIRO; OLIVEIRA, LISZT PALMEIRA DE; BATISTA, LUIZ ALBERTO

    2016-01-01

    Objective : To compare gait spatiotemporal parameters of healthy and ACL reconstructed subjects in order to classify the status of gait normality. Methods : Fourteen healthy subjects and eight patients submitted to ACL reconstruction walked along a walkway while the lower limbs movement was captured by an infrared camera system. The frames where the initial contact and toe-off took place were determined and the following dependent variables, which were compared between groups through the Mann-Whitney test (a=0.05) were calculated: percentage of time in initial double stance, percentage of time in single stance, percentage of time in terminal double stance, stride length and gait velocity. Initially, all variables were compared between groups using a Mann-Whitney test. A logistic regression was applied, including all dependent variables, to create a model that could differentiate healthy and ACL reconstructed subjects. Results : ACL reconstructed group showed no differences in any spatiotemporal parameter of gait (p > 0.05) in relation to the control group, although the angular kinematic differences of the knee remained altered, as evidenced in a study with a similar sample. Conclusion : The regression classified all subjects as healthy, including the ACL reconstructed group, suggesting the spatiotemporal variables should not be used as the sole criterion of return to sports activities at the same level as prior to injury. Level of Evidence III, Case Control Study. PMID:26981039

  4. Stress fractures of the femur after ACL reconstruction with transfemoral fixation.

    PubMed

    Arriaza, Rafael; Señaris, Jose; Couceiro, Gonzalo; Aizpurua, Jesus

    2006-11-01

    The ACL reconstruction with hamstring tendons has become increasingly popular, in part because it is assumed that the complication rate associated with the technique and their severity are lower than with patellar tendon. Two cases of stress reaction of the medial supracondylar area of the femur after ACL reconstruction with hamstring tendons using BioTransfix (Arthrex, Naples, FL, USA) devices for fixation within femur are presented. Both patients were professional athletes (one soccer and one basketball player), and it is hypothesized that the accelerated rehabilitation program used might have represented a risk factor for stress fractures when associated with the guide pin exit hole in the medial femoral cortex. To our knowledge, no such cases have been published to date, but it is important to consider this possibility if an unexplained pain arises in the rehabilitation process of an ACL reconstruction using transfemoral fixation.

  5. Extra-articular extraosseous migration of a bioabsorbable femoral interference screw after ACL reconstruction.

    PubMed

    Sharma, Vivek; Curtis, Christine; Micheli, Lyle

    2008-10-01

    Anterior cruciate ligament (ACL) reconstruction is quite commonly used to treat anterior knee instability. Surgeon preference and patient functional goals determine graft selection and graft fixation techniques. Interference screws are considered a safe and effective device for graft fixation in surgical ACL reconstruction. Poly-L-lactide acid (PLLA) bioabsorbable interference screws are becoming increasingly popular in ACL reconstruction surgery. There are several reasons why they may be more advantageous than metallic screws, including reduced graft laceration during insertion, ease of performance of revision procedures, avoidance of graft injury encountered with aperture fixation using metallic screws, and fewer artifacts on magnetic resonance images (MRI). Few studies describe complications associated with PLLA bioabsorbable screws, particularly extra-articular screw migration. This article presents a case of an extra-articular extraosseous migration of the femoral bioabsorbable interference screw. This case further demonstrates the problem of the femoral bioabsorbable interference screw.

  6. Transverse femoral implant prominence: four cases demonstrating a preventable complication for ACL reconstruction.

    PubMed

    Argintar, Evan; Scherer, Benjamin; Jordan, Tom; Klimkiewicz, John

    2010-12-01

    Anterior cruciate ligament (ACL) tear is a commonly occurring injury that often demands surgical reconstruction. Although the utility of this operation is widely accepted, many specific components, including graft fixation technique, remain controversial. Many clinicians favor transverse femoral implant fixation for soft tissue ACL grafts. This technique can be accomplished successfully; however, in a minority of the cases, the femoral implant can be excessively prominent, leading to iatrogenic postoperative iliotibial band syndrome. This article presents 4 patients that developed postoperative iliotibial band syndrome resulting from transverse femoral implant prominence. Despite achievement of knee ligamentous stability, implant prominence compromised final clinical results following ACL reconstruction. Through change in Lysholm value, we reviewed the clinical outcomes of these patients following femoral implant hardware removal for treatment of iliotibial band syndrome. On hardware removal, all patients demonstrated complete symptomatic improvement, mirroring an average Lysholm value increase of 38. We believe transverse femoral implant prominence is avoidable, and subsequent iliotibial band syndrome is a preventable postoperative complication.

  7. Knee instability scores for ACL reconstruction.

    PubMed

    Rahnemai-Azar, Ata A; Naendrup, Jan-Hendrik; Soni, Ashish; Olsen, Adam; Zlotnicki, Jason; Musahl, Volker

    2016-06-01

    Despite abundant biological, biomechanical, and clinical research, return to sport after anterior cruciate ligament (ACL) injury remains a significant challenge. Residual rotatory knee laxity has been identified as one of the factors responsible for poor functional outcome. To improve and standardize the assessment of knee instability, a variety of instability scoring systems is available. Recently, devices to objectively quantify static and dynamic clinical exams have been developed to complement traditional subjective grading systems. These devices enable an improved evaluation of knee instability and possible associated injuries. This additional information may promote the development of new treatment algorithms and allow for individualized treatment. In this review, the different subjective laxity scores as well as complementary objective measuring systems are discussed, along with an introduction of injury to an individualized treatment algorithm. PMID:26980119

  8. KNEE SYNERGISM DURING GAIT REMAIN ALTERED ONE YEAR AFTER ACL RECONSTRUCTION

    PubMed Central

    LEPORACE, GUSTAVO; METSAVAHT, LEONARDO; PEREIRA, GLAUBER RIBEIRO; OLIVEIRA, LISZT PALMEIRA DE; CRESPO, BERNARDO; BATISTA, LUIZ ALBERTO

    2016-01-01

    ABSTRACT Objective: To compare the activation of the vastus lateralis (VL) and biceps femoris (BF) muscles during gait, as well VL/BF muscular co-contraction (MCC) between healthy (CG) and anterior cruciate ligament reconstructed (ACL-R) subjects. Methods: Nineteen subjects, ten controls and nine ACL-R patients had a VL and BF electromyogram (EMG) captured to calculate the MCC ratio. A Principal Component (PC) Analysis was applied to reduce the dimensionality effect of each of the MCC, VL and BF curves for both healthy and ACL reconstructed groups. The PC scores were used to calculate the standard distance (SD). SD values were employed in order to compare each dependent variable (MCC, VL and BF) between the two groups using unpaired t-test. Results: ACL-R group presented a lower VL activation at the beginning and at the end of the gait cycle, as compared to the control group. However, no difference was found for BF or VL/BF MCC. Conclusion: The gait analysis of ACL reconstructed patients demonstrated a persistent deficit in VL activation when compared to the control group, even one year after surgery. Level of Evidence III. Case Control Study PMID:27217814

  9. Pre-operative factors predicting good outcome in terms of health-related quality of life after ACL reconstruction.

    PubMed

    Månsson, O; Kartus, J; Sernert, N

    2013-02-01

    The life situation of many patients changes after an anterior cruciate ligament (ACL) rupture and subsequent reconstruction, and this may affect their health-related quality of life in many ways. It is well known that the overall clinical results after ACL reconstruction are considered good, but pre-operative predictive factors for a good post-operative clinical outcome after ACL reconstruction have not been studied in as much detail. The purpose of this study was to identify pre-operative factors that predict a good post-operative outcome as measured by the Short Form 36 (SF-36) and Knee Osteoarthritis Outcome Score (KOOS) 3-6 years after ACL reconstruction. Seventy-three patients scheduled for ACL reconstruction were clinically examined pre-operatively. The SF-36 and KOOS questionnaires were sent by mail to these patients 3-6 years after reconstruction. Predictive factors for health-related quality of life were investigated using a stepwise regression analysis. In conclusion, pre-operative factors, such as pivot shift, knee function, and range of motion, may predict a good post-operative outcome and explain up to 25% in terms of health-related quality of life after ACL reconstruction. Furthermore, it appears that the patients' pre-injury and pre-operative Tegner activity levels are important predictors of post-operative health-related quality of life.

  10. The Effects of Balance Training on Static and Dynamic Postural Stability Indices After Acute ACL Reconstruction

    PubMed Central

    Akbari, Asghar; Ghiasi, Fateme; Mir, Mohsen; Hosseinifar, Mohammad

    2016-01-01

    Background: Proprioception and postural stability play an important role in knee movements. However, there are controversies about the overall recovery time of proprioception following knee surgery and onset of balance and neuromuscular training after ACL reconstruction. Therefore, it is necessary to evaluate the effect of balance training in early stage of knee rehabilitation after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to evaluate the effect of balance exercises on postural stability indices in subjects with anterior cruciate ligament (ACL) reconstruction. Methods: The study was a controlled randomized trial study. Twenty four patients who had ACL reconstructed (balance training group) and twenty four healthy adults without any knee injury (control group) were recruited in the study. The balance exercises group performed balance exercises for 2 weeks. Before and after the interventions, overall, anteroposterior, and mediolateral stability indices were measured with a Biodex Balance System in bilateral and unilateral stance positions with the eyes open and closed. T-tests were used for statistical analysis (p<0.05). Results: Results showed that amount of static stability indices did not change after training and there were not significant differences in static stability indices before and after balance training (p>0.05). Although amount of dynamic stability indices decreased, there were not significant differences in dynamic stability indices before and after balance training (p>0.05). Amount of dynamic stability indices were decreased in balance training group, however, there were not significant differences between groups (p>0.05). Conclusion: These results support that balance exercise could partially improved dynamic stability indices in early stage of ACL reconstruction rehabilitation. The results of this study suggest that balance exercises should be part of the rehabilitation program following ACL reconstruction. PMID

  11. Positive culture in allograft ACL-reconstruction: what to do?

    PubMed

    Díaz-de-Rada, P; Barriga, A; Barroso, J L; García-Barrecheguren, E; Alfonso, M; Valentí, J R

    2003-07-01

    The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment-other than an antibiotic protocol-would be required when facing a case of positive culture of a graft piece after its implantation.

  12. Positive culture in allograft ACL-reconstruction: what to do?

    PubMed

    Díaz-de-Rada, P; Barriga, A; Barroso, J L; García-Barrecheguren, E; Alfonso, M; Valentí, J R

    2003-07-01

    The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment-other than an antibiotic protocol-would be required when facing a case of positive culture of a graft piece after its implantation. PMID:12827226

  13. In vivo analysis of the pivot shift phenomenon during computer navigated ACL reconstruction.

    PubMed

    Lane, Clayton G; Warren, Russell F; Stanford, Fatima C; Kendoff, Daniel; Pearle, Andrew D

    2008-05-01

    ACL insufficiency can be documented clinically with the pivot shift maneuver, but the specific pathologic kinematics of the pivot shift is difficult to quantify. Navigation provides an opportunity to analyze in vivo the motions that comprise the pivot shift and the kinematic changes that are inherent after ACL reconstruction. We hypothesized that tibial rotation, anterior tibial translation (ATT), acceleration of posterior translation (APT) and the newly described angle of P, quantified during navigated pivot shift examination, correlate with clinical grading of the pivot shift phenomena. Navigation data from 12 patients who underwent navigated ACL surgery were retrospectively reviewed. A characteristic P-shaped track of motion is recorded by the navigation software during the pivot-shift examination. The "angle of P" was developed as a means characterizing this track of motion and was measured in all cases. The tibial rotation, maximum anterior tibial translation and acceleration of posterior translation during the pivot shift were also measured. The charts of these patients were reviewed to obtain information on the clinical grading of the pivot-shift before and after ACL reconstruction. Spearman correlation analysis was then used to identify significant correlations between clinical grade of the pivot shift and the angle of p measured with computer navigation. After reconstruction, the clinical grade of the pivot shift was zero in all patients. The tibial rotation, maximum ATT, APT and the angle of p also decreased. On analysis of 24 EUAs, 12 before reconstruction and 12 after, there was excellent and significant correlation between the clinical grade of pivot shift examination and the angle of P (R2 = 0.97, p < 0.001). Only good correlation was noted between the clinical pivot shift and the rotation (R2 = 0.77, p < 0.0001), maximum ATT (R2 = 0.87, p < 0.0001) and APT (R2 = 0.81, p < 0.0001). There was a stepwise increase of 6-7 mm of translation and 5-6 degrees

  14. Fifteen Year Prospective Comparison of Patellar & Hamstring Tendon Grafts for ACL Reconstruction

    PubMed Central

    Roe, Justin; Salmon, Lucy; Kok, Alison; Linklater, James; Pinczewski, Leo

    2016-01-01

    Objective: This prospective longitudinal study compares isolated endoscopic ACL reconstruction utilizing 4-strand hamstring tendon (HT) or patellar tendon (PT) autograft over a 15-year period with respect to clinical outcomes and the development of osteoarthritis. Method: 90 consecutive patients with isolated ACL rupture were reconstructed with a PT autograft and 90 patients received HT autograft, with an identical surgical technique. Patients were assessed at 2, 5, 7, 10 and 15 years. Assessment included the IKDC Knee Ligament Evaluation including radiographic evaluation, KT1000, kneeling pain, and clinical outcomes. Results: Subjects who received the PT graft had significantly worse outcomes at 15 years for the variables of radiologically detectable osteoarthritis (p=0.001), motion loss (p=0.02), single leg hop test (p=0.002), participation in strenuous activity (p=0.03), knee related decrease in activity level (p=0.002) and kneeling pain (p=0.03). There was no significant difference between the HT and PT groups in overall IKDC grade (p=0.28). ACL graft rupture occurred in 16% of HT group and 8% of the PT group (p=0.10). Contralateral ACL rupture occurred in significantly more PT patients (24%) than HT patients (12%) (p=0.03). Conclusion: Significant differences have developed at 15 years after surgery which were not seen at earlier reviews. Compared to the HT Group, the PT group had significantly worse outcomes with respect to radiological osteoarthritis, range of motion and functional tests but no significant difference in laxity was identified. There was a high incidence of ACL injury after reconstruction, to both the reconstructed and the contralateral knee.

  15. Predictors of Lateral Compartment Joint Space Difference at a Minimum of Two Years after ACL Reconstruction

    PubMed Central

    Jones, Morgan H.; Reinke, Emily; Duryea, Jeffrey; Fleming, Braden C.; Obuchowski, Nancy; Winalski, Carl S.; Spindler, Kurt P.

    2016-01-01

    Objectives: ACL reconstruction effectively restores knee stability and allows a return to athletic activities after ACL injury, but patients are still at higher risk of developing post-traumatic OA. Patient reported outcomes from the Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort of over 1500 patients undergoing ACL reconstruction showed no increase in OA symptoms (KOOS subscale) at 2 or 6 years after surgery. Therefore, identification of structural changes of OA that may precede the onset of symptoms is of critical importance for determining risk factors for the initiation and progression of post-traumatic OA in addition to measuring the effectiveness of potential disease-modifying treatments. One structural measure of OA is radiographic joint space width (JSW). We previously demonstrated that meniscus treatment and age predict narrower medial compartment JSW. Methods: 335 patients from the MOON cohort (154 males, 181 females, median age 18 years at the time of surgery) were recruited at a minimum of 2 years following surgery for on-site evaluations including bilateral metatarsophalangeal joint (MTP) radiographs to assess JSW. To minimize bias related to pre-existing knee injury or OA, subjects were 35 years or younger, were injured playing a sport, had primary ACL reconstruction without prior meniscus or articular cartilage surgery, did not undergo subsequent ACL revision, and had a surgically normal contralateral knee. Radiographic JSW was measured in the lateral compartment of both knees using a validated semiautomated method. The association of age, sex, BMI, meniscus treatment, and articular cartilage treatment with lateral compartment JSW differences (JSD) between the reconstructed and normal knees was examined using multivariable generalized linear models. The Holm-Bonferroni method was used to account for multiple comparisons. Results: The mean lateral compartment JSW was 7.73 mm and (95% CI 7.61-7.85 mm) for ACL

  16. Risk Factors and Predictors of Subsequent ACL Injury in either Knee after ACL Reconstruction: Prospective Analysis of 2488 Primary ACL Reconstructions from the MOON Cohort

    PubMed Central

    Kaeding, Christopher C.; Pedroza, Angela D.; Reinke, Emily K.; Huston, Laura J.; Spindler, Kurt P.

    2015-01-01

    Background Anterior cruciate ligament (ACL) re-injury results in worse outcomes and increases risk of post-traumatic osteoarthritis. Objectives To identify the risk factors for both ipsilateral and contralateral ACL tears after primary ACL reconstruction (ACLR). Study Design Cohort study; Level of evidence, 3. Methods Data from the Multicenter Orthopaedic Outcomes Network (MOON), a prospective longitudinal cohort, were used to identify risk factors for ACL retear. Subjects with primary ACLR, no history of contralateral knee surgery, and a minimum of 2-year follow-up data were included. Age, sex, Marx activity score, graft type, lateral meniscus tear, medial meniscus tear, sport played at index injury, and surgical facility were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear. Results A total of 2683 subjects with average age of 27 ± 11 years (1498 men; 56%) met all study inclusion/exclusion criteria. Overall there were 4.4% ipsilateral graft tears and 3.5% contralateral ACL tears. The odds of ipsilateral retear were 5.2 times greater for an allograft (p<0.01) compared with a bone-patellar tendon-bone (BTB) autograft; the odds of retear were not significantly different between BTB autograft and hamstring autograft (p=0.12). The odds of an ipsilateral ACL retear decreased by 0.09 for every yearly increase in age (p<0.01) and increased by 0.11 for every increased point on the Marx score (p< 0.01). The odds were not significantly influenced by sex, smoking status, sport played, medial or lateral meniscus tear, or consortium site (p>0.05). The odds of a contralateral ACL tear decreased by 0.04 for every yearly increase in age (p=0.04) and increased by 0.12 for every increased point on the Marx score (p<0.01); these odds were not significantly different between sex, smoking status, sport played, graft type, medial meniscal tear, and lateral meniscal tear (p>0.05). Conclusions Younger age, higher activity level, and

  17. Successful feed-forward strategies following ACL injury and reconstruction.

    PubMed

    Bryant, Adam L; Newton, Robert U; Steele, Julie

    2009-10-01

    The purpose of this study was to elucidate the most successful feed-forward strategies responsible for enhancing dynamic restraint following anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR). Ten male ACL deficient (ACLD) subjects (18-35 years) together with 27 matched males who had undergone ACLR (14 using a patella tendon graft and 13 using a combined semitendinosus and gracilis graft) and 22 matched-control subjects were recruited. After their knee functionality (0- to 100-point scale) was rated using the Cincinnati Knee Rating System, each subject performed a maximal, countermovement hop for distance on their involved limb while EMG data were collected from the vastus lateralis (VL), vastus medialis (VM), semitendinosus (ST) and biceps femoris (BF) muscles. Acceleration transients at the proximal tibia were recorded using a uniaxial accelerometer mounted at the level of the tibial tuberosity. Whilst pre-programmed muscle activation strategies and tibial acceleration transients when landing from a single-leg long hop for distance were not contingent upon ACL status, a number of significant correlations were identified between neuromuscular variables and knee functionality of ACLD and ACLR subjects. Increased hamstring preparatory activity together with a greater ability to control tibial motion during dynamic deceleration was associated with higher levels of knee functionality in the ACLD subjects. Successful feed-forward strategies following ACLR were related to graft selection; STGT subjects with superior knee function activated their quadriceps earlier and were better able to synchronise peak hamstring muscle activity closer to initial ground contact whilst more functional PT subjects demonstrated enhanced tibial control despite a lack of evidence supporting modified pre-programmed muscular activation patterns. Our conclusion was that more functional individuals used sensory feedback to build treatment-specific, feed-forward strategies to

  18. Popliteus function in ACL-deficient patients.

    PubMed

    Weresh, M J; Gabel, R H; Brand, R A; Tearse, D S

    1997-02-01

    Anterior cruciate ligament (ACL) injuries commonly result in anterolateral rotary instability and a 'pivot shift' phenomenon. Since popliteus muscle stimulation causes a pivot shift, some postulate the popliteus muscle plays a role in causing pivot shifts. To see if patients with pivot shifts exhibited excessive popliteus muscle activity, we studied fine-wire EMGs of the popliteus in 16 normal subjects and 10 ACL-deficient subjects. Subjects performed six activities (level walking and jogging, ascending walking and jogging, and descending walking and jogging). Except for minor timing differences in ascending treadmill and ascending jogging, the signals were similar for injured and uninjured limbs; similar variance ratios suggested similar pattern variability. Thus, we observed only minor popliteus EMG signal differences in this group of patients. We conclude that the popliteus muscle does not actively contribute to instability in the studied activities.

  19. Performance and return-to-sport after ACL reconstruction in NFL quarterbacks.

    PubMed

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

    2014-08-01

    Anterior cruciate ligament (ACL) rupture is a significant injury in National Football League (NFL) quarterbacks. The purpose of this study was to determine (1) return-to-sport (RTS) rate in NFL quarterbacks following ACL reconstruction, (2) performance upon RTS, and (3) the difference in RTS and performance between players who underwent ACL reconstruction and controls. Thirteen quarterbacks (14 knees) who met inclusion criteria underwent ACL reconstruction while in the NFL. Matched controls were selected from the NFL during the same time span to compare and analyze age, body mass index (BMI), position, performance, and NFL experience. Student t tests were performed for analysis of within- and between-group variables. Bonferroni correction was used in the setting of multiple comparisons. Twelve quarterbacks (13 knees; 92%) were able to RTS in the NFL. Mean player age was 27.2±2.39 years. Mean career length in the NFL following ACL reconstruction was 4.85±2.7 years. Only 1 player needed revision ACL reconstruction. In both cases and controls, player performance was not significantly different from preinjury performance after ACL reconstruction (or index year in controls). There was also no significant performance difference between case and control quarterbacks following ACL reconstruction (or index year in controls). There is a high rate of RTS in the NFL following ACL reconstruction. In-game performance following ACL reconstruction was not significantly different from preinjury or from controls.

  20. Recovery of Psychological Readiness May Differ Between Genders Following ACL Reconstruction in Adolescent Athletes

    PubMed Central

    Milewski, Matthew David; Kostyun, Regina; Iannicelli, Julie P.; Kostyun, Kyle J.; Solomito, Matthew; Nissen, Carl W.

    2016-01-01

    , higher IKDC scores (p=0.013, Ɓ =-0.09) and higher ACL-RSI scores (p = 0.002, Ɓ = -0.06) were associated with an earlier time to RTP. This association was not found in male athletes. Conclusion: Although both genders felt their knee would function well during sport at approximately six months following ACL reconstruction, male athletes seem to demonstrate an overall stronger psychological readiness to RTP. However, better scores on the ACL-RSI and IKDC were associated with an earlier RTP only in female athletes. The results of this study suggest a difference in the psychological readiness to RTP between male and female adolescent athletes approximately six months following ACL reconstruction. Further investigations are warranted to investigate the psychological hurdles that face each gender when trying to RTP following an ACL injury. A better understanding of these emotional limitations could help to clinically identify patients that may benefit from counseling.

  1. ALL‐EPIPHYSEAL ACL RECONSTRUCTION: A THREE‐YEAR FOLLOW‐UP

    PubMed Central

    Akinleye, Sheriff D.; Sewick, Amy

    2013-01-01

    Background/Introduction: With an increasing number of pre‐adolescents participating in sports, anterior cruciate ligament injuries and resultant reconstruction in the skeletally immature athlete are becoming more common. Many different surgical techniques and rehabilitation protocols have been proposed for the treatment of anterior cruciate ligament (ACL) injuries, but there is a lack of agreement as to which approach results in the best outcome. Rehabilitation protocols have marked variation regarding postoperative weight bearing, immobilization, bracing, and length. Case description: This is a case of a ten year old female who sustained bilateral ACL tears within the period of a year. The purpose of this case report is to describe the early result and subsequent rehabilitation following bilateral physeal‐sparing all‐epiphyseal ACL reconstructions on a skeletally immature patient with a three‐year follow‐up. Outcomes: The early post‐surgical recovery period on the first injured knee was complicated by knee stiffness requiring manipulation. Following this minor setback, the patient met all physical therapy goals and had no additional complications. The rehabilitation after the second surgery followed a typical course. At three‐year follow‐up, the patient had grown an additional seven inches, with radiographic evidence of symmetric physeal growth and joint stability. She has returned to playing competitive sports. Discussion and Conclusion: This innovative physeal‐sparing technique has huge implications as, historically; the feared complication of growth disturbance and angular deformity from transphyseal ACL reconstruction has complicated the management of ACL injuries in children and pre‐adolescents. This case report demonstrates the success of this technique, and the subsequent rehabilitation, as this patient did not experience a reduction in long‐term bone growth. Level of Evidence: 5 Case Report PMID:23772346

  2. Popliteus function in ACL-deficient patients.

    PubMed

    Weresh, M J; Gabel, R H; Brand, R A; Tearse, D S

    1994-01-01

    Anterior cruciate ligament (ACL) injuries commonly result in anterolateral instability, resulting in a "pivot shift" phenomenon. Given that popliteus muscle stimulation results in a pivot shift, others have postulated that the popliteus muscle has a role in the pivot shift phenomenon. We hypothesized that patients with instability from ACL injuries may have excessive popliteus muscle activity. Therefore, we studied the EMG activity (using fine wire electrodes) of the popliteus muscle in sixteen normal subjects and ten ACL-deficient subjects. We recorded the EMG in six activities (level walking and jogging, ascending walking and jogging, and descending walking and jogging). Person's Product Moment Correlations were above 0.7, except in the case of ascending the treadmill (r = 0.427) and ascending jogging (r = 0.645), suggesting that the timing of the signals was similar for injured and uninjured limbs. Variance ratios for the injured and uninjured limbs were statistically similar, suggesting similar variability of patterns. Thus, we observed only minor popliteus EMG signal differences in this group of patients. We conclude that the popliteus muscle does not contribute to instability in the studied activities.

  3. A canine hybrid double-bundle model for study of arthroscopic ACL reconstruction.

    PubMed

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

    2015-08-01

    Development and validation of a large animal model for pre-clinical studies of intra-articular anterior cruciate ligament (ACL) reconstruction that addresses current limitations is highly desirable. The objective of the present study was to investigate a translational canine model for ACL reconstruction. With institutional approval, adult research hounds underwent arthroscopic debridement of the anteromedial bundle (AMB) of the ACL, and then either received a tendon autograft for "hybrid double-bundle" ACL reconstruction (n = 12) or no graft to remain ACL/AMB-deficient (n = 6). Contralateral knees were used as non-operated controls (n = 18) and matched canine cadaveric knees were used as biomechanical controls (n = 6). Dogs were assessed using functional, diagnostic imaging, gross, biomechanical, and histologic outcome measures required for pre-clinical animal models. The data suggest that this canine model was able to overcome the major limitations of large animal models used for translational research in ACL reconstruction and closely follow clinical aspects of human ACL reconstruction. The "hybrid double-bundle" ACL reconstruction allowed for sustained knee function without the development of osteoarthritis and for significantly improved functional, diagnostic imaging, gross, biomechanical, and histologic outcomes in grafted knees compared to ACL/AMB-deficient knees.

  4. Adverse effect of femoral nerve blockade on quadriceps strength and function after ACL reconstruction.

    PubMed

    Krych, Aaron; Arutyunyan, Grigoriy; Kuzma, Scott; Levy, Bruce; Dahm, Diane; Stuart, Michael

    2015-02-01

    The purpose of this study was to determine if quadriceps strength and functional outcomes were similar at 6 months following anterior cruciate ligament [ACL] reconstruction in patients receiving a continuous 48-hour femoral nerve blockade for postoperative analgesia (FNB group) versus patients with no FNB (control group). A retrospective cohort was designed including athletes who underwent primary ACL reconstruction with patellar tendon autograft between 2005 and 2010 at our institution with identical rehabilitation protocols. The FNB group included 96 patients with an average age of 21 years and the control group included 100 patients with an average age of 20 years. At 6 months following ACL reconstruction, isokinetic strength (slow and fast activation) and functional tests including vertical jump, single hop, triple hop, and return to sport were analyzed with an α value < 0.05 as significant. Multivariate regression models were used to compare these outcomes between the FNB and control groups after adjusting for gender and competitive athlete status. At 6 months, fast extension isokinetic strength was inferior in the FNB group (78 vs. 85%; p < 0.01). After adjusting for gender and competitive athlete status, fast (p = 0.002) and slow extension strength (p = 0.01), vertical jump (p = 0.03) and single jump (p = 0.02) were also inferior in the FNB group. There were no significant differences in full return to sport between the two groups (86% at 7.5 months in the FNB group vs. 93% at 7.3 months in the control group). In this retrospective comparative study, the hypothesis that patients treated with continuous FNB for postoperative analgesia following ACL reconstruction with patellar tendon autograft will have inferior knee extension (quadriceps) strength and function at 6 months follow-up was affirmed. However, no differences were observed in return to sport, bringing into question whether these statistical differences translate into

  5. Acute Vs Delayed ACL Reconstruction. Early Differences and Preliminary Two Year Results

    PubMed Central

    Eriksson, Karl; Barenius, Björn

    2016-01-01

    Objectives: Historically acute ACL reconstruction has been avoided due to reports of early rehabilitation problems with stiffness. Are these reports still valid today with modern arthroscopic techniques? Methods: 70 patients with a high recreational activity level (Tegner ≥6) who presented with a acute ACL injury were randomized to an acute reconstruction within 8 days from the injury or delayed reconstruction after 6-10 weeks. Four surgeons performed the ACL reconstructions with quadrupled semitendinosus tendon grafts and endobutton and metallic interference screw fixation. The rehabilitation training was performed at the same physiotherapy center for all patients. The follow up at 6 and 24 months included ROM, Lachman, Rolimeter, pivot shift, one leg hop, IKDC, KOOS, Lysholm and Tegner activity level. Results: There were no differences between the groups in ROM, IKDC, activity level or laxity at 6 months. Four patients had a combined extension and flexion deficit of more than 15 degrees, two from each group. In the acute group 79% had an objective IKDC grade A or B compared with 73% in the delayed group. The one leg hop index above 90% was found in 50% in the acute group and 24% in the delayed group (p=0.04). Functional data for the 2-year follow up are not available at the time of abstract writing. The median activity level according to Tegner was restored to pre-injury levels in both groups after one year, and was stationary at 2 years. The visual analogue scale (VAS) response to the question “How is your knee working on a scale from 0-100? (100 = best)” revealed 81 in the acute and 71 in the delayed group (p=0.1). To the question “How does your knee affect your activity level on a scale from 0-100? (100 = no affection)” the mean score was 75 in the acute group and 67 in the delayed group (p=0.3). At one and two years the KOOS was statistically similar between the groups but with slightly higher subscale “Sport and recreation” scores, 85 in the

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

    NASA Astrophysics Data System (ADS)

    Nawasreh, Zakariya Hussein

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

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

    NASA Astrophysics Data System (ADS)

    Nawasreh, Zakariya Hussein

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

  8. Utilization of Modified NFL Combine Testing to Identify Functional Deficits in Athletes Following ACL Reconstruction

    PubMed Central

    MYER, GREGORY D.; SCHMITT, LAURA C.; BRENT, JENSEN L.; FORD, KEVIN R.; BARBER FOSS, KIM D.; SCHERER, BRADLEY J.; HEIDT, ROBERT S.; DIVINE, JON G.; HEWETT, TIMOTHY E.

    2012-01-01

    STUDY DESIGN Case control. OBJECTIVES To use modified NFL Combine testing methodology to test for functional deficits in athletes following anterior cruciate ligament (ACL) reconstruction following return to sport. BACKGROUND There is a need to develop objective, performance-based, on-field assessment methods designed to identify potential lower extremity performance deficits and related impairments in this population. METHODS Eighteen patients (mean ± SD age, 16.9 ± 2.1 years; height, 170.0 ± 8.7 cm; body mass, 71.9 ± 21.8 kg) who returned to their sport within a year following ACL reconstruction (95% CI: 7.8 to 11.9 months from surgery) participated (ACLR group). These individuals were asked to bring 1 or 2 teammates to serve as control participants, who were matched for sex, sport, and age (n = 20; mean ± SD age, 16.9 ± 1.1 years; height, 169.7 ± 8.4 cm; body mass, 70.1 ± 20.7 kg). Functional performance was tested using the broad jump, vertical jump, modified long shuttle, modified pro shuttle, modified agility T-test, timed hop, triple hop, single hop, and crossover hop tests. A 1-way multivariate analysis of variance (MANOVA) was used to evaluate group differences for dependent performance variables. RESULTS The functional performance measurements of skills requiring bilateral involvement of both lower extremities showed no group differences between the ACLR and control groups (P>.05). An overall group difference (P = .006) was observed for the combined limb symmetry index (LSI) measures. However, the modified double-limb performance tasks (long shuttle, modified agility T-test, and pro shuttle) were not, independently, sufficiently sensitive to detect limb deficits in individuals with ACL reconstruction. Conversely, the LSI on the distance measures of the single-limb performance tasks all provided moderate to large effect sizes to differentiate between the ACLR and control groups, as the individuals who had ACL reconstruction demonstrated involved

  9. Increased Platelet Concentration does not Improve Functional Graft Healing in Bio-Enhanced ACL Reconstruction

    PubMed Central

    Fleming, Braden C.; Proffen, Benedikt L.; Vavken, Patrick; Shalvoy, Matthew R.; Machan, Jason T.; Murray, Martha M.

    2014-01-01

    Purpose The use of an extra-cellular matrix scaffold (ECM) combined with platelets to enhance healing of an ACL graft (“bio-enhanced ACL reconstruction”) has shown promise in animal models. However, the effects of platelet concentration on graft healing remains unknown. The objectives of this study were to determine if increasing the platelet concentration in the ECM scaffold would; 1) improve the graft biomechanical properties, and 2) decrease cartilage damage after surgery. Methods Fifty-five adolescent minipigs were randomized to 5 treatment groups; untreated ACL transection (n=10), conventional ACL reconstruction (n=15), and bio-enhanced ACL reconstruction using 1X (n=10), 3X (n=10) or 5X (n=10) platelet-rich plasma. The graft biomechanical properties, anteroposterior (AP) knee laxity, graft histology and macroscopic cartilage integrity were measured at 15 weeks. Results The mean linear stiffness of the bio-enhanced ACL reconstruction procedure using the 1X preparation was significantly greater than traditional reconstruction while the 3X and 5X preparations were not. The failure loads of all the ACL reconstructed groups were equivalent but significantly greater than untreated ACL transection. There were no significant differences in the ligament maturity index or AP laxity between reconstructed knees. Macroscopic cartilage damage was relatively minor, though significantly less when the ECM-platelet composite was used. Conclusions Only the 1X platelet concentration improved healing over traditional ACL reconstruction. Increasing the platelet concentration from 1X to 5X in the ECM scaffold did not further improve the graft mechanical properties. The use of an ECM-platelet composite decreased the amount of cartilage damage seen after ACL surgery. PMID:24633008

  10. Operative and nonoperative treatment options for ACL tears in the adult patient: a conceptual review.

    PubMed

    Bogunovic, Ljiljana; Matava, Matthew J

    2013-11-01

    Injury to the anterior cruciate ligament (ACL) is common among athletic individuals. Both nonoperative and operative treatment options exist. The optimal treatment of an adult with an ACL tear depends on several patient-specific factors, including age, occupation, and desired activity level. In less active patients with sedentary jobs, nonoperative management, consisting of physical therapy, bracing, and activity modification can yield successful results. In active patients who want to resume participation in jumping, cutting, or pivoting sports, patients who have physically demanding occupations, or patients who fail a trial of nonoperative management, ACL reconstruction is recommended. Reconstruction utilizing autograft tissue is preferred over allograft, especially in the younger athlete, but allograft tissue is a reasonable option in the older (aged > 40 years) and less active adult, as well. Successful results have been achieved with both patellar tendon and hamstring grafts. The optimal treatment in adult patients with ACL tears should be based on careful consideration of the patient's goals for return to activity, knee-specific comorbidities, such as coexistent meniscal pathology or osteoarthritis, and his or her willingness to follow a detailed rehabilitation regimen. Our article provides an overview of current nonoperative and operative treatment options for adults with ACL tears, considers the outcomes of both nonoperative and operative strategies, and provides general recommendations as to the ideal management for a given patient. PMID:24231595

  11. Knee Hyperextension as a Predictor of Failure in Revision ACL Reconstruction

    PubMed Central

    Cooper, Daniel E.; Dunn, Warren R.; Wright, Rick W.; Haas, Amanda; Huston, Laura J.

    2016-01-01

    Objectives: We studied the minimum 2 year follow-up outcomes in an ACL revision cohort. The hypothesis is that knees that hyperextend will have a worse outcome and greater odds of graft failure than knees that do not hyperextend. The null hypothesis is that there is no difference in outcomes or graft rupture between the two groups. 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. A regression model using graft failure as the dependent variable included graft type, age, and hyperextension greater than or equal to 5 degrees yes/no (HE) in order to assess these potential surgical risk factors for clinical outcomes 2 years after revision ACL reconstruction. Results: There were 1,145 subjects included in the analyses. The median age of the cohort was 26 (IQR= 20, 35), and 58% were male. The proportion that were enrolled for their first revision surgery was 88%, their second 10%, and third or greater 2%. The number of subjects categorized as HE was 375 (33%). The median age of subjects that failed was 18, compared to 26 for those with intact grafts. All three variables included in our regression model were significant predictors of graft failure: younger age, inter-quartile range odds ratio (IQROR) = 3.32 (95%CI 1.5, 7.2) p= 0.002; use of allograft OR = 3.1 (95%CI 1.4, 6.9) p= 0.01, and HE 2.1 (95%CI 1.02, 4.42) p= 0.04. Conclusion: The MARS Study Group has previously reported that young age and the use of allograft as a graft source are independent predictors (over 3X odds ratio) of graft rupture after revision ACLR. This study found that knee hyperextension greater than or equal to 5 degrees is present in 1/3 of

  12. Differences in Mechanisms of Failure, Intraoperative Findings, and Surgical Characteristics Between Single- and Multiple-Revision ACL Reconstructions

    PubMed Central

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

    2013-01-01

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

  13. Meniscus treatment and age associated with narrower radiographic joint space width 2 – 3 years after ACL reconstruction: Data from the MOON onsite cohort

    PubMed Central

    Jones, Morgan H.; Spindler, Kurt P.; Fleming, Braden C.; Duryea, Jeffrey; Obuchowski, Nancy A.; Scaramuzza, Erica A.; Oksendahl, Heidi L.; Winalski, Carl S.; Duong, Carol L.; Huston, Laura J.; Parker, Richard D.; Kaeding, Christopher C.; Andrish, Jack T.; Flanigan, David C.; Dunn, Warren R.; Reinke, Emily K.

    2015-01-01

    Objective To identify risk factors for radiographic signs of post-traumatic OA 2–3 years after ACL reconstruction through multivariable analysis of minimum joint space width (mJSW) differences in a specially designed nested cohort. Methods A nested cohort within the Multicenter Orthopaedic Outcomes Network cohort included 262 patients (148 females, average age 20) injured in sport who underwent ACL reconstruction in a previously uninjured knee, were 35 or younger, and did not have ACL revision or contralateral knee surgery. mJSW on semi-flexed radiographs was measured in the medial compartment using a validated computerized method. A multivariable generalized linear model was constructed to assess mJSW difference between the ACL reconstructed and contralateral control knees while adjusting for potential confounding factors. Results Unexpectedly, we found the mean mJSW was 0.35 mm wider in ACL reconstructed than in control knees (5.06 mm (95% CI 4.96 – 5.15 mm) versus 4.71 mm (95% CI 4.62 – 4.80 mm), p<0.001). However, ACL reconstructed knees with meniscectomy had narrower mJSW compared to contralateral normal knees by 0.64 mm (95% C.I. 0.38 – 0.90 mm) (p<0.001). Age (p<0.001) and meniscus repair (p=0.001) were also significantly associated with mJSW difference. Conclusion Semi-flexed radiographs can detect differences in mJSW between ACL reconstructed and contralateral normal knees 2–3 years following ACL reconstruction, and the unexpected wider mJSW in ACL reconstructed knees may represent the earliest manifestation of post-traumatic osteoarthritis and warrants further study. PMID:25559582

  14. Bone tunnel enlargement after ACL reconstruction using autologous hamstring tendons: a CT study

    PubMed Central

    Iorio, Raffaele; Vadalà, Antonio; Argento, Giuseppe; Di Sanzo, Vincenzo

    2006-01-01

    Purpose: To evaluate prospectively the increase in the size of the tibial and femoral bone tunnel following arthroscopic anterior cruciate ligament (ACL) reconstruction with quadrupled-hamstring autograft. Methods: Twenty-five consecutive patients underwent arthroscopic ACL reconstruction with quadrupled-hamstring autograft. Preoperative clinical evaluation was performed using the Lysholm knee score, Tegner activity level, and International Knee Documentation Committee forms and a KT-1000 arthrometer (side to side). Computed tomography (CT) of the femoral and tibial tunnel was performed on the day after operation in all cases and at mean follow-up of 10 months (range 9–11 months).Results: All of the clinical evaluation scales performed showed an overall improvement. The postoperative anterior laxity difference was <3 mm in 16 patients (70%) and 3–5 mm in seven patients (30%). The mean average femoral tunnel diameter increased significantly (3%) from 9.04±0.05 mm postoperatively to 9.3±0.8 mm at 10 months; tibial tunnel increased significantly (11%) from 9.03±0.04 mm to 10±0.8 mm. There were no statistically significant differences between tunnel enlargement, clinical results, and arthrometer evaluation. Conclusions: The rate of tunnel widening observed in this study seems to be lower than that reported in previous studies that used different techniques. We conclude that an anatomical surgical technique and a less aggressive rehabilitation process influenced the amount of tunnel enlargement after ACL reconstruction with doubled hamstrings. PMID:16683112

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

    PubMed Central

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

    2016-01-01

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

  16. Magnetic Resonance Imaging of Cartilage Contact and Bound Water in ACL-Deficient and ACL Reconstructed Knees

    PubMed Central

    Baer, Geoffrey Scott; Kaiser, Jarred; Vignos, Michael; Liu, Fang; Smith, Colin Robert; Kijowski, Richard; Thelen, Darryl

    2016-01-01

    Objectives: Osteoarthritis (OA) is common following ACL-reconstructive (ACLR) surgery (6). The cause of early OA is not understood, but theories have focused on osteochondral damage at the time of injury (2) and abnormal joint mechanics following surgical repair (7). In this study, we investigate the inter-relationship of cartilage mechanics and biomarkers of OA in both ACL-deficient (ACLD) and ACLR knees. Our approach employs a novel dynamic MR sequence to measure joint mechanics (3) and the recently developed mcDESPOT to assess regional variations in water bound to proteoglycan (PG) (5). We hypothesize that bound water will be diminished in the cartilage of ACLD knees and, after surgery, will continue to adapt in a manner that reflects altered cartilage loading. This abstract presents initial observations on a cross-section of healthy, ACLD and ACLR knees. Methods: The dominant knees of 8 healthy controls, ACLD knees of 5 patients and ACLR knees of 8 patients were imaged in a 3 T MRI scanner (Table). Controls had no history of pain, injury, or surgery to their knee. Patients had no additional ligament injury and no meniscal damage. ACLD subjects were imaged prior to reconstructive surgery. Femoral and tibial cartilage were segmented from MR images and cartilage thickness was calculated. The mcDESPOT sequence provided a fraction map of water bound to PG (Fpg). Subjects flexed their knee against an inertial load at 0.5 Hz, while a SPGR-VIPR sequence continuously acquired volumetric data. Kinematics were obtained using model tracking of the dynamic images (3). Cartilage was registered to the bone segments for all frames, and contact patterns were characterized by the proximity between surfaces. Spatial representations of tibial cartilage contact, thickness and Fpg were co-registered for each subject. Results: Our initial images suggest lower Fpg values in ACLD knees, primarily on the posterior-lateral tibia. This is also observed in ACLR knees, with additional

  17. Treatment of persistent extraarticular infection using a temporary cement spacer on the tibia after ACL reconstruction.

    PubMed

    Jung, Kwang Am; Lee, Soo Chan; Song, Moon Bok; Lee, Choon Key

    2008-01-01

    Postoperative infection after anterior cruciate ligament (ACL) reconstruction is an uncommon but serious complication. Although several treatments for intraarticular infection have been reported, no report has been recorded on the treatment of persistent extraarticular infections. The authors experienced reconstructed graft removal due to a refractory extraarticular infection on tibia. Early ACL reimplantation was performed using a temporary cement spacer containing antibiotics and a irradiated bone patellar tendon bone allograft.

  18. Treatment of persistent extraarticular infection using a temporary cement spacer on the tibia after ACL reconstruction.

    PubMed

    Jung, Kwang Am; Lee, Soo Chan; Song, Moon Bok; Lee, Choon Key

    2008-01-01

    Postoperative infection after anterior cruciate ligament (ACL) reconstruction is an uncommon but serious complication. Although several treatments for intraarticular infection have been reported, no report has been recorded on the treatment of persistent extraarticular infections. The authors experienced reconstructed graft removal due to a refractory extraarticular infection on tibia. Early ACL reimplantation was performed using a temporary cement spacer containing antibiotics and a irradiated bone patellar tendon bone allograft. PMID:17899003

  19. Patients With Isolated PCL Injuries Improve From Surgery as Much as Patients With ACL Injuries After 2 Years

    PubMed Central

    Owesen, Christian; Sivertsen, Einar Andreas; Engebretsen, Lars; Granan, Lars-Petter; Årøen, Asbjørn

    2015-01-01

    Background: Reports on outcome after posterior cruciate ligament (PCL) reconstruction often contain both isolated PCL and combined knee ligament injuries. This makes it difficult to conclude on the outcome after reconstruction of isolated PCL injuries. Purpose: To investigate the outcome after PCL reconstruction in patients with an isolated PCL injury and to compare this with the outcome of patients treated with reconstruction after isolated anterior cruciate ligament (ACL) injuries. Study Design: Cohort study; Level of evidence, 3. Methods: Seventy-one patients with an isolated PCL injury that was reconstructed surgically and who had registered in the Norwegian Knee Ligament Registry between 2004 and 2010 were included in this study. Patients with isolated ACL reconstructions (n = 9661) who had registered in the same period were included for comparison. Knee Injury and Osteoarthritis Outcome Score (KOOS) was used as the patient-reported outcome measure. Preoperative and 2-year postoperative KOOS scores were compared. Changes in KOOS score reported by the PCL patients were compared with changes reported by the ACL patients. Results: At the 2-year postoperative follow-up of the PCL-reconstructed patients, the patient-reported outcome was improved, measured by KOOS as follows: pain, 15.1 (95% CI, 8.5-21.8; P < .001); symptoms, 0.9 (95% CI, –6.6 to 8.3; P = .82); activities of daily living, 13.2 (95% CI, 6.6-13.9; P < .001); sports, 20.7 (95% CI, 11.8-29.4; P < .001); and quality of life, 26.6 (95% CI, 18.9-34.2; P < .001). According to the KOOS, the incremental improvements were similar for PCL and ACL patients. Time from injury to surgery was longer for the PCL patients compared with ACL patients (median, 21.5 vs 8.0 months; P < .001). Conclusion: Patients undergoing PCL reconstruction can expect the same improvements in KOOS score as patients undergoing ACL reconstruction. However, PCL patients start out with an inferior score on average and consequently end up

  20. Return to sport after ACL reconstruction: how, when and why? A narrative review of current evidence.

    PubMed

    Zaffagnini, Stefano; Grassi, Alberto; Serra, Margherita; Marcacci, Maurilio

    2015-01-01

    Allowing a patient to return to sport and unrestricted physical activity after ACL injury and reconstruction is one of the most challenging and difficult decisions an orthopaedic surgeon has to make. Indeed, many factors have to be taken into account before it can be considered safe for a patients to load a reconstructed knee. The current literature contains plenty of studies aimed at evaluating return to sport, and the factors that may affect or predict this outcome, e.g. intrinsic factors like genetics, biology, type of lesion, anatomical features, motivation and psychology, and extrinsic factors such as graft type, surgical technique, rehabilitation protocols, and biological support. It is possible that awareness of these issues could help the clinician to optimise outcomes, and possibly avoid failures too, although as yet no universal criteria for resuming sport have been produced. PMID:26151036

  1. Return to sport after ACL reconstruction: how, when and why? A narrative review of current evidence

    PubMed Central

    ZAFFAGNINI, STEFANO; GRASSI, ALBERTO; SERRA, MARGHERITA; MARCACCI, MAURILIO

    2015-01-01

    Allowing a patient to return to sport and unrestricted physical activity after ACL injury and reconstruction is one of the most challenging and difficult decisions an orthopaedic surgeon has to make. Indeed, many factors have to be taken into account before it can be considered safe for a patients to load a reconstructed knee. The current literature contains plenty of studies aimed at evaluating return to sport, and the factors that may affect or predict this outcome, e.g. intrinsic factors like genetics, biology, type of lesion, anatomical features, motivation and psychology, and extrinsic factors such as graft type, surgical technique, rehabilitation protocols, and biological support. It is possible that awareness of these issues could help the clinician to optimise outcomes, and possibly avoid failures too, although as yet no universal criteria for resuming sport have been produced. PMID:26151036

  2. Persons with reconstructed ACL exhibit altered knee mechanics during high-speed maneuvers.

    PubMed

    Lee, S-P; Chow, J W; Tillman, M D

    2014-06-01

    Anterior cruciate ligament (ACL) injury is a sports trauma that causes long-term disability. The function of the knee during dynamic activities can be severely limited even after successful surgical reconstruction. This study examined the effects of approach velocity during side-step cutting on knee joint mechanics in persons with reconstructed ACL (ACLR). 22 participants (11 with unilateral ACLR, 11 matched-controls) participated. Knee joint mechanics were tested in 3 approach conditions: counter-movement, one-step, and running. Dependent variables, including peak knee flexion, extension, valgus, varus, internal rotation, external rotation angles and corresponding peak joint moments, were assessed during the stance phase of cutting. Two 2×3 ("group" by "approach condition") mixed MANOVA tests were used to examine the effects of ACLR and approach velocity on knee mechanics. ACLR participants exhibited higher knee internal rotator moment (0.22 vs. 0.13 Nm/kg, p=0.003). Inter-group comparisons revealed that the ACLR participants exhibited significantly higher abductor and internal rotator moments only in the running condition (1.86 vs. 1.16 Nm/kg, p=0.018; 0.28 vs. 0.17 Nm/kg, p=0.010, respectively). Our findings suggested that patients with ACLR may be at increased risk of re-injury when participating in high-demand physical activities. Task demand should be considered when prescribing progressive therapeutic interventions to ACLR patients.

  3. Quadriceps function relates to muscle size following ACL reconstruction.

    PubMed

    Kuenze, Christopher M; Blemker, Silvia S; Hart, Joseph M

    2016-09-01

    It remains unclear what role reduced volume and cross-section area (CSA) of individual quadriceps muscles may play in persistent quadriceps weakness and more global dysfunction following ACL reconstruction (ACLR). The purpose of this investigation was to establish the relationship between cross-sectional area of the quadriceps muscle group and measures of knee related and quadriceps function following ACLR. Thirty participants with a history of primary, unilateral ACLR experiencing persistent quadriceps activation failure participated in this cohort study. Clinical factors including International Knee Documentation Committee (IKDC) score, normalized knee extension MVIC torque (Nm/kg) and quadriceps central activation ratio (CAR, %) were assessed in addition to CSA. Quadriceps CSA was measured via magnetic resonance imaging (MRI; Siemens Avanto 1.5T). Quadriceps CSA (cm(2) ) and quadriceps volume (cm(3) ) as well as individual muscle estimates were identified within a 10 cm mid-thigh capture area. Pearson's product-moment correlation coefficients (r) established relationships between CSA and all other variables. Stepwise linear regression established which CSA factors were able to successfully predict clinical factors. Knee extension MVIC torque was strongly correlated with Vastus Intermedius (VI; r =  0.857, p < 0.001) CSA as well as partial VI (r = 0.849, p < 0.001) and quadriceps (r = 0.830, p < 0.001) volume. Partial VI (r = 0.365, p = 0.047) volume was weakly correlated with IKDC score. Knee extension MVIC torque was strongly predicted using VI CSA alone (R(2)  = 0.725) or in combination with Vastus Medialis CSA (VM; R(2)  = 0.756). Statement of Clinical Significance: Atrophy of the VI and VM muscles negatively impacts knee extension strength following ACLR. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1656-1662, 2016.

  4. Comparison of the postural control between football players following ACL reconstruction and healthy subjects

    PubMed Central

    Pahnabi, Gholamreza; Akbari, Mohammad; Ansari, Noureddin Nakhostin; Mardani, Mahmoud; Ahmadi, Mehdi; Rostami, Mohamad

    2014-01-01

    Background: Rupture of the Anterior Cruciate Ligment (ACL) is a common knee injury. The purpose of this study was to determine the balance control in football players with and without ACL reconstruction in posture of injury. Methods: Sway of the center of gravity of 15 patients with ACL reconstruction was compared with 15 healthy, age and sex-matched subjects as the control group. All tests were done unilaterally in the posture of injury, using a kistler force plate with the open and -closed eye conditions. Results: The knee of the operated side of the case group showed more displacement of the center of gravity when compared to the non-operated side in the same subject for all variables of the force plate. The operated side of the case group showed more displacement of the center of gravity for all variables of the force plate in comparison with the dominant side of knees in control group. There were significant differences between the non-operated side in the case group and the dominant side of the control group. Conclusion: All together, postural control in the operated side of the case group was weaker than the nonoperated side of the same group and the dominant limb of the control group, which might have resulted from poor proprioception. The postural control was even weaker in the non-operated side of the case group as compared with the dominant limb of the control group, which can justify the hypo mobility of limb for several months after the surgery. PMID:25664302

  5. Validation of GAITRite and PROMIS as High-Throughput Physical Function Outcome Measures Following ACL Reconstruction

    PubMed Central

    Papuga, M. Owen; Beck, Christopher A.; Kates, Stephen L.; Schwarz, Edward M.; Maloney, Michael D.

    2014-01-01

    New healthcare demands for quality measures of elective procedures, such as anterior cruciate ligament (ACL) reconstructive surgery, warrant the establishment of high through-put outcomes for high volume clinics. To this end we evaluated the PROMIS and GAITRite as physical function outcome measures to quantify early healing and post-operative complications in 106 patients at pre-op and 3, 10, 20 and 52 weeks post-ACL reconstruction with bone-tendon-bone autograft, and compared the results to the current IKDC validated outcome measure. The results showed that both PROMIS and GAITRite were significantly quicker to administer versus IKDC (p < 0.0001). Additional advantages were that PROMIS and GAITRite detected a significant decrease in physical function at 3 weeks post-op, and a significant improvement at 10 weeks post-op, versus pre-op (p<0.001), which were not detected with IKDC. GAITRite was limited by a low ceiling that could not detect improvement of physical function beyond 20 weeks, while both PROMIS and IKDC detected significant improvement out to 52 weeks postop (p<0.001). Linear regressions demonstrated a significant relationship between IKDC and PROMIS, with a combined correlation value of 0.8954 (p<.001) for all time points. Finally, ROC curve analysis demonstrated that PROMIS is a diagnostic test for poor outcomes. PMID:24532421

  6. Avoiding Complications and Technical Variability During Arthroscopically Assisted Transtibial ACL Reconstructions by Using a C-Arm With Image Intensifier

    PubMed Central

    Trentacosta, Natasha; Fillar, Allison Liefeld; Liefeld, Cynthia Pierce; Hossack, Michael D.; Levy, I. Martin

    2014-01-01

    Background: Surgical reconstruction of the anterior cruciate ligament (ACL) can be complicated by incorrect and variable tunnel placement, graft tunnel mismatch, cortical breaches, and inadequate fixation due to screw divergence. This is the first report describing the use of a C-arm with image intensifier employed for the sole purpose of eliminating those complications during transtibial ACL reconstruction. Purpose: To determine if the use of a C-arm with image intensifier during arthroscopically assisted transtibial ACL reconstruction (IIAA-TACLR) eliminated common complications associated with bone–patellar tendon–bone ACL reconstruction, including screw divergence, cortical breaches, graft-tunnel mismatch, and improper positioning of the femoral and tibial tunnels. Study Design: Case series; Level of evidence, 4. Methods: A total of 110 consecutive patients (112 reconstructed knees) underwent identical IIAA-TACLR using a bone–patellar tendon–bone autograft performed by a single surgeon. Intra- and postoperative radiographic images and operative reports were evaluated for each patient looking for evidence of cortical breeching and screw divergence. Precision of femoral tunnel placement was evaluated using a sector map modified from Bernard et al. Graft recession distance and tibial α angles were recorded. Results: There were no femoral or tibial cortical breaches noted intraoperatively or on postoperative images. There were no instances of loss of fixation screw major thread engagement. There were no instances of graft-tunnel mismatch. The positions of the femoral tunnels were accurate and precise, falling into the desired sector of our location map (sector 1). Tibial α angles and graft recession distances varied widely. Conclusion: The use of the C-arm with image intensifier enabled accurate and precise tunnel placement and completely eliminated cortical breach, graft-tunnel mismatch, and screw divergence during IIAA-TACLR by allowing incremental

  7. The location-specific healing response of damaged articular cartilage after ACL reconstruction: short-term follow-up.

    PubMed

    Nakamura, Norimasa; Horibe, Shuji; Toritsuka, Yukiyoshi; Mitsuoka, Tomoki; Natsu-ume, Takashi; Yoneda, Kenji; Hamada, Masayuki; Tanaka, Yoshinari; Boorman, Richard S; Yoshikawa, Hideki; Shino, Konsei

    2008-09-01

    Although many different interventions have been proposed for treating cartilage lesions at the time of ACL reconstruction, the normal healing response of these injuries has not been well documented. To address this point, we compared the arthroscopic status of chondral lesions at the time of ACL reconstruction with that obtained at second-look arthroscopy. We hypothesized that there might be a location-specific difference in the healing response of damaged articular cartilage. Between September 1998 and March 2000, 383 patients underwent arthroscopically-assisted hamstring ACL reconstruction without any intervention to the articular cartilage. Among these patients, 84 patients underwent second-look arthroscopy (ranging from 6 to 52 months following initial surgery) and make up the population of the present study. Chondral injuries, left untreated at ACL reconstruction, were arthroscopically evaluated using the Outerbridge classification, and were again evaluated at second-look arthroscopy. At second-look arthroscopy, there was significant recovery of chondral lesions by Outerbridge grading on both the medial and lateral femoral condyles. Among the recovered chondral lesions, 69% of cases of the medial femoral condyle, 88% of cases of the lateral femoral condyle were partial thickness injuries (grade I and II). Conversely, there was no significant recovery of chondral lesions observed at the patello-femoral joint or tibial plateaus. Our study revealed that there was a location-specific difference in the natural healing response of chondral injury. Untreated cartilage lesions on the femoral condlyes had a superior healing response compared to those on the tibial plateaus, and in the patello-femoral joint.

  8. Nonoperative management of a partial patellar tendon rupture after bone-patellar tendon-bone graft harvest for ACL reconstruction.

    PubMed

    Benner, Rodney W; Shelbourne, K Donald; Freeman, Heather

    2013-12-01

    This is a case report of a young athlete who sustained a partial tear of the patellar tendon after anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone (BPTB) autograft. The injury, diagnostic workup, and decision-making process that lead to the choice of nonsurgical treatment are described. Furthermore, the rehabilitation process is described in detail. The patient returned to his previous level of sports activity and had a good clinical outcome as measured by range of motion, isokinetic quadriceps muscle strength testing, single leg hop testing, and the modified Noyes survey. In the absence of extensor mechanism incompetence or radiographic evidence of significant patella alta, partial ruptures of the patella tendon after ACL reconstruction using a BPTB autograft may be treated nonoperatively.

  9. Anatomic ACL reconstruction: rectangular tunnel/bone-patellar tendon-bone or triple-bundle/semitendinosus tendon grafting.

    PubMed

    Shino, Konsei; Mae, Tatsuo; Tachibana, Yuta

    2015-05-01

    Anatomic ACL reconstruction is the reasonable approach to restore stability without loss of motion after ACL tear. To mimic the normal ACL like a ribbon, our preferred procedures is the anatomic rectangular tunnel (ART) technique with a bone-patellar tendon-bone (BTB) graft or the anatomic triple bundle (ATB) procedure with a hamstring (HS) tendon graft. It is important to create tunnel apertures inside the attachment areas to lessen the tunnel widening. To identify the crescent-shaped ACL femoral attachment area, the upper cartilage margin, the posterior cartilage margin and the resident's ridge are used as landmarks. To delineate the C-shaped tibial insertion, medial intercondylar ridge, Parson's knob and anterior horn of the lateral meniscus are helpful. In ART-BTB procedure which is suitable for male patients engaged in contact sports, the parallelepiped tunnels with rectangular apertures are made within the femoral and tibial attachment areas. In ATB-HS technique which is mainly applied to female athletes engaged in non-contact sports including skiing or basketball, 2 femoral and 3 tibial round tunnels are created inside the attachment areas. These techniques make it possible for the grafts to run as the native ACL without impingement to the notch or PCL. After femoral fixation with an interference screw or cortical fixation devices including Endobutton, the graft is pretensioned in situ by repetitive manual pulls at 15-20° of flexion, monitoring the graft tension with tensioners on a tensioning boot installed on the calf. Tibial fixation with pullout sutures is achieved using Double Spike Plate and a screw at the pre-determined amount of tension of 10-20N. While better outcomes with less failure rate are being obtained compared to those in the past, higher graft tear rate remains a problem. Improved preventive training may be required to avoid secondary ACL injuries.

  10. Anatomic ACL reconstruction: rectangular tunnel/bone-patellar tendon-bone or triple-bundle/semitendinosus tendon grafting.

    PubMed

    Shino, Konsei; Mae, Tatsuo; Tachibana, Yuta

    2015-05-01

    Anatomic ACL reconstruction is the reasonable approach to restore stability without loss of motion after ACL tear. To mimic the normal ACL like a ribbon, our preferred procedures is the anatomic rectangular tunnel (ART) technique with a bone-patellar tendon-bone (BTB) graft or the anatomic triple bundle (ATB) procedure with a hamstring (HS) tendon graft. It is important to create tunnel apertures inside the attachment areas to lessen the tunnel widening. To identify the crescent-shaped ACL femoral attachment area, the upper cartilage margin, the posterior cartilage margin and the resident's ridge are used as landmarks. To delineate the C-shaped tibial insertion, medial intercondylar ridge, Parson's knob and anterior horn of the lateral meniscus are helpful. In ART-BTB procedure which is suitable for male patients engaged in contact sports, the parallelepiped tunnels with rectangular apertures are made within the femoral and tibial attachment areas. In ATB-HS technique which is mainly applied to female athletes engaged in non-contact sports including skiing or basketball, 2 femoral and 3 tibial round tunnels are created inside the attachment areas. These techniques make it possible for the grafts to run as the native ACL without impingement to the notch or PCL. After femoral fixation with an interference screw or cortical fixation devices including Endobutton, the graft is pretensioned in situ by repetitive manual pulls at 15-20° of flexion, monitoring the graft tension with tensioners on a tensioning boot installed on the calf. Tibial fixation with pullout sutures is achieved using Double Spike Plate and a screw at the pre-determined amount of tension of 10-20N. While better outcomes with less failure rate are being obtained compared to those in the past, higher graft tear rate remains a problem. Improved preventive training may be required to avoid secondary ACL injuries. PMID:25753837

  11. Single-Bundle Anterior Cruciate Ligament Reconstruction with Semitendinosus Tendon Using the PINN-ACL CrossPin System: Minimum 4-Year Follow-up

    PubMed Central

    Baek, Seung-Gil; Lee, Byoung-Joo; Lee, Chang-Hwa

    2015-01-01

    Purpose This study evaluated mid-term results of anterior cruciate ligament (ACL) reconstruction using the PINN-ACL CrossPin system that allowed for short graft fixation. Materials and Methods Forty-three patients underwent single-bundle ACL reconstruction with a 4-strand semitendinosus tendon graft using the PINN-ACL CrossPin system. Femoral fixation was done using the PINN-ACL CrossPin system, and the tibial side was fixed with post-tie and a bioabsorbable interference screw. The mean follow-up period was 50 months. Evaluation was done using the Lachman test, pivot-shift test, International Knee Documentation Committee (IKDC) score and grade. Anterior displacement was assessed. Results There was improvement in the Lachman test and pivot-shift test at final follow-up, form grade II (n=40) or III (n=3) to grade I (n=3) or 0 (n=40) and from grade I (n=20) or II (n=10) to grade I (n=8) or 0 (n=22), respectively. The mean IKDC score was 88.7, and grade A and B were 93.0% at final follow-up. Side-to-side difference was improved from 6.7 mm to 2.1 mm at final follow-up. Complications occurred in 3 patients, a re-ruptured due to trauma at 2 years after surgery and a deep infection and a superficial infection. Conclusions The mid-term follow-up results of ACL reconstruction with the PINN-ACL CrossPin system were satisfactory. The PINN-ACL CrossPin can be considered as a useful instrument for short graft fixation. PMID:25750893

  12. Perturbation training prior to ACL reconstruction improves gait asymmetries in non-copers.

    PubMed

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

    2009-06-01

    We investigated whether preoperative perturbation training would help anterior cruciate ligament (ACL) deficient individuals who complain of knee instability ("non-copers") regain quadriceps strength and walk normally after ACL reconstruction. Nineteen non-copers with acute ACL injury were randomly assigned into a perturbation group (PERT) or a strengthening group (STR). The PERT group received specialized neuromuscular training and progressive quadriceps strength training, whereas the STR group received progressive quadriceps strength training only. We compared quadriceps strength indexes and knee excursions during the mid-stance phase of gait preoperatively to data collected 6 months after ACL reconstruction. Analyses of Variance with repeated measures (time/limb) were conducted to compare quadriceps strength index values over time (time x group) and differences in knee excursions in limbs between groups over time (limb x time x group). If significance was found, post hoc analyses were performed using paired and independent t-tests. Quadriceps strength indexes before intervention (Pert: 87.2%; Str: 75.8%) improved 6 months after ACL reconstruction in both groups (Pert: 97.1%; Str: 94.4%). Non-copers who received perturbation training preoperatively had no differences in knee excursions between their limbs 6 months after ACL reconstruction (p = 0.14), whereas those who received just strength training continued to have smaller knee excursions during the mid-stance phase of gait (p = 0.007). Non-copers strength and knee excursions were more symmetrical 6 months postoperatively in the group that received perturbation training and progressive quadriceps strength training than the group who received strength training alone.

  13. Predictive mathematical modeling of knee static laxity after ACL reconstruction: in vivo analysis.

    PubMed

    Signorelli, C; Bonanzinga, T; Grassi, A; Lopomo, N; Zaffagnini, S; Marcacci, M

    2016-11-01

    Previous studies did not take into consideration such large variety of surgery variables which describe the performed anterior cruciate ligament (ACL) reconstruction and the interaction among them in the definition of postoperative outcome. Seventeen patients who underwent navigated Single Bundle plus Lateral Plasty ACL reconstruction were enrolled in the study. Static laxity was evaluated as the value of anterior/posterior displacement at 30° and at 90° of flexion, internal/external rotation at 30° and 90° of knee flexion, varus/valgus test at 0° and 30° of flexion. The evaluated surgical variables were analyzed through a multivariate analysis defining the following models: AP30estimate, AP90estimate, IE30estimate, IE90estimate, VV0estimate, VV30estimate. Surgical variables has been defined as the angles between the tibial tunnel and the three planes, the lengths of the tunnel and the relationship between native footprints and tunnels. An analogous characterization was performed for the femoral side. Performance and significance of the defined models have been quantified by the correlation ratio (η(2)) and the corresponding p-value (*p < 0.050). The analyzed models resulted to be statistically significant (p < 0.05) for prediction of postoperative static laxity values. The only exception was the AP90estimate model. The η(2) ranged from 0.568 (IE90estimate) to 0.995 (IE30estimate). The orientation of the tibial tunnel resulted to be the most important surgical variable for the performed laxity estimation. Mathematical models for postoperative knee laxity is a useful tool to evaluate the effects of different surgical variables on the postoperative outcome.

  14. Predictive mathematical modeling of knee static laxity after ACL reconstruction: in vivo analysis.

    PubMed

    Signorelli, C; Bonanzinga, T; Grassi, A; Lopomo, N; Zaffagnini, S; Marcacci, M

    2016-11-01

    Previous studies did not take into consideration such large variety of surgery variables which describe the performed anterior cruciate ligament (ACL) reconstruction and the interaction among them in the definition of postoperative outcome. Seventeen patients who underwent navigated Single Bundle plus Lateral Plasty ACL reconstruction were enrolled in the study. Static laxity was evaluated as the value of anterior/posterior displacement at 30° and at 90° of flexion, internal/external rotation at 30° and 90° of knee flexion, varus/valgus test at 0° and 30° of flexion. The evaluated surgical variables were analyzed through a multivariate analysis defining the following models: AP30estimate, AP90estimate, IE30estimate, IE90estimate, VV0estimate, VV30estimate. Surgical variables has been defined as the angles between the tibial tunnel and the three planes, the lengths of the tunnel and the relationship between native footprints and tunnels. An analogous characterization was performed for the femoral side. Performance and significance of the defined models have been quantified by the correlation ratio (η(2)) and the corresponding p-value (*p < 0.050). The analyzed models resulted to be statistically significant (p < 0.05) for prediction of postoperative static laxity values. The only exception was the AP90estimate model. The η(2) ranged from 0.568 (IE90estimate) to 0.995 (IE30estimate). The orientation of the tibial tunnel resulted to be the most important surgical variable for the performed laxity estimation. Mathematical models for postoperative knee laxity is a useful tool to evaluate the effects of different surgical variables on the postoperative outcome. PMID:27123692

  15. High intensity running results in an impaired neuromuscular response in ACL reconstructed individuals.

    PubMed

    Patras, Kostas; Ziogas, Giorgos; Ristanis, Stavros; Tsepis, Elias; Stergiou, Nicholas; Georgoulis, Anastasios D

    2009-08-01

    Anterior cruciate ligament (ACL) reconstruction reestablishes electromyographic activity during moderate activities such as walking but is unclear if this is also the case in sports activities such as high intensity running that results in accumulation of metabolic fatigue. Nine bone-patella tendon-bone ACL reconstructed athletes were evaluated 19.2 (5.7) months post-operatively using a telemetric electromyographic system. The neuromuscular response of vastus lateralis and biceps femoris muscles was tested bilaterally on separate occasions during 10 min running at moderate intensity (20% below the lactate threshold) and 10 min running at high intensity (40% above the lactate threshold). During moderate intensity running, electromyographic activity did not change for either leg. During high intensity running, electromyographic activity did not change for the vastus lateralis of the ACL reconstructed leg [267.8 (142.8)-263.8 (128.9) microV, P > 0.05] while it increased significantly [294.2 (120.6)-317.1 (140.5) microV, P = 0.03] for the vastus lateralis of the intact leg. High intensity exercise that is associated with accumulation of metabolic fatigue, results in an impaired neuromuscular response for the vastus lateralis muscle of the ACL reconstructed leg.

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

    PubMed Central

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

    2014-01-01

    Purpose Evidence-based quadriceps femoris muscle (QF) strength guidelines for return to sport following anterior cruciate ligament (ACL) reconstruction are lacking. This study investigated the impact of QF strength asymmetry on knee landing biomechanics at the time of return to sport following ACL reconstruction. Methods Seventy-seven individuals (17.4 years) at the time of return to sport following primary ACL reconstruction (ACLR group) and 47 uninjured control individuals (17.0 years) (CTRL group) participated. QF strength was assessed and Quadriceps Index calculated (QI = [involved strength/uninvolved strength]*100%). The ACLR group was sub-divided based on QI: High Quadriceps (HQ, QI≥90%) and Low-Quadriceps (LQ, QI<85%). Knee kinematic and kinetic variables were collected during a drop vertical jump maneuver. Limb symmetry during landing, and discrete variables were compared among the groups with multivariate analysis of variance and linear regression analyses. Results The LQ group demonstrated worse asymmetry in all kinetic and ground reaction force variables compared to the HQ and CTRL groups, including reduced involved limb peak knee external flexion moments (p<.001), reduced involved limb (p=.003) and increased uninvolved limb (p=.005) peak vertical ground reaction forces, and higher uninvolved limb peak loading rates (p<.004). There were no differences in the landing patterns between the HQ and CTRL groups on any variable (p>.05). In the ACLR group, QF strength estimated limb symmetry during landing after controlling for graft type, meniscus injury, knee pain and symptoms. Conclusion At the time of return to sport, individuals post-ACL reconstruction with weaker QF demonstrate altered landing patterns. Conversely, those with nearly symmetrical QF strength demonstrate landing patterns similar to uninjured individuals. Consideration of an objective QF strength measure may aid clinical decision-making to optimize sports participation following ACL

  17. Comparison of volumetric bone mineral density in the tibial region of interest for ACL reconstruction.

    PubMed

    Klein, Scott A; Nyland, John; Caborn, David N M; Kocabey, Yavuz; Nawab, Akbar

    2005-12-01

    Adequate tibial bone mineral density (BMD) is essential to soft tissue graft fixation during anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare volumetric bone plug density measurements at the tibial region of interest for ACL reconstruction using a standardized immersion technique and Archimedes' principle. Cancellous bone cores were harvested from the proximal, middle, and distal metaphyseal regions of the lateral tibia and from the standard tibial tunnel location used for ACL reconstruction of 18 cadaveric specimens. Proximal tibial cores displayed 32.6% greater BMD than middle tibial cores and 31.8% greater BMD than distal tibial cores, but did not differ from the BMD of the tibial tunnel cores. Correlational analysis confirmed that the cancellous BMD in the tibial tunnel related to the cancellous BMD of the proximal and distal lateral tibial metaphysis. In conjunction with its adjacent cortical bone, the cancellous BMD of the region used for standard tibial tunnel placement provides an effective foundation for ACL graft fixation. In tibia with poor BMD, bicortical fixation that incorporates cortical bone from the distal tibial tunnel region is recommended. PMID:16237489

  18. A medium to long-term follow-up of ACL reconstruction using double gracilis and semitendinosus grafts.

    PubMed

    Ferretti, Andrea; Monaco, Edoardo; Giannetti, Silvio; Caperna, Ludovico; Luzon, David; Conteduca, Fabio

    2011-03-01

    This paper reports the results of our approach to ACL tears and knee laxity, based on 30 years of experience in ACL reconstruction with hamstrings and founded on the following cornerstones: the use of doubled semitendinosus and gracilis as a free graft; the use of an out-in technique for femoral drilling and of very strong and stiff fixation devices; the careful examination and repair or reconstruction of the lateral compartment in selected patients; and the use of unaggressive rehabilitation. We prospectively evaluated a series of 100 consecutive patients who underwent ACL reconstruction between 2001 and 2002. A clinical and radiological follow-up was performed at a minimum of 6 years. After 6 years, the International Knee Documentation Committee score demonstrated good-to-excellent results (A and B) in 98% of patients. However, arthrometric results using the KT-1000 demonstrated that 6/80 patients (7.5%) had >5 mm manual maximum side-to-side difference. The median Tegner activity score was 5 (range 1-9); the median Lysholm score was 96 (range 81-100); and the median subjective IKDC score was 94 (range 66-100). We reported 6/80 failures as revealed by a 2+ or 3+ pivot-shift test result and/or KT-1000 side-to-side difference of more than 5 mm. The IKDC score revealed excellent results in all women who underwent extra-articular tenodesis. Radiographic evaluation demonstrated early signs of osteoarthritis in 9% of patients.

  19. Neuromuscular adaptations and correlates of knee functionality following ACL reconstruction.

    PubMed

    Bryant, Adam L; Kelly, Jason; Hohmann, Erik

    2008-01-01

    The objective of this research was to examine the dynamic restraint mechanism by establishing the neuromuscular characteristics of lower extremity muscles in anterior cruciate ligament reconstruction (ACLR) subjects. This study also investigated neuromuscular variables that relate to post-ACLR functional outcome. Thirteen patients having undergone ACLR using the bone patella tendon bone graft at least 6 months prior participated in this study. Knee functionality (0- to 100-point scale) was rated using the Cincinnati Knee Rating System. The median frequency of the electromyographic (EMG) recordings from the vastus medialis (VM) and vastus lateralis (VL) muscles together with the isokinetic quadriceps torque generated in 10 degrees intervals between 80 degrees and 10 degrees knee flexion was determined for the noninvolved and involved limbs. Lower limb musculotendinous stiffness was also assessed for the noninvolved and involved limbs. Limb symmetry indexes were calculated for each of the physiological measures. Compared to the noninvolved limb, the median frequency of the EMG from the involved limb VM and VL muscles was significantly lower as was the quadriceps torque generated at the seven knee flexion intervals. In contrast, musculotendinous stiffness was significantly higher in the involved lower limb compared to the noninvolved limb. Significant, moderate correlations were identified between knee functionality and symmetry indexes for all variables except for the isokinetic quadriceps torque produced between 80 degrees -70 degrees and 20 degrees -10 degrees knee flexion. More functional ACLR subjects demonstrated enhanced motor unit recruitment reflective of less quadriceps muscle fiber atrophy together with increased quadriceps strength and musculotendinous stiffness of the lower limb musculature.

  20. Which one Enhances Muscular Performance in ACL Reconstructed Subjects

    PubMed Central

    Harput, Gulcan; Ulusoy, Burak; Atay, Ahmet Ozgur; Baltacı, Gul

    2014-01-01

    Objectives: The aim of this study was to investigate the effects of functional knee brace and kinesiotaping on muscular performance in anterior cruciate ligament reconstructed subjects who reached return to sport phase of the rehabilitation. Methods: Twenty (17 males, 3 females, Age: 24.7±7.1 years, Body weight: 74.4±12.0 kg, Height: 177.9±6.5 cm, BMI: 23.9±3.6 kg/m2) subjects who underwent anterior cruciate ligament reconstruction by using hamstring tendon auto graft were included in this study. When the subjects reached the return to sports phase of rehabilitation which was 6th months after surgery, knee muscle strength, jump performance and balance tests were performed 3 times: bare, with knee brace and with kinesio taping. The order of the tests were randomized to eliminate the effects of fatigue and motor learning. Quadriceps and hamstring muscle strength was measured on an isokinetic dynamometer at 180 °/s and 60°/s angular velocities. Vertical Jump (VJ) and One Leg Hop Tests (OLHT) were used to assess jump performance. Star Excursion Balance Test (SEBT) with anterior, posteromedial and posterolateral reach distance was used to assess the dynamic balance. When all tests were performed, the subjects were asked under which test condition they felt more confident. Repeated measures of ANOVA was used to analyze the difference among three test conditions (bare, kinesiotaping, knee brace). Bonferroni post hoc test was used for pairwise comparison. Results: SEBT posteromedial (PM)and posterolateral (PL) reach distances were found significantly different among three test conditions(PM: F(2,38)=3.42,p=0.04), PL: F(2,38)=4.37,p=0.02). Kinesiotaping increased posteromedial reach distance (p=0.03). On the other hand, brace decreased posterolateral reach distance (p=0.04). VJ and OLHT performance were also found significantly different between three test conditions (VJ: F (2,38)=3.44,p=0.04, OLHT: (F(2,38)=4.04,p=0.02). Kinesio taping increased one leg hop distance

  1. Use of ultra-high molecular weight polycaprolactone scaffolds for ACL reconstruction.

    PubMed

    Leong, Natalie L; Kabir, Nima; Arshi, Armin; Nazemi, Azadeh; Jiang, Jie; Wu, Ben M; Petrigliano, Frank A; McAllister, David R

    2016-05-01

    Previously, we reported on the implantation of electrospun polycaprolactone (PCL) grafts for use in ACL tissue engineering in a small animal model. In the present study, we hypothesized that grafts fabricated from ultra-high molecular weight polycaprolactone (UHMWPCL) would have similarly favorable biologic properties but superior mechanical properties as compared to grafts fabricated from PCL. Two forms of polycaprolactone were obtained (UHMWPCL, MW = 500 kD, and PCL, MW = 80 kD) and electrospun into scaffolds that were used to perform ACL reconstruction in 7-8 week old male Lewis rats. The following groups were examined: UHMWPCL, PCL, flexor digitorum longus (FDL) allograft, native ACL, as well as sham surgery in which the ACL was transsected. At 16 weeks post-operatively, biomechanical testing, histology, and immunohistochemistry (IHC) were performed. Analysis of cellularity indicated that there was no significant difference among the UHMWPCL, PCL, and FDL allograft groups. Quantification of birefringence from picrosirius red staining demonstrated significantly more aligned collagen fibers in the allograft than the PCL group, but no difference between the UHMWPCL and allograft groups. The peak load to failure of the UHMWPCL grafts was significantly higher than PCL, and not significantly different from FDL allograft. This in vivo study establishes the superiority of the higher molecular weight version of polycaprolactone over PCL as a scaffold material for ACL reconstruction. By 16 weeks after implantation, the UHMWPCL grafts were not significantly different from the FDL allografts in terms of cellularity, peak load to failure, stiffness, and collagen fiber alignment. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:828-835, 2016. PMID:26497133

  2. Giant Cell Tumor within the Proximal Tibia after ACL Reconstruction.

    PubMed

    Takahashi, Takashi; MacCormick, Lauren; Ellermann, Jutta; Clohisy, Denis; Marette, Shelly

    2016-01-01

    26-year-old female with prior anterior cruciate ligament reconstruction developed an enlarging lytic bone lesion around the tibial screw with sequential imaging over the course of one year demonstrating progression of this finding, which was confirmed histologically to be a giant cell tumor of bone. The lesion originated around the postoperative bed, making the diagnosis challenging during the early course of the presentation. The case demonstrates giant cell tumor which originated in the metaphysis and subsequently grew to involve the epiphysis; therefore, early course of the disease not involving the epiphysis should not exclude this diagnosis. PMID:26981302

  3. Giant Cell Tumor within the Proximal Tibia after ACL Reconstruction

    PubMed Central

    Takahashi, Takashi; MacCormick, Lauren; Ellermann, Jutta; Clohisy, Denis; Marette, Shelly

    2016-01-01

    26-year-old female with prior anterior cruciate ligament reconstruction developed an enlarging lytic bone lesion around the tibial screw with sequential imaging over the course of one year demonstrating progression of this finding, which was confirmed histologically to be a giant cell tumor of bone. The lesion originated around the postoperative bed, making the diagnosis challenging during the early course of the presentation. The case demonstrates giant cell tumor which originated in the metaphysis and subsequently grew to involve the epiphysis; therefore, early course of the disease not involving the epiphysis should not exclude this diagnosis. PMID:26981302

  4. COMPARATIVE STUDY OF ACL RECONSTRUCTION WITH ANATOMICAL POSITIONING OF THE TUNNELS USING THE PATELLAR TENDON VERSUS HAMSTRING TENDON

    PubMed Central

    de Pádua, Vitor Barion Castro; Maldonado, Hilário; Vilela, Júlio César Rodrigues; Provenza, Alexandre Ribeira; Monteiro, Cleverson; de Oliveira Neto, Heleno Cavalcante

    2015-01-01

    Objective: To compare ACL reconstruction with anatomical positioning of the tunnels using the hamstring or patellar tendons. Methods: We prospectively evaluated 52 patients who underwent ACL reconstruction using the Chambat's technique, with anatomical positioning of the tunnels drilled outside in. They were divided into group A, with 27 patients, using the patellar tendon as a graft, and group B, with 25 patients, using the hamstring. Results: In group A 26 patients were very satisfied or satisfied and 1 unhappy, in group B. 25 patients were very satisfied or satisfied with the procedure (p = 0.990). According to the Lysholm scale, group A had a mean score of 96.11 and group B, 95.32 (p=0.594). In relation to preoperative IKDC, 100% of the patients in group A and 92% of those in group B were IKDC C or D (p = 0.221); in the assessment with a minimum of two-year follow-up, 96% of group A and 92% of group B were IKDC A or B (p = 0.256). The Lachman test, pivot shift, return to sports activities, and the comparative difference in anterior translation (RolimeterTM) also showed no statistically significant difference. In group A, 5 patients (18.5%) were unable to kneel on a hard surface, whereas no patient in group B had this complaint. Conclusion: The anterior cruciate ligament reconstruction presents similar results using the hamstring or patellar tendon with anatomical positioning of the tunnels. Drilling the femoral tunnel outside in is a reproducible and accurate option in the correct placement the femoral tunnel. PMID:27027082

  5. THE ROLE AND IMPLEMENTATION OF ECCENTRIC TRAINING IN ATHLETIC REHABILITATION: TENDINOPATHY, HAMSTRING STRAINS, AND ACL RECONSTRUCTION

    PubMed Central

    Reiman, Michael

    2011-01-01

    The benefits and proposed physiological mechanisms of eccentric exercise have previously been elucidated and eccentric exercise has been used for well over seventy years. Traditionally, eccentric exercise has been used as a regular component of strength training. However, in recent years, eccentric exercise has been used in rehabilitation to manage a host of conditions. Of note, there is evidence in the literature supporting eccentric exercise for the rehabilitation of tendinopathies, muscle strains, and in anterior cruciate ligament (ACL) rehabilitation. The purpose of this Clinical Commentary is to discuss the physiologic mechanism of eccentric exercise as well as to review the literature regarding the utilization of eccentric training during rehabilitation. A secondary purpose of this commentary is to provide the reader with a framework for the implementation of eccentric training during rehabilitation of tendinopathies, muscle strains, and after ACL reconstruction. PMID:21655455

  6. Quadriceps Strength Asymmetry Following ACL Reconstruction Alters Knee Joint Biomechanics and Functional Performance at Time of Return to Activity

    PubMed Central

    Palmieri-Smith, RM; Lepley, LK

    2016-01-01

    Background Quadriceps strength deficits are observed clinically following anterior cruciate injury and reconstruction and are often not overcome despite rehabilitation. Given that quadriceps strength may be important for achieving symmetrical joint biomechanics and promoting long-term joint health, determining the magnitude of strength deficits that lead to altered mechanics is critical. Purpose To determine if the magnitude of quadriceps strength asymmetry alters knee and hip biomechanical symmetry, as well as functional performance and self-reported function. Study Design Cross-Sectional study. Methods Seventy-three patients were tested at the time they were cleared for return to activity following ACL reconstruction. Quadriceps strength and activation, scores on the International Knee Documentation Committee form, the hop for distance test, and sagittal plane lower extremity biomechanics were recorded while patients completed a single-legged hop. Results Patients with high and moderate quadriceps strength symmetry had larger central activation ratios as well as greater limb symmetry indices on the hop for distance compared to patients with low quadriceps strength symmetry (P<0.05). Similarly, knee flexion angle and external moment symmetry was higher in the patients with high and moderate quadriceps symmetry compared to those with low symmetry (P<0.05). Quadriceps strength was found to be associated with sagittal plane knee angle and moment symmetry (P<0.05). Conclusion Patients with low quadriceps strength displayed greater movement asymmetries at the knee in the sagittal plane. Quadriceps strength was related to movement asymmetries and functional performance. Rehabilitation following ACL reconstruction needs to focus on maximizing quadriceps strength, which likely will lead to more symmetrical knee biomechanics. PMID:25883169

  7. Effects of ACL reconstruction surgery on muscle activity of the lower limb during a jump-cut maneuver in males and females.

    PubMed

    Coats-Thomas, Margaret S; Miranda, Daniel L; Badger, Gary J; Fleming, Braden C

    2013-12-01

    We compared muscle activity of the quadriceps, hamstring, and gastrocnemius muscles when ACL-intact (ACL(INT)) and ACL-reconstructed (ACL(REC)) male and female subjects performed a jump-cut task. Surface electromyography sensors were used to evaluate time to peak muscle activity and muscle activity ratios. Rectus femoris (RF) and vastus medialis (VM) peak timing was 71 and 78 ms earlier in ACL(INT) than in ACL(REC) subjects, respectively. Biceps femoris (BF) peak timing was 90 ms earlier in ACL(INT) than in ACL(REC) subjects and 75 ms earlier in females than in males. Medial gastrocnemius (MG) muscle peak timing was 77 ms earlier in ACL(INT) than in ACL(REC) subjects. Lateral gastrocnemius (LG) and MG muscle peak times were 106 ms and 87 ms earlier in females than in males, respectively. The RF, VM, BF, and MG peaked later in ACL(REC) than in ACL(INT) subjects. There was evidence suggesting that the loading phase quadriceps:hamstring (quad:ham) muscle activity ratio was greater in ACL(REC) than in ACL(INT) subjects. Finally, the injury risk phase quad:ham muscle activity ratio was 4.8 times greater in females than in males. In conclusion, differences exist in muscle activity related to ACL status and sex that could potentially help explain graft failure risk and the sex bias.

  8. Assessing 3D tunnel position in ACL reconstruction using a novel single image 3D-2D registration

    NASA Astrophysics Data System (ADS)

    Kang, X.; Yau, W. P.; Otake, Y.; Cheung, P. Y. S.; Hu, Y.; Taylor, R. H.

    2012-02-01

    The routinely used procedure for evaluating tunnel positions following anterior cruciate ligament (ACL) reconstructions based on standard X-ray images is known to pose difficulties in terms of obtaining accurate measures, especially in providing three-dimensional tunnel positions. This is largely due to the variability in individual knee joint pose relative to X-ray plates. Accurate results were reported using postoperative CT. However, its extensive usage in clinical routine is hampered by its major requirement of having CT scans of individual patients, which is not available for most ACL reconstructions. These difficulties are addressed through the proposed method, which aligns a knee model to X-ray images using our novel single-image 3D-2D registration method and then estimates the 3D tunnel position. In the proposed method, the alignment is achieved by using a novel contour-based 3D-2D registration method wherein image contours are treated as a set of oriented points. However, instead of using some form of orientation weighting function and multiplying it with a distance function, we formulate the 3D-2D registration as a probability density estimation using a mixture of von Mises-Fisher-Gaussian (vMFG) distributions and solve it through an expectation maximization (EM) algorithm. Compared with the ground-truth established from postoperative CT, our registration method in an experiment using a plastic phantom showed accurate results with errors of (-0.43°+/-1.19°, 0.45°+/-2.17°, 0.23°+/-1.05°) and (0.03+/-0.55, -0.03+/-0.54, -2.73+/-1.64) mm. As for the entry point of the ACL tunnel, one of the key measurements, it was obtained with high accuracy of 0.53+/-0.30 mm distance errors.

  9. ACL reconstruction

    MedlinePlus

    Anterior cruciate ligament repair ... Micheo W, Amy E, Sepuleveda F. Anterior cruciate ligament tear. In: Frontera, WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2015: ...

  10. Combination of Eccentric Exercise and Neuromuscular Electrical Stimulation to Improve Quadriceps Function Post-ACL Reconstruction

    PubMed Central

    Lepley, Lindsey K.; Wojtys, Edward M.; Palmieri-Smith, Riann M.

    2014-01-01

    Background Neuromuscular electrical stimulation (NMES) has been shown to reduce quadriceps activation failure (QAF), and eccentric exercise has been shown lessen muscle atrophy post-ACL reconstruction. Given that these are two critical components of quadriceps strength, intervention combining these therapies may be effective at reinstituting quadriceps function post-anterior cruciate ligament (ACL) reconstruction. Objectives To evaluate the effectiveness of a combined NMES and eccentric exercise intervention to improve the recovery of quadriceps activation and strength post-reconstruction. Design Parallel longitudinal design. Setting Laboratory. Participants Thirty-six individuals post-injury were placed into four treatment groups (N&E, NMES and eccentrics; E-only, eccentrics only; N-only, NMES-only; STND, standard of care) and ten healthy controls participated. Intervention N&E and N-only received the NMES protocol 2x per week for the first six weeks post-reconstruction. N&E and E-only received the eccentric exercise protocol 2x per week beginning six weeks post-reconstruction. Main outcome measure Quadriceps activation was assessed via the superimposed burst technique and quantified via the central activation ratio. Quadriceps strength was assessed via maximal voluntary isomeric contractions (Nm/kg). Data was gathered on three occasions: pre-operative, 12-weeks-post-surgery and at return-to-play. Results No differences in pre-operative measures existed (P>0.05). E-only recovered quadriceps activation better than N-only or STND (P<0.05). N&E and E-only recovered strength better than N-only or the STND (P<0.05) and had strength values that were similar to healthy individuals at return-to-play (P>0.05). Conclusion Eccentric exercise was capable of restoring levels of quadriceps activation and strength that were similar to those of healthy adults and better than NMES alone. PMID:25819154

  11. Knee stability, athletic performance and sport-specific tasks in non-professional soccer players after ACL reconstruction: comparing trans-tibial and antero-medial portal techniques

    PubMed Central

    Tudisco, Cosimo; Bisicchia, Salvatore; Cosentino, Andrea; Chiozzi, Federica; Piva, Massimo

    2015-01-01

    Summary Background a wrong position of bone tunnels, in particular on the femur, is one of the most frequent causes of a failed anterior cruciate ligament (ACL) reconstruction. Several studies demonstrated that drilling the femoral tunnel through the antero-medial portal (AMP) allows a more anatomical placement on the lateral femoral condyle and higher knee stability, compared to trans-tibial (TT) technique. The aim of this study was to retrospectively evaluate two groups of soccer players operated on for ACL reconstruction according to either one of these two techniques. Methods two groups of non-professional soccer players operated on for a single bundle ACL reconstruction with hamstrings autograft using either a TT (20 patients) or an AMP (23 patients) technique were retrospectively evaluated with KT-1000 arthrometer, manual pivot shift test, isokinetic test, the incremental treadmill-running test, athletic and sport specific tasks, and knee scores (IKDC, Lysholm and KOOS). Results the AMP group showed better results at pivot shift test and KOOS, but lower flexion angles at single leg squat test. There were no differences in all the other considered outcomes. Conclusions the better rotational stability of the knee achieved in AMP group did not lead to significantly better clinical and functional results in our patients. Level of evidence III. Treatment study Case-control study. PMID:26605191

  12. Electromechanical delay of the knee extensor muscles is not altered after harvesting the patellar tendon as a graft for ACL reconstruction: implications for sports performance.

    PubMed

    Georgoulis, A D; Ristanis, S; Papadonikolakis, A; Tsepis, E; Moebius, U; Moraiti, C; Stergiou, N

    2005-09-01

    Although the scar tissue, which heals the donor site defect, has different elasticity from the neighbouring patellar tissue, it remains unclear if this scar tissue can lead to the changes of the electromechanical delay (EMD) of the knee extensor muscles. If such changes do exist, they can possibly affect both the utilization of the stored energy in the series elastic component, as well as the optimal performance of the knee joint movement. The purpose of this study was to investigate the influence of harvesting the patellar tendon during anterior cruciate ligament (ACL) reconstruction and the associated patellar tendon scar tissue development on the EMD of the rectus femoris (RF) and vastus medialis (VM) muscles. Seventeen patients who underwent an ACL reconstruction using the medial third of the patellar tendon were divided in two groups based upon their post-operative time interval. Maximal voluntary contraction from the knee extensors, surface EMG activity, and ultrasonographic measurements of the patellar tendon cross-section area were obtained from both knees. Our results revealed that no significant changes for the maximal voluntary contraction of the knee extensors and for the EMD of the RF and the VM muscles due to patellar scar tissue development after harvesting the tendon for ACL reconstruction. The EMD, as a component of the stretch reflex, is important for the utilization of the stored energy in the series elastic component and thus, optimal sports performance. However, from our results, it can be implied that the ACL reconstruction using a patellar tendon graft would not impair sports performance as far as EMD is concerned.

  13. Is there significant variation in the material properties of four different allografts implanted for ACL reconstruction.

    PubMed

    Penn, David; Willet, Thomas L; Glazebrook, Mark; Snow, Martyn; Stanish, William D

    2009-03-01

    The aims of our study were to: (1) determine if there are differences in the material properties of tendon obtained from implanted tibialis anterior, achilles, bone-patella- bone and tibialis posterior allografts; (2) determine the variability in material properties between the implanted specimens. A total of 60 specimens were collected from fresh frozen allografts implanted at ACL reconstruction. Specimens collected included 15 tibialis anterior, 15 tibialis posterior, 15 achilles and 15 bone-patella-bone tendons. Each specimen was mounted in a custom made cryogrip. The mounted specimens were loaded onto a MTS Testline servo-hydraulic testing machine in a uni-axial tensile test configuration. Specimens were subjected to a strain rate of 5% per second until the ultimate tensile stress (UTS), failure strain and high strain modulus was calculated for each specimen after being normalized for specimen dimensions. Individual material properties were tested using one way analysis of variance (ANOVA) and post hoc Tukey's B test with a P value of <0.05 considered significant. Homogeneity of variance was assessed using the Levene's test. As a result, no significant difference was found between all four grafts with regards to UTS, failure strain or high strain linear modulus. The UTS was plotted against the modulus demonstrating a linear relationship which is typical of soft tissues. Significant variability in the results were observed. In conclusion, there was no significant statistical difference between the material properties of the four tendon allografts tested. But significant variability in results was observed within groups and between groups, which may provide one explanation for the range of results in allograft ACL reconstruction reported in the literature.

  14. Is there significant variation in the material properties of four different allografts implanted for ACL reconstruction.

    PubMed

    Penn, David; Willet, Thomas L; Glazebrook, Mark; Snow, Martyn; Stanish, William D

    2009-03-01

    The aims of our study were to: (1) determine if there are differences in the material properties of tendon obtained from implanted tibialis anterior, achilles, bone-patella- bone and tibialis posterior allografts; (2) determine the variability in material properties between the implanted specimens. A total of 60 specimens were collected from fresh frozen allografts implanted at ACL reconstruction. Specimens collected included 15 tibialis anterior, 15 tibialis posterior, 15 achilles and 15 bone-patella-bone tendons. Each specimen was mounted in a custom made cryogrip. The mounted specimens were loaded onto a MTS Testline servo-hydraulic testing machine in a uni-axial tensile test configuration. Specimens were subjected to a strain rate of 5% per second until the ultimate tensile stress (UTS), failure strain and high strain modulus was calculated for each specimen after being normalized for specimen dimensions. Individual material properties were tested using one way analysis of variance (ANOVA) and post hoc Tukey's B test with a P value of <0.05 considered significant. Homogeneity of variance was assessed using the Levene's test. As a result, no significant difference was found between all four grafts with regards to UTS, failure strain or high strain linear modulus. The UTS was plotted against the modulus demonstrating a linear relationship which is typical of soft tissues. Significant variability in the results were observed. In conclusion, there was no significant statistical difference between the material properties of the four tendon allografts tested. But significant variability in results was observed within groups and between groups, which may provide one explanation for the range of results in allograft ACL reconstruction reported in the literature. PMID:19039574

  15. Treatment of Type 3 Arthrofibrosis Following Arthroscopic Reconstruction of ACL and Posterolateral Corner Injury with Tibia Plateau Fracture in a Professional Dancer

    PubMed Central

    Aksu, Neslihan; Abay, Burak; Soydan, Ramazan; Atansay, Vefa

    2014-01-01

    Objectives: Arthrofibrosis is a serious complication following the reconstruction of anterior cruciate ligament (ACL) and posterolateral corner (PLC) injury. Loss of motion caused by arthrofibrosis can be disabling in young and active patients. We report the clinical results of the treatment of arthrofibrosis following arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft and surgically repairing PLC with 2 suture anchors in a 30 year-old professional dancer, treated with surgical lysis and manipulation under general anesthesia followed by aggressive physical therapy. Methods: A 30 year-old male professional dancer presented with pain, effusion and severe instability in his left knee after falling in a dance event. The pain was evaluated on Visual analog scale (VAS) as 6 to 8. At the physical examination, anterior drawer test was evaluated as grade 3, pivot shift test, varus test, dial test and posterolateral drawer test were found positive. The Tegner Lysholm score was evaluated as 22 (poor). Under general anesthesia, left knee had tendency to external rotation and recurvatum when leg was suspended by toes. A magnetic resonance image (MRI) revealed the presence of a total ACL rupture, PLC injury and a fracture of lateral tibia plateau. The patient was treated with arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft fixed with endobutton through femoral tunnel and bio interference screw through tibial tunnel and PLC injury was treated with 2 suture anchors. Postoperatively first day, quadriceps musculature and active and passive ROM exercises was trained. During postoperatively third week, the patient was allowed to mobilize nonweight bearing with the use of two crutches without functional knee brace. At the sixth week, arthroscopic lysis was performed due to type 3 arthrofibrosis. At the tenth week, manipulation was performed to the left knee under general anesthesia. Results: At the 3 month- follow-up, the patient

  16. Multicenter Orthopaedic Outcome Network Early Anti-inflammatory Treatment in Patients with Acute ACL Tear” (MOON-AAA) Clinical Trial

    PubMed Central

    Lattermann, Christian; Proffitt, Mary; Huston, Laura J.; Gammon, Lee; Johnson, Darren L.; Kraus, Virginia B.; Spindler, Kurt P.

    2016-01-01

    Objectives: We present the early results from the “Multicenter Orthopaedic Outcome Network Early Anti-inflammatory Treatment in Patients with Acute ACL Tear and Painful Effusions” (MOON-AAA) clinical trial (figure 1). This trial allows for a well controlled prospective cohort of patients with isolated ACL injury at risk for OA. We compared the effect of a single versus a repeated dosage of Kenalog within the first two weeks after ACL injury and its effect on chondral degradation in the first 4 weeks prior to surgical reconstruction of the ACL. Methods: 49 patients with isolated ACL tears were enrolled. Knee joints were aspirated and patients received an injection with 40 mg Kenalog either within 4 days, 10 days, both time points or not at all (saline injection control). Serum, synovial fluid and urine were collected at 3 time points. Permutated block randomization, triple blinding, independent monitoring and standardized x-ray was performed to comply with GCP standards. Patient reported outcomes were collected at 6 time points up to 6 months post-ACL reconstruction(IKDC, KOOS and Marx activity level). A standardized synovial fluid biomarker panel was analyzed according to OARSI guidelines. Statistical analysis were performed using SAS mixed models analysis. Results: Serum analysis shows significant change after injury. Chondrodegradatory markers such as CTX-II, MMP-1 and MMP-3 as well as COMP indicate a progressive destruction of chondral matrix and collagen breakdown . There is a dramatic (250%) increase of CTX-II in the first 4 weeks. Matrix proteins such as MMP-1 and 3 as well as COMP show an initial increase and then a steep decline (see figure 1). Inflammatory markers (IL-1 alpha, IL-1beta, IRAP) show a decline from the time of injury. IL-1 alpha, however shows a dramatic uptake after week 2. This longitudinal data confirms a dramatic onset of early osteoarthritic biomarker profiles immediately after ACL injury as measured in synovial fluid

  17. Patient Demographics and Surgical Characteristics in ACL Revision: A Comparison of French, Norwergian, and North American Cohorts

    PubMed Central

    Magnussen, Robert A.; Trojani, Christophe; Granan, Lars-Petter; Neyret, Philippe; Colombet, Philippe; Engebretsen, Lars; Wright, Rick W.; Kaeding, Christopher C.

    2014-01-01

    Purpose The goal of this paper is to compare patient factors, intra-operative findings, and surgical techniques between patients followed in large cohorts in France, Norway, and North America. Methods Data collected on 2286 patients undergoing revision ACLR were obtained. These data included 1216 patients enrolled in the Multicenter ACL Revision Study (MARS) in North America, 793 patients undergoing revision ACLR and recorded in the Norwegian Knee Ligament Registry (NKLR), and 277 patients recorded in the revision ACL database of the Société Française d’Arthroscopie (SFA) in France. Data collected from each database included patient demographics (age, sex, height, and weight), graft choice and reason for failure of the primary ACLR, time from primary to revision ACLR, pre-revision patient-reported outcome scores (KOOS, subjective IKDC), associated intra-articular findings and treatments at revision, and graft choice for revision reconstruction. Results Patient demographics in the three databases were relatively similar. Graft choice for primary and revision ACLR varied significantly, with more allografts used in the MARS cohort. Hamstring autograft was favored in the NKRL, while BTB autograft was most common in the SFA cohort. Reasons for failure of the primary ACLR were comparable, with recurrent trauma noted in 46 to 56% of patients in each of the three cohorts. Technical error was cited in 44 to 51% of patients in the MARS and SFA cohorts, but was not clearly elucidated in the NKLR cohort. Biologic failure of the primary graft was more common in the MARS cohort. Differences in associated intra-articular findings were noted at the time of revision ACLR, with significantly more high grade cartilage lesions noted in the MARS group. Conclusions Significant differences exist between patient populations followed in revision ACL cohorts throughout the world that should be considered when applying findings from such cohorts to different patient populations. PMID

  18. Whole Body Vibration Exercise Protocol versus a Standard Exercise Protocol after ACL Reconstruction: A Clinical Randomized Controlled Trial with Short Term Follow-Up

    PubMed Central

    Berschin, Gereon; Sommer, Björn; Behrens, Antje; Sommer, Hans-Martin

    2014-01-01

    The suitability and effectiveness of whole body vibration (WBV) exercise in rehabilitation after injury of the anterior cruciate ligament (ACL) was studied using a specially designed WBV protocol. We wanted to test the hypothesis if WBV leads to superior short term results regarding neuromuscular performance (strength and coordination) and would be less time consuming than a current standard muscle strengthening protocol. In this prospective randomized controlled clinical trial, forty patients who tore their ACL and underwent subsequent ligament reconstruction were enrolled. Patients were randomized to the whole body vibration (n=20) or standard rehabilitation exercise protocol (n=20). Both protocols started in the 2nd week after surgery. Isometric and isokinetic strength measurements, clinical assessment, Lysholm score, neuromuscular performance were conducted weeks 2, 5, 8 and 11 after surgery. Time spent for rehabilitation exercise was reduced to less than a half in the WBV group. There were no statistically significant differences in terms of clinical assessment, Lysholm score, isokinetic and isometric strength. The WBV group displayed significant better results in the stability test. In conclusion, preliminary data indicate that our whole body vibration muscle exercise protocol seems to be a good alternative to a standard exercise program in ACL-rehabilitation. Despite of its significant reduced time requirement it is at least equally effective compared to a standard rehabilitation protocol. Key points In this prospective randomized controlled clinical trial, we tested the hypothesis if WBV leads to superior short term results regarding neuromuscular performance (strength and coordination) and would be less time consuming than a current standard muscle strengthening protocol in forty patients who underwent ACL reconstruction. Time spent for rehabilitation exercise was reduced to less than a half in the WBV group as compared to the standard exercise group. Both

  19. An intelligent recovery progress evaluation system for ACL reconstructed subjects using integrated 3-D kinematics and EMG features.

    PubMed

    Malik, Owais A; Senanayake, S M N Arosha; Zaheer, Dansih

    2015-03-01

    An intelligent recovery evaluation system is presented for objective assessment and performance monitoring of anterior cruciate ligament reconstructed (ACL-R) subjects. The system acquires 3-D kinematics of tibiofemoral joint and electromyography (EMG) data from surrounding muscles during various ambulatory and balance testing activities through wireless body-mounted inertial and EMG sensors, respectively. An integrated feature set is generated based on different features extracted from data collected for each activity. The fuzzy clustering and adaptive neuro-fuzzy inference techniques are applied to these integrated feature sets in order to provide different recovery progress assessment indicators (e.g., current stage of recovery, percentage of recovery progress as compared to healthy group, etc.) for ACL-R subjects. The system was trained and tested on data collected from a group of healthy and ACL-R subjects. For recovery stage identification, the average testing accuracy of the system was found above 95% (95-99%) for ambulatory activities and above 80% (80-84%) for balance testing activities. The overall recovery evaluation performed by the proposed system was found consistent with the assessment made by the physiotherapists using standard subjective/objective scores. The validated system can potentially be used as a decision supporting tool by physiatrists, physiotherapists, and clinicians for quantitative rehabilitation analysis of ACL-R subjects in conjunction with the existing recovery monitoring systems.

  20. Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up

    PubMed Central

    Alentorn-Geli, Eduard; Samitier, Gonzalo; Álvarez, Pedro; Steinbacher, Gilbert

    2010-01-01

    Drilling of the femoral tunnel with the transtibial (TT) technique is widely used in bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction. Recent studies suggest higher knee stability with the use of the anteromedial portal (AMP). The purpose of this study was to compare functional and clinical outcomes of BPTB ACL reconstruction using the TT or the AMP technique for drilling the femoral tunnel. All ACL reconstructions between January 2003 and April 2006 were approached for eligibility. Forty-seven patients met inclusion criteria (21 TT group and 26 AMP group). Blinded assessments of IKDC score, knee stability and range of motion, one-leg hop test, mid-quadriceps circumference, VAS for satisfaction with surgery, Lysholm and Tegner scores, and SF-12 questionnaire were obtained for both groups. Data on preoperative and postoperative surgical timing were retrospectively reviewed through the charts. The AMP group demonstrated a significantly lower recovery time from surgery to walking without crutches (p < 0.01), to return to normal life (p < 0.03), to return jogging (p < 0.03), to return training (p < 0.03), and to return to play (p < 0.03). Knee stability values measured with KT-1000, Lachman test, pivot-shift sign, and objective IKDC score assessments were significantly better for the AMP compared to TT group (p < 0.002, p < 0.03, p < 0.02, p < 0.015, respectively). No differences were found for VAS for satisfaction with surgery, Lysholm, Tegner, and SF-12 between both groups. The use of the AMP technique significantly improved the anterior-posterior and rotational knee stability, IKDC scores, and recovery time from surgery compared to the TT technique. PMID:20401753

  1. Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up.

    PubMed

    Alentorn-Geli, Eduard; Samitier, Gonzalo; Alvarez, Pedro; Steinbacher, Gilbert; Cugat, Ramón

    2010-06-01

    Drilling of the femoral tunnel with the transtibial (TT) technique is widely used in bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction. Recent studies suggest higher knee stability with the use of the anteromedial portal (AMP). The purpose of this study was to compare functional and clinical outcomes of BPTB ACL reconstruction using the TT or the AMP technique for drilling the femoral tunnel. All ACL reconstructions between January 2003 and April 2006 were approached for eligibility. Forty-seven patients met inclusion criteria (21 TT group and 26 AMP group). Blinded assessments of IKDC score, knee stability and range of motion, one-leg hop test, mid-quadriceps circumference, VAS for satisfaction with surgery, Lysholm and Tegner scores, and SF-12 questionnaire were obtained for both groups. Data on preoperative and postoperative surgical timing were retrospectively reviewed through the charts. The AMP group demonstrated a significantly lower recovery time from surgery to walking without crutches (p < 0.01), to return to normal life (p < 0.03), to return jogging (p < 0.03), to return training (p < 0.03), and to return to play (p < 0.03). Knee stability values measured with KT-1000, Lachman test, pivot-shift sign, and objective IKDC score assessments were significantly better for the AMP compared to TT group (p < 0.002, p < 0.03, p < 0.02, p < 0.015, respectively). No differences were found for VAS for satisfaction with surgery, Lysholm, Tegner, and SF-12 between both groups. The use of the AMP technique significantly improved the anterior-posterior and rotational knee stability, IKDC scores, and recovery time from surgery compared to the TT technique. PMID:20401753

  2. Lower limb asymmetry in mechanical muscle function: A comparison between ski racers with and without ACL reconstruction.

    PubMed

    Jordan, M J; Aagaard, P; Herzog, W

    2015-06-01

    Due to a high incidence of anterior cruciate ligament (ACL) re-injury in alpine ski racers, this study aims to assess functional asymmetry in the countermovement jump (CMJ), squat jump (SJ), and leg muscle mass in elite ski racers with and without anterior cruciate ligament reconstruction (ACL-R). Elite alpine skiers with ACL-R (n = 9; 26.2 ± 11.8 months post-op) and uninjured skiers (n = 9) participated in neuromuscular screening. Vertical ground reaction force during the CMJ and SJ was assessed using dual force plate methodology to obtain phase-specific bilateral asymmetry indices (AIs) for kinetic impulse (CMJ and SJ phase-specific kinetic impulse AI). Dual x-ray absorptiometry scanning was used to assess asymmetry in lower body muscle mass. Compared with controls, ACL-R skiers had increased AI in muscle mass (P < 0.001), kinetic impulse AI in the CMJ concentric phase (P < 0.05), and the final phase of the SJ (P < 0.05). Positive associations were observed between muscle mass and AI in the CMJ concentric phase (r = 0.57, P < 0.01) as well as in the late SJ phase (r = 0.66, P < 0.01). Future research is required to assess the role of the CMJ and SJ phase-specific kinetic impulse AI as a part of a multifaceted approach for improving outcome following ACL-R in elite ski racers.

  3. Persistent Biomechanical Alterations After ACL Reconstruction Are Associated With Early Cartilage Matrix Changes Detected by Quantitative MR

    PubMed Central

    Amano, Keiko; Pedoia, Valentina; Su, Favian; Souza, Richard B.; Li, Xiaojuan; Ma, C. Benjamin

    2016-01-01

    Background: The effectiveness of anterior cruciate ligament (ACL) reconstruction in preventing early osteoarthritis is debated. Restoring the original biomechanics may potentially prevent degeneration, but apparent pathomechanisms have yet to be described. Newer quantitative magnetic resonance (qMR) imaging techniques, specifically T1ρ and T2, offer novel, noninvasive methods of visualizing and quantifying early cartilage degeneration. Purpose: To determine the tibiofemoral biomechanical alterations before and after ACL reconstruction using magnetic resonance imaging (MRI) and to evaluate the association between biomechanics and cartilage degeneration using T1ρ and T2. Study Design: Cohort study; Level of evidence, 2. Methods: Knee MRIs of 51 individuals (mean age, 29.5 ± 8.4 years) with unilateral ACL injuries were obtained prior to surgery; 19 control subjects (mean age, 30.7 ± 5.3 years) were also scanned. Follow-up MRIs were obtained at 6 months and 1 year. Tibial position (TP), internal tibial rotation (ITR), and T1ρ and T2 were calculated using an in-house Matlab program. Student t tests, repeated measures, and regression models were used to compare differences between injured and uninjured sides, observe longitudinal changes, and evaluate correlations between TP, ITR, and T1ρ and T2. Results: TP was significantly more anterior on the injured side at all time points (P < .001). ITR was significantly increased on the injured side prior to surgery (P = .033). At 1 year, a more anterior TP was associated with elevated T1ρ (P = .002) and T2 (P = .026) in the posterolateral tibia and with decreased T2 in the central lateral femur (P = .048); ITR was associated with increased T1ρ in the posteromedial femur (P = .009). ITR at 6 months was associated with increased T1ρ at 1 year in the posteromedial tibia (P = .029). Conclusion: Persistent biomechanical alterations after ACL reconstruction are related to significant changes in cartilage T1ρ and T2 at 1 year

  4. Functional Outcome Following Arthroscopic ACL Reconstruction with Rigid Fix: A Retrospective Observational Study

    PubMed Central

    Shervegar, Satish; Nagaraj, Prashanth; Grover, Amit; DJ, Niranthara Ganesh; Ravoof, Abdul

    2015-01-01

    Background: No uniform consensus exists to decide type of fixation for arthroscopic anterior cruciate ligament reconstruction. Hypothsis: There is similar functional outcome after rigid fix compared to other methods of fixation which has been published. Study design: Retrospective observational study. Methods: A total of 50 patients underwent arthroscopic anterior cruciate ligament reconstruction with hamstring tendons using femoral Rigid fix cross-pin and interference screw tibial fixation. The evaluation methods were clinical examination, IKDC scores, Lysholm and pre injury and post reconstruction Tegner score. Patients were followed up from minimum of 6 months to 4 year seven months. Results: C In our study of sample size 50 we found that mean age of patients was 30.8 Years with male preponderance. Mean post operative IKDC and Lysholm score has been 75.6 and 84.4 respectively. Mean Tegner pre-injury score and post reconstruction score has been 5.4 and 4.26. Box plot comparison of pre injury and post operativeTegner score reveals a statistically significant difference with respect to paired t test P<0.001. Conclusions: Arthroscopic anterior cruciate ligament reconstruction with femoral rigid fix cross pins and tibial interference screws results in comparable short term to midterm functional results compared to other types of fixation PMID:26550591

  5. Early versus late start of open kinetic chain quadriceps exercises after ACL reconstruction with patellar tendon or hamstring grafts: a prospective randomized outcome study.

    PubMed

    Heijne, Annette; Werner, Suzanne

    2007-04-01

    The purpose of the present investigation was to evaluate physical outcome after anterior cruciate ligament (ACL) reconstruction with early versus late initiation of open kinetic chain (OKC) exercises for the quadriceps in patients operated on either patellar tendon or hamstring grafts. Sixty-eight patients, 36 males and 32 females, with either patellar tendon graft (34 patients) or hamstring graft (34 patients) were enrolled in this study. All patients were randomly allocated to either early (the 4th postoperative week) or late (the 12th postoperative week) start of OKC exercises for the quadriceps, resulting in four subgroups: patellar tendon reconstruction, early start (P4) or late start (P12) of OKC quadriceps exercises, hamstring tendon reconstruction, early start (H4) or late start (H12) of quadriceps OKC exercises. Prior to surgery and 3, 5 and 7 months later, assessments of range of motion (goniometer), anterior knee laxity (KT-1000), postural sway (KAT 2000), thigh muscle torques (Kin-Com dynamometer) and anterior knee pain (anterior knee pain score) were evaluated. No significant group differences were found in terms of range of motion 3, 5 and 7 months postoperatively. The H4 group showed a significantly higher mean difference of laxity over time of 1.0 mm (CI: 0.18-1.86) than the P4 group (P=0.04). Within the same type of surgery, the H4 against the H12, the mean difference over time was 1.2 mm (0.37-2.1) higher in the H4 group than in the H12 group (P=0.01). There were no significant group differences in terms of postural sway or anterior knee pain at the different test occasions. Significant differences in trends (changes over time) were found when comparing the four groups, for both quadriceps muscle torques (P<0.001) and hamstring muscle torques (P<0.001). All groups, except the P4 group, reached preoperative values of quadriceps muscle torques at the 7 months follow-up. In the H4 and the H12 groups, significantly lower hamstring muscle torques at

  6. Effect of Calcium Phosphate–Hybridized Tendon Graft in Anatomic Single-Bundle ACL Reconstruction in Goats

    PubMed Central

    Mutsuzaki, Hirotaka; Fujie, Hiromichi; Nakajima, Hiromi; Fukagawa, Makoto; Nomura, Shunsuke; Sakane, Masataka

    2016-01-01

    Background: We previously developed a novel technique using an alternate soaking process that improves tendon-bone healing by hybridizing the tendon graft with calcium phosphate (CaP). However, the effects of the CaP-hybridized tendon graft on anatomic single-bundle anterior cruciate ligament (ACL) reconstruction remain unclear. Purpose: To determine the effects of CaP-hybridized tendon grafts compared with untreated tendon grafts 6 months after anatomic single-bundle ACL reconstruction using a goat model. Study Design: Controlled laboratory study. Methods: Animals were divided into a CaP group (n = 5 goats) and a control group (n = 5 goats), and we analyzed (1) knee kinematics and in situ forces under applied anterior tibial loads of 50 N and internal tibial torque of 2.0 N·m in the grafts at full extension and at 60° and 90° of knee flexion, (2) the mean percentage of bone tunnel enlargement using computed tomography (CT), and (3) the histology of the tendon-bone interface. Results: The in situ forces under applied anterior tibial loads of 50 N at 60° and 90° of knee flexion in the CaP group were greater than those in the control group (P < .05). The red safranin-O–stained area, indicating glycosaminoglycans in the cartilage layers at the joint aperture sites of the anterior femoral and posterior tibial bone tunnel, was greater in the CaP group than that in the control group (P < .05). The lengths of the nonbonding gap area between the anterior femoral and posterior tibial bone tunnels in the control group were greater than those in the CaP group (P < .05). No significant difference could be detected in the mean percentage of bone tunnel enlargement between the 2 groups. Conclusion: The CaP-hybridized tendon graft enhanced tendon-bone healing at the joint aperture site in both anterior femoral and posterior tibial tunnels 6 months after anatomic single-bundle ACL reconstruction in goats. The in situ forces under applied anterior tibial loads at greater

  7. Effect of Calcium Phosphate–Hybridized Tendon Graft in Anatomic Single-Bundle ACL Reconstruction in Goats

    PubMed Central

    Mutsuzaki, Hirotaka; Fujie, Hiromichi; Nakajima, Hiromi; Fukagawa, Makoto; Nomura, Shunsuke; Sakane, Masataka

    2016-01-01

    Background: We previously developed a novel technique using an alternate soaking process that improves tendon-bone healing by hybridizing the tendon graft with calcium phosphate (CaP). However, the effects of the CaP-hybridized tendon graft on anatomic single-bundle anterior cruciate ligament (ACL) reconstruction remain unclear. Purpose: To determine the effects of CaP-hybridized tendon grafts compared with untreated tendon grafts 6 months after anatomic single-bundle ACL reconstruction using a goat model. Study Design: Controlled laboratory study. Methods: Animals were divided into a CaP group (n = 5 goats) and a control group (n = 5 goats), and we analyzed (1) knee kinematics and in situ forces under applied anterior tibial loads of 50 N and internal tibial torque of 2.0 N·m in the grafts at full extension and at 60° and 90° of knee flexion, (2) the mean percentage of bone tunnel enlargement using computed tomography (CT), and (3) the histology of the tendon-bone interface. Results: The in situ forces under applied anterior tibial loads of 50 N at 60° and 90° of knee flexion in the CaP group were greater than those in the control group (P < .05). The red safranin-O–stained area, indicating glycosaminoglycans in the cartilage layers at the joint aperture sites of the anterior femoral and posterior tibial bone tunnel, was greater in the CaP group than that in the control group (P < .05). The lengths of the nonbonding gap area between the anterior femoral and posterior tibial bone tunnels in the control group were greater than those in the CaP group (P < .05). No significant difference could be detected in the mean percentage of bone tunnel enlargement between the 2 groups. Conclusion: The CaP-hybridized tendon graft enhanced tendon-bone healing at the joint aperture site in both anterior femoral and posterior tibial tunnels 6 months after anatomic single-bundle ACL reconstruction in goats. The in situ forces under applied anterior tibial loads at greater

  8. Effect of graft choice on the outcome of revision anterior cruciate ligament reconstruction in the Multicenter ACL Revision Study (MARS) Cohort

    PubMed Central

    Wright, Rick W.; Huston, Laura J.; Haas, Amanda K.; Spindler, Kurt P.; Nwosu, Sam K.; Allen, Christina R.; Anderson, Allen F.; Cooper, Daniel E.; DeBerardino, Thomas M.; Dunn, Warren R.; Lantz, Brett (Brick) A.; Stuart, Michael J.; Garofoli, Elizabeth A.; Albright, John P.; Amendola, Annunziato (Ned); Andrish, Jack T.; Annunziata, Christopher C.; Arciero, Robert A.; Bach, Bernard R.; Baker, Champ L.; Bartolozzi, Arthur R.; Baumgarten, Keith M.; Bechler, Jeffery R.; Berg, Jeffrey H.; Bernas, Geoffrey A.; Brockmeier, Stephen F.; Brophy, Robert H.; Bush-Joseph, Charles A.; Butler, J. Brad; Campbell, John D.; Carey, James L.; Carpenter, James E.; Cole, Brian J.; Cooper, Jonathan M.; Cox, Charles L.; Creighton, R. Alexander; Dahm, Diane L.; David, Tal S.; Flanigan, David C.; Frederick, Robert W.; Ganley, Theodore J.; Gatt, Charles J.; Gecha, Steven R.; Giffin, James Robert; Hame, Sharon L.; Hannafin, Jo A.; Harner, Christopher D.; Harris, Norman Lindsay; Hechtman, Keith S.; Hershman, Elliott B.; Hoellrich, Rudolf G.; Hosea, Timothy M.; Johnson, David C.; Johnson, Timothy S.; Jones, Morgan H.; Kaeding, Christopher C.; Kamath, Ganesh V.; Klootwyk, Thomas E.; Levy, Bruce A.; Ma, C. Benjamin; Maiers, G. Peter; Marx, Robert G.; Matava, Matthew J.; Mathien, Gregory M.; McAllister, David R.; McCarty, Eric C.; McCormack, Robert G.; Miller, Bruce S.; Nissen, Carl W.; O'Neill, Daniel F.; Owens, Brett D.; Parker, Richard D.; Purnell, Mark L.; Ramappa, Arun J.; Rauh, Michael A.; Rettig, Arthur C.; Sekiya, Jon K.; Shea, Kevin G.; Sherman, Orrin H.; Slauterbeck, James R.; Smith, Matthew V.; Spang, Jeffrey T.; Svoboda, Steven J.; Taft, Timothy N.; Tenuta, Joachim J.; Tingstad, Edwin M.; Vidal, Armando F.; Viskontas, Darius G.; White, Richard A.; Williams, James S.; Wolcott, Michelle L.; Wolf, Brian R.; York, James J.

    2015-01-01

    Background Most surgeons believe that graft choice for ACL reconstruction is an important factor related to outcome. Although graft choice may be limited in the revision setting based on previously used grafts, it is still felt to be important. Hypothesis The purpose of this study was to determine if revision ACL graft choice predicts outcomes related to sports function, activity level, OA symptoms, graft re-rupture, and reoperation at two years following revision reconstruction. We hypothesized that autograft use would result in increased sports function, increased activity level, and decreased OA symptoms (as measured by validated patient reported outcome instruments). Additionally, we hypothesized that autograft use would result in decreased graft failure and reoperation rate 2 years following revision ACL reconstruction. Study Design Prospective cohort study; Level of evidence, 2. Methods Revision ACL reconstruction patients were identified and prospectively enrolled by 83 surgeons over 52 sites. 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 at 2 years, and asked to complete the identical set of outcome instruments. Incidence of additional surgery and reoperation due to graft failure were also recorded. Multivariate regression models were used to determine the predictors (risk factors) of IKDC, KOOS, WOMAC, Marx scores, graft re-rupture, and reoperation rate at 2 years following revision surgery. Results 1205 patients were successfully enrolled with 697 (58%) males. Median age was 26. In 88% this was their first revision. 341 (28%) were undergoing revision by the surgeon that had performed the previous reconstruction. 583 (48%) underwent revision reconstruction utilizing an autograft, 590 (49%) allograft, and 32 (3%) both autograft and allograft. Median time since their last ACL

  9. Risk Factors at Time of Primary ACL Reconstruction that Contribute to Significant Chondral Surface Change at Time of Revision ACL Reconstruction

    PubMed Central

    Kaeding, Christopher C.; Group, Mars

    2016-01-01

    Objectives: Articular cartilage health is an important issue following primary anterior cruciate ligament reconstruction (ACLR). It is not clear what risk factors at the time of primary reconstruction affect future articular cartilage health. The purpose of this study was to examine risk factors affecting chondral surface change in a cohort from the time of primary ACLR to revision ACLR. Methods: Subjects who had both primary and revision data contained in the MOON and MARS registries were included. Data included chondral surface status (grade and size) at time of primary and revision, meniscal status (no treatment/repair, ≤33% excision, >33% excision) at time of primary, time from primary to revision ACLR, and age, sex, BMI, Marx, KOOS, and IKDC at time of revision. Significant chondral surface change was defined as >25% deterioration between time of primary and revision in the femoral condyle, tibial plateau, patella, or trochlea. Logistic regression was used to test each variable’s contribution to significant chondral surface change in the medial compartment, lateral compartment, and patellofemoral compartment. Results: 134 subjects met our inclusion criteria. 34/134 (25.4%) had significant lateral compartment chondral surface change, 32/134 (23.9%) had significant medial compartment chondral surface change, and 31/134 (23.1%) had significant patellofemoral chondral surface change. Median age at time of revision was 19.5 years [IQ range 17-25] and median time from primary to revision was 462.5 days [IQ range 292-1049]. KOOS and IKDC at revision were not associated with significant chondral surface change in any compartment. Patients with >33% of their lateral meniscus excised had 13.5 times the odds of having significant lateral compartment surface change compared to subjects who either did not have lateral meniscal damage, had it repaired, or had an excision of ≤33% controlling for age (p<0.001). Patients with ≤33% excision of their medial meniscus had

  10. KNEE KINEMATICS FOLLOWING ACL RECONSTRUCTION IN FEMALES; THE EFFECT OF VISION ON PERFORMANCE DURING A CUTTING TASK

    PubMed Central

    Di Fabio, Richard P.

    2011-01-01

    Purpose/Background: Specific movement patterns have been identified as influential in ACL injury; however several key kinematic variables that might be predictive of future performance have not been fully investigated. The purpose of this research was to: 1) determine if subjects with ACL reconstruction display different displacement, velocity, and time to peak ground reaction force (GRF) during cutting activities than healthy subjects, 2) observe if subjects with visual disruption display differences in these variables, and 3) determine if visual disruption alters these variables in subjects with ACL reconstruction relative to healthy subjects. Methods: Seventeen healthy female subjects and 17 female subjects with unilateral ACL reconstruction (ACLR) performed 40 trials of a cutting movement during which knee position was measured via a 3D electromagnetic system. Visual conditions were randomized to disrupt vision for 1 second as the subject began the cutting movement, or allow full vision for movement duration. Independent variables were lead/push off leg (ACLR limb or healthy non-dominant limb) and vision (disrupted or full). 2-way ANOVAs were utilized to determine differences between knee kinematics using dependent variables of displacement (m), absolute velocity (m/sec), and time to reach peak GRF (% of cut). Results: Knee displacement was significantly less for ACLR (.76±.11; .75±.16) than non-dominant (.85±.08; .87±.12). Knee velocity was significantly slower for ACLR (.81±.14; .84±.16) than non-dominant (.92±.11; .97±.14). A significant interaction was noted for displacement and average velocity (p<.05). Time to reach peak GRF was significantly longer for ACLR (79.41±2.28) than non-dominant (76.65±4.41). Conclusions: Subjects with ACLR displayed less knee displacement, slower velocity, and an increased time to reach peak GRF relative to healthy subjects' non-dominant knee. Visual disruption appeared to have some effect on movement, as noted by

  11. Comparison of hamstring muscle behavior for anterior cruciate ligament (ACL) patient and normal subject during local marching

    NASA Astrophysics Data System (ADS)

    Amineldin@Aminudin, Nurul Izzaty Bt.; Rambely, A. S.

    2014-09-01

    This study aims to investigate the hamstring muscle activity after the surgery by carrying out an electromyography experiment on the hamstring and to compare the behavior of the ACL muscle activity between ACL patient and control subject. Electromyography (EMG) is used to study the behavior of muscles during walking activity. Two hamstring muscles involved which are semitendinosus and bicep femoris. The EMG data for both muscles were recorded while the subject did maximum voluntary contraction (MVC) and marching. The study concluded that there were similarities between bicep femoris of the ACL and control subjects. The analysis showed that the biceps femoris muscle of the ACL subject had no abnormality and the pattern is as normal as the control subject. However, ACL patient has poor semitendinosus muscle strength compared to that of control subject because the differences of the forces produced. The force of semitendinosus value for control subject was two times greater than that of the ACL subject as the right semitendinosus muscle of ACL subject was used to replace the anterior cruciate ligament (ACL) that was injured.

  12. Functional tests should be accentuated more in the decision for ACL reconstruction.

    PubMed

    Eitzen, Ingrid; Moksnes, Håvard; Snyder-Mackler, Lynn; Engebretsen, Lars; Risberg, May Arna

    2010-11-01

    A high pre-injury activity level, the desire of the patient to continue pivoting sports and fear of future give-way episodes are considered the most significant factors affecting the decision to perform anterior cruciate ligament reconstruction. However, since the functional status of the knee at the time of surgery affects the final outcome, assessments of knee function should be considered in the decision making for surgery. Individuals with anterior cruciate ligament injury can be classified as potential copers or non-copers from an existing screening examination. The purpose of this study was to investigate whether the functional tests incorporated in the original screening examination could contribute to explain those who later go through anterior cruciate ligament reconstruction and to examine whether changes to the content or the time of conducting the screening examination (before or after ten sessions of exercise therapy) could improve its explanatory value. One-hundred and forty-five individuals were included and prospectively followed for 15 months, after where 51% had gone through anterior cruciate ligament reconstruction and 49% were managed non-operatively. The only significant baseline differences between those who later went through anterior cruciate ligament reconstruction and those who were non-operatively treated were that those who had surgery were younger and had a higher activity level (P < 0.05). Regression analyses revealed that the explanatory value for those who later went through anterior cruciate ligament reconstruction significantly improved when the original screening examination was considered compared to only age, activity level and give-way episodes. Changes to the content further improved the explanatory value, with quadriceps muscle strength as the single variable with the highest impact. Finally, conducting the screening examination after ten sessions of progressive exercise therapy gave the overall highest explanatory values

  13. Effect of Intraoperative Platelet-Rich-Plasma Treatment on Post Operative Donor Site Knee Pain in Patellar Tendon Autograft ACL Reconstruction

    PubMed Central

    Walters, Brian L.; Hobart, Sarah; Porter, David; Hogan, Daniel E.; McHugh, Malachy P.; Bedford, Benjamin B.; Nicholas, Stephen J.; Klein, Devon; Harousseau, Kendall

    2016-01-01

    Objectives: Donor site morbidity in the form of anterior knee pain is a frequent complication after bone-patellar tendon-bone (BPTB) autograft ACL reconstruction. The purpose of this Level I study was to examine the effect of the intraoperative administration of platelet-rich plasma on post operative knee pain and patellar defect healing. Methods: Fifty-nine patients (29±12 y/o) undergoing BPTB ACL reconstruction and eligible to enter the study, were randomized to the treatment (PRP; n=31) or non treatment (sham n=28) arms of the study just prior to surgery. In either case, 10 cc of venous blood was drawn prior to the induction of anesthesia and either discarded (sham) or processed (PRP) for preparation of a PRP gel to be later mixed with donor site bone chips and inserted into the patellar defect. At 12 weeks and 6 months after surgery, patients completed IKDC forms and VAS pain scores for ADLs and kneeling (0-10 scale). Healing indices at the donor site were assessed by MRI at 6 months and included the following measurements taken from axial sequences: AP tendon dimensions at the level of the superior tibial cortex, roof of the intercondylar notch and width at the largest patella graft deficit. Mixed model ANOVA was used to assess the effect of PRP on patient symptoms and MRI indices of donor site healing. The primary dependent variable was VAS kneeling pain. It was estimated that with 25 patients per group there would be 80% power to detect a 1.5-point difference in kneeling pain between treatments at P<0.05. A between group difference of 1.5-points in VAS for kneeling pain was deemed to represent a clinically relevant difference. Results: VAS Kneeling Pain at 12 weeks tended to be lower in the PRP versus placebo group (4.5±3.6 vs. 6.2±2.4, P=0.051) but no difference was apparent at 6 months (3.7±3.2 vs. 4.4±2.9, P=0.41). Kneeling pain decreased from 12 weeks to 6 months (P<0.001) with a trend for a greater decrease in the placebo group (Time by Treatment P

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

    PubMed

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

    2014-12-01

    Anterior cruciate ligament (ACL) reconstruction is an increasingly established method even in patients older than 35 years. Our hypothesis is that functional outcome after ACL reconstruction is comparable in patients younger and older than 35 years. A total of 28 patients (5 women and 23 men) with average age of 41.5 years (36-68) were retrospectively evaluated. The average follow-up period was 33 months. All of them were treated operatively with arthroscopic single-bundle four-strand hamstring tendon autograft. The functional outcome was determined by clinical scores (Tegner activity scale and Lysholm knee score). The median values for the Lysholm knee score were preoperatively 77 and postoperatively 96 points (range, 90-100) with significant improvement (p < 0.05) and that for the Tegner activity scale were preoperatively 4.6 points (range, 3-6), which is the same pre- and postoperatively with an overall return to baseline for all patients. No significant correlation between functional outcome and patients' age was present and no reported significant complications. The good results and a high level of patient satisfaction show that ACL reconstruction is justified even in patients (older than 35 years) with symptomatic anterior knee instability. We commonly propose surgical treatment in symptomatic patients who express the need to restore their preinjury activity levels, regardless of their age.

  15. Quantifying Quadriceps Muscle Strength in Patients With ACL Injury, Focal Cartilage Lesions, and Degenerative Meniscus Tears

    PubMed Central

    Eitzen, Ingrid; Grindem, Hege; Nilstad, Agnethe; Moksnes, Håvard; Risberg, May Arna

    2016-01-01

    Background: Reduced quadriceps strength influences knee function and increases the risk of knee osteoarthritis. Thus, it is of significant clinical relevance to precisely quantify strength deficits in patients with knee injuries. Purpose: To evaluate isokinetic concentric quadriceps muscle strength torque values, assessed both from peak torque and at specific knee flexion joint angles, in patients with anterior cruciate ligament (ACL) injury, focal cartilage lesions, and degenerative meniscus tears. Study Design: Cohort study; Level of evidence, 3. Methods: Data were synthesized from patients included in 3 previously conducted research projects: 2 prospective cohort studies and 1 randomized controlled trial. At the time of inclusion, all patients were candidates for surgery. Isokinetic concentric quadriceps muscle strength measurements (60 deg/s) were performed at baseline (preoperative status) and after a period of progressive supervised exercise therapy (length of rehabilitation period: 5 weeks for ACL injury, 12 weeks for cartilage lesions and degenerative meniscus). Outcome measures were peak torque and torque at specific knee flexion joint angles from 20° to 70°. All patients had unilateral injuries, and side-to-side deficits were calculated. For comparisons between and within groups, we utilized 1-way analysis of variance and paired t tests, respectively. Results: In total, 250 patients were included. At baseline, cartilage patients had the most severe deficit (39.7% ± 24.3%; P < .001). Corresponding numbers for ACL and degenerative meniscus subjects were 21.7% (±13.2%) and 20.7% (±16.3%), respectively. At retest, there was significant improvement in all groups (P < .001), with remaining deficits of 24.7% (±18.5%) for cartilage, 16.8% (±13.9%) for ACL, and 3.3% (±17.8%) for degenerative meniscus. Peak torque was consistently measured at 60° of knee flexion, whereas the largest mean deficits were measured at 30° at baseline and 70° at retest for the

  16. 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

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

    PubMed Central

    Aue Sobol, Nanna; Andersen, Lars L.; Kiel, Peter; Løfholm, Peter; Magnusson, S. Peter; Krogsgaard, Michael R.

    2014-01-01

    Objective. Persistent weakness is a common problem after anterior cruciate ligament- (ACL-) reconstruction. This study investigated the effects of high-intensity (HRT) versus low-intensity (LRT) resistance training on leg extensor power and recovery of knee function after ACL-reconstruction. Methods. 31 males and 19 females were randomized to HRT (n = 24) or LRT (n = 26) from week 8–20 after ACL-reconstruction. Leg extensor power, joint laxity, and self-reported knee function were measured before and 7, 14, and 20 weeks after surgery. Hop tests were assessed before and after 20 weeks. Results. Power in the injured leg was 90% (95% CI 86–94%) of the noninjured leg, decreasing to 64% (95% CI 60–69%) 7 weeks after surgery. During the resistance training phase there was a significant group by time interaction for power (P = 0.020). Power was regained more with HRT compared to LRT at week 14 (84% versus 73% of noninjured leg, resp.; P = 0.027) and at week 20 (98% versus 83% of noninjured leg, resp.; P = 0.006) without adverse effects on joint laxity. No other between-group differences were found. Conclusion. High-intensity resistance training during rehabilitation after ACL-reconstruction can improve muscle power without adverse effects on joint laxity. PMID:24877078

  18. Bridge-Enhanced ACL Repair: A Review of the Science and the Pathway through FDA Investigational Device Approval

    PubMed Central

    Proffen, Benedikt L.; Perrone, Gabriel S.; Roberts, Gordon; Murray, Martha M.

    2016-01-01

    Injuries to the anterior cruciate ligament (ACL) are currently treated with replacement of the torn ligament with a graft of tendon harvested from elsewhere in the knee. This procedure, called "ACL reconstruction," is excellent for restoring gross stability to the knee; however, there are relatively high graft failure rates in adolescent patients,4, 12, 60 and the ACL reconstruction procedure does not prevent the premature osteoarthritis seen in patients after an ACL injury.1, 46, 52 Thus, new solutions are needed for ACL injuries. Researchers have been investigating the use of scaffolds, growth factors and cells to supplement a suture repair of the ACL (bio-enhanced repair). In this paper, we will review the varied approaches, which have been investigated for stimulating ACL healing and repair in preclinical models and how one of these technologies was able to move from promising preclinical results to FDA acceptance of an Investigational Device Exemption (IDE) application for a first-in-human study. PMID:25631206

  19. Calcium phosphate-hybridized tendon graft to enhance tendon-bone healing two years after ACL reconstruction in goats

    PubMed Central

    2011-01-01

    Background We developed a novel technique to improve tendon-bone attachment by hybridizing calcium phosphate (CaP) with a tendon graft using an alternate soaking process. However, the long-term result with regard to the interface between the tendon graft and the bone is unclear. Methods We analyzed bone tunnel enlargement by computed tomography and histological observation of the interface and the tendon graft with and without the CaP hybridization 2 years after anterior cruciate ligament (ACL) reconstruction in goats using EndoButton and the postscrew technique (CaP, n = 4; control, n = 4). Results The tibial bone tunnel enlargement rates in the CaP group were lower than those in the control group (p < 0.05). In the CaP group, in the femoral and tibial bone tunnels at the anterior and posterior of the joint aperture site, direct insertion-like formation that contained a cartilage layer without tidemarks was more observed at the tendon-bone interface than in the control group (p < 0.05). Moreover, the gap area between the tendon graft and the bone was more observed at the femoral bone tunnel of the joint aperture site in the control group than in the CaP group (p < 0.05). The maturation of the tendon grafts determined using the ligament tissue maturation index was similar in both groups. Conclusions The CaP-hybridized tendon graft enhanced the tendon-bone healing 2 years after ACL reconstruction in goats. The use of CaP-hybridized tendon grafts can reduce the bone tunnel enlargement and gap area associated with the direct insertion-like formation in the interface near the joint. PMID:22166674

  20. What is the best candidate allograft for ACL reconstruction? An in vitro mechanical and histologic study in a canine model.

    PubMed

    Qu, Jin; Thoreson, Andrew R; An, Kai-Nan; Amadio, Peter C; Zhao, Chunfeng

    2015-07-16

    The knee joint is generally characterized by very low friction and high wear resistance. Several previous studies have compared ACL with the commonly used allografts from tensile properties perspective. No study has reported about the graft tendons from a frictional perspective, which is an important parameter for ACL functional performance. Twenty hind legs were used to harvest FDP tendon, ACL, ACH, and patellar tendon. Samples were evaluated with surface friction testing, indentation testing for tendon compressive moduli, lubricin immunohistochemistry, and histologic analysis. Frictional force of FDP tendon and ACL was significantly less than that of patellar tendon and ACH at first and fifth cycles. At the tenth cycle, the FDP tendon, ACL, and ACH showed significantly less frictional force than patellar tendon; after 100 cycles, the FDP tendon and ACL showed significantly less frictional force than patellar tendon. The compressive moduli of the FDP tendon, ACL, and ACH were significantly greater than that of patellar tendon. Histologic results showed that FDP tendon and ACL had a smooth surface with a thin layer of epitenon cells; patellar tendon and ACH had a rough surface and a layer of paratenon. Lubricin was found on the surface and extracellular matrix of FDP tendon and ACL. There was only limited lubricin expression on the surface and extracellular matrix of the ACH and patellar tendon. The FDP tendon has friction force and lubricin expression similar to those of native ACL. However, patellar tendon and ACH show higher friction force and less lubricin expression than ACL. PMID:25981102

  1. Individualized anatomic anterior cruciate ligament reconstruction.

    PubMed

    van Eck, Carola F; Widhalm, Harrald; Murawski, Christopher; Fu, Freddie H

    2015-02-01

    Anterior cruciate ligament (ACL) injuries are often seen in young participants in sports such as soccer, football, and basketball. Treatment options include conservative management as well as surgical intervention, with the goal of enabling the patient to return to cutting and pivoting sports and activities. Individualized anatomic ACL reconstruction is a surgical technique that tailors the procedure to the individual patient using preoperative measurements on plain radiographs and magnetic resonance imaging and intraoperative measurement to map the patients' native ACL anatomy in order to replicate it as closely as possible. Anatomic ACL reconstruction, therefore, is defined as reconstruction of the ACL to its native dimensions, collagen orientation, and insertion site. The surgical reconstruction is followed by a specific rehabilitation protocol that is designed to enable the patient to regain muscle strength and proprioception while facilitating healing of the reconstructed ACL prior to the patient's returning to sports activities.

  2. Do early quadriceps exercises affect the outcome of ACL reconstruction? A randomised controlled trial.

    PubMed

    Shaw, Triston; Williams, Marie T; Chipchase, Lucy S

    2005-01-01

    A prospective, blinded, randomised controlled trial investigated the effectiveness of quadriceps exercises following anterior cruciate ligament reconstruction. A treatment group (Quadriceps exercise group) performed straight leg raises and isometric quadriceps contractions throughout the first two postoperative weeks, and a second group (No quadriceps exercise group) did not. A battery of outcome measures assessed subjects postoperatively at day one, two weeks, and one, three and six months. A total of 103 patients (Quadriceps exercise n = 48, No quadriceps exercise n = 55) commenced the study with 91 subjects available at final follow up (Quadriceps exercise n = 47, No quadriceps exercise n = 44). Performance of quadriceps exercises significantly improved a number of knee flexion and extension range of motion measurements (p = 0.01 to 0.04). No significant differences were found between the two groups at any postoperative period for quadriceps lag (p = 0.36), functional hop testing (p = 0.49 to 0.51), isokinetic quadriceps strength (p = 0.70 to 0.72), the majority of numerical analogue scores (p = 0.1 to 0.94) and Cincinnati scores (p = 0.10 to 0.84). Subjects performing quadriceps exercises reported significantly higher pain scores with exercise on the first postoperative day (p = 0.02). At six months postoperatively, the Quadriceps exercise subjects reported significantly more favourable Cincinnati scores for symptoms (p = 0.005) and problems with sport (p = 0.05). While average knee laxity was not significantly different between treatment groups over time (p = 0.27 to 0.94), quadriceps exercise performance was associated with a significantly lower incidence of abnormal knee laxity. Isometric quadriceps exercises and straight leg raises can be safely prescribed during the first two postoperative weeks and confer advantages for faster recovery of knee range of motion and stability. It remains to be proven whether the magnitude of differences between groups is

  3. Increased Risk of Revision after ACL Reconstruction with Soft Tissue Allograft Compared to Autograft

    PubMed Central

    Maletis, Gregory; Chen, Jason; Inacio, Maria Carolina Secorun; Love, Rebecca; Funahashi, Tadashi Ted

    2016-01-01

    Objectives: The use of allograft tissue for anterior cruciate ligament reconstruction (ACLR) remains controversial. Numerous meta-analysis and systematic reviews of small clinical studies have not found differences between autograft and allograft outcomes but large registry studies have shown an increased risk of revision with allografts. The purpose of this study was to compare the risk of aseptic revision between bone-patellar tendon-bone (BPTB) autografts, hamstring tendon autografts and soft tissue allografts. Methods: A retrospective cohort study of prospectively collected data was conducted using an US ACLR Registry. A cohort of primary unilateral ACLR cases reconstructed with BPTB autografts, hamstring autografts and soft tissue allografts (from any site) was identified. Aseptic revision was the end point of the study. Type of graft and allograft processing methods (non-processed, <1.8Mrads with and without chemical processing (Allowash or AlloTrue methods), >1.8 Mrads irradiation with and without chemical processing, and chemical processing alone (BioCleanse)) were the exposures of interest evaluated. Time from surgery was evaluated as an effect modifier. All analyses were adjusted for age, gender, and race. Kaplan-Meier curves and Cox proportional hazard models were employed. Hazard ratios (HR), 95% confidence intervals (CI) are provided. Results: The cohort had 14015 cases, 8924 (63.7%) were male, 6397 (45.6%) were White, 4557 (32.5%) cases used BPTB autograft, 3751 (26.8%) cases used soft tissue allograft and 5707 (40.7%) cases used hamstring autograft. The median age was 34.6 years-old (IQR 24.1-43.2) for allograft cases and 24.3 years-old (IQR 17.7-33.8) for hamstring autograft cases, and 22.0 years-old (IQR 17.6-30.0) for BPTB autograft cases. Compared to hamstring tendon autografts, an increased risk of revision was found in allografts processed with >1.8Mrads without chemical processing after 2.5 years (HR: 3.88 95%CI 1.48-10.12), and >1.8Mrads with

  4. Two-Stage Revision Anterior Cruciate Ligament Reconstruction.

    PubMed

    Erickson, Brandon J; Cvetanovich, Gregory; Waliullah, Khalid; Khair, Michael; Smith, Patrick; Bach, Bernard; Sherman, Seth

    2016-05-01

    The number of primary anterior cruciate ligament (ACL) tears is rapidly increasing. In patients who wish to return to their preoperative level of function, specifically as it pertains to participation in sports, the gold standard of treatment following an ACL tear remains an anterior cruciate ligament (ACL) reconstruction. Despite a majority of good/excellent results following primary ACL reconstruction, there is a growing subset of patients with persistent or recurrent functional instability who require revision ACL reconstruction. Preoperative planning for revision ACL reconstruction requires a careful understanding of the root cause of ACL failure, including possible technical causes of primary ACL failure and the presence of combined knee pathology that was not addressed at the index ACL reconstruction. The decision to perform 2-stage revision ACL reconstruction is multifactorial and is reached by technical considerations that may make a 1-stage revision less optimal, including tunnel widening, arthrofibrosis, active infection, and others. Concomitant knee pathology such as meniscal deficiency, malalignment (including an increase in posterior tibial slope), chondral lesions, and other ligamentous laxity may also require a staged approach to treatment. This evidence-based review covers the indications for 2-stage revision ACL reconstruction, surgical techniques, evidence for and technique of bone grafting prior ACL tunnels, and outcomes of 2-stage revision stratified by initial cause of ACL reconstruction failure. With proper preoperative planning and an understanding of the cause of failure following the primary ACL reconstruction, revision ACL reconstruction can offer excellent outcomes in the motivated patient. [Orthopedics. 2016; 39(3):e456-e464.]. PMID:27045480

  5. The Influence of Task Complexity on Knee Joint Kinetics Following ACL Reconstruction

    PubMed Central

    Schroeder, Megan J.; Krishnan, Chandramouli; Dhaher, Yasin Y.

    2015-01-01

    Background Previous research indicates that subjects with anterior cruciate ligament reconstruction exhibit abnormal knee joint movement patterns during functional activities like walking. While the sagittal plane mechanics have been studied extensively, less is known about the secondary planes, specifically with regard to more demanding tasks. This study explored the influence of task complexity on functional joint mechanics in the context of graft-specific surgeries. Methods In 25 participants (10 hamstring tendon graft, 6 patellar tendon graft, 9 matched controls), three-dimensional joint torques were calculated using a standard inverse dynamics approach during level walking and stair descent. The stair descent task was separated into two functionally different sub-tasks—step-to-floor and step-to-step. The differences in external knee moment profiles were compared between groups; paired differences between the reconstructed and non-reconstructed knees were also assessed. Findings The reconstructed knees, irrespective of graft type, typically exhibited significantly lower peak knee flexion moments compared to control knees during stair descent, with the differences more pronounced in the step-to-step task. Frontal plane adduction torque deficits were graft-specific and limited to the hamstring tendon knees during the step-to-step task. Internal rotation torque deficits were also primarily limited to the hamstring tendon graft group during stair descent. Collectively, these results suggest that task complexity was a primary driver of differences in joint mechanics between anterior cruciate ligament reconstructed individuals and controls, and such differences were more pronounced in individuals with hamstring tendon grafts. Interpretation The mechanical environment experienced in the cartilage during repetitive, cyclical tasks such as walking and other activities of daily living has been argued to contribute to the development of degenerative changes to the joint

  6. BIOMECHANICAL STUDY OF TRANSCORTICAL OR TRANSTRABECULAR BONE FIXATION OF PATELLAR TENDON GRAFT WITH BIOABSORBABLE PINS IN ACL RECONSTRUCTION IN SHEEP

    PubMed Central

    Albano, Mauro Batista; Borges, Paulo César; Namba, Mario Massatomo; da Silva, João Luiz Vieira; de Assis Pereira Filho, Francisco; Filho, Edmar Stieven; Matias, Jorge Eduardo Fouto

    2015-01-01

    Objective: To determine the initial resistance of fixation using the Rigid Fix® system, and compare it with traditional fixation methods using metal interference screws; and to evaluate the resistance of the fixation with the rigid fix system when the rotational position of the bone block is altered in the interior of the femoral tunnel. Methods: forty ovine knee specimens (stifle joints) were submitted to anterior cruciate ligament reconstruction (ACL) using a bone-tendon-bone graft. In twenty specimens, the Rigid Fix method was used; this group was subdivided into two groups: ten knees the pins transfixed only the spongious area of the bone block, and ten for fixation passing through the layer of cortical bone. In the twenty remaining specimens, the graft was fixed with 9mm metal interference screws. Results: comparison of the RIGIDFIX® method with the metal interference screw fixation method did not show any statistically significant differences in terms of maximum load and rigidity; also, there were no statistically significant differences when the rotational position of the bone block was altered inside the femoral tunnel. For these evaluations, a level of significance of p < 0.017 was considered. Conclusion: fixation of the bone-tendon-bone graft with 2 bioabsorbable pines, regardless of the rotational position inside the femoral tunnel, gave a comparable fixation in terms of initial resistance to the metal interference screw, in this experimental model. PMID:27027081

  7. 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

  8. Injury patterns in patients presenting with a recurrent anterior cruciate ligament tear following primary reconstruction

    PubMed Central

    Sayampanathan, Andrew A.; Bin Abd Razak, Hamid Rahmatullah; Chong, Hwei Chi; Tan, Hwee-Chye Andrew

    2016-01-01

    Background An anterior cruciate ligament (ACL) graft rupture or a primary ACL injury in the contralateral knee is one of the greatest concerns of patients following primary anterior cruciate ligament reconstruction (ACLR). Our study describes the epidemiology and presence of concomitant meniscal injuries of patients with a graft rupture following primary ACLR or a primary rupture of the contralateral ACL following primary ACLR of the ipsilateral knee. Methods We reviewed the medical records of 42 patients who underwent a second ACLR. ACLR was performed using the ipsilateral semitendinosus and gracilis autograft. Variables extracted included the presence of concomitant MM and LM injuries intra-operatively, the patients’ level of intensity of sport (light, moderate, strenuous), duration of rehabilitation and mechanism of injury (contact, non-contact). Results Twenty-four (57.1%) patients had graft rupture of a previously reconstructed ACL of which 20 (83.3%) were male and 18 (42.9%) patients had a primary ACL tear of the contralateral knee following ACLR of the ipsilateral knee of which 18 (100%) were male. Patient who sustained a graft rupture were younger (29.5 vs. 31.9 years), had a higher body mass index (BMI) (26.42 vs. 25.10 kg/m2) and had a longer time before re-injury (6.18 vs. 4.94 years). Concomitant meniscal injury rates were comparable in both groups and the medial meniscus was injured more often. Conclusions This study describes the demographics of 2nd ACL injuries in the Asian population. Additional studies that investigate the differences in knee anatomy of Asians and Caucasians and their impact on ACL injuries should be performed. PMID:27429958

  9. Adolescent ACL injury: treatment considerations.

    PubMed

    Pavlovich, Raymond; Goldberg, Steven H; Bach, Bernard R

    2004-04-01

    Anterior cruciate ligament (ACL) injury in a skeletally immature patient presents unique treatment challenges. In many cases, conservative treatment with bracing and physical therapy fails, resulting in recurrent instability, pain, swelling, and meniscal and chondral injury. The goal of surgical reconstruction is to recreate ACL stability without causing growth plate arrest, leg-length discrepancy, or angular deformity. Patient characteristics such as skeletal age, Tanner stage, onset of menses, family member height, growth spurt, recent change in foot size, and growth charts can help the surgeon approximate the degree of skeletal maturity and aid in selecting the timing and safest type of reconstruction. Numerous surgical techniques, ranging from an extra-articular reconstruction to intra-articular graft passage without physeal violation to standard transtibial and transfemoral tunnel placement with physeal violation, have been popularized. The majority of existing studies are retrospective case series, describing a particular author's specific technique experience. This article reviews the basic science and clinical literature, presents a treatment algorithm, and provides several case studies.

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

    PubMed Central

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

    2015-01-01

    Background: Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample. Purpose: To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients’ medical records were also thoroughly reviewed. Results: Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P < .017). Conclusion: Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction

  11. Quadriceps Muscle Function After Rehabilitation With Cryotherapy in Patients With Anterior Cruciate Ligament Reconstruction

    PubMed Central

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

    2014-01-01

    Context: Persistent muscle weakness after anterior cruciate ligament (ACL) reconstruction may be due to underlying activation failure and arthrogenic muscle inhibition (AMI). Knee-joint cryotherapy has been shown to improve quadriceps function transiently in those with AMI, thereby providing an opportunity to improve quadriceps muscle activation and strength in patients with a reconstructed ACL. Objective: To compare quadriceps muscle function in patients with a reconstructed ACL who completed a 2-week intervention including daily cryotherapy (ice bag), daily exercises, or both. Design: Cross-sectional study. Setting: Laboratory. Patients or Other Participants: A total of 30 patients with reconstructed ACLs who were at least 6 months post-index surgery and had measurable quadriceps AMI. Intervention(s): The patients attended 4 supervised visits over a 2-week period. They were randomly assigned to receive 20 minutes of knee-joint cryotherapy, 1 hour of therapeutic rehabilitation exercises, or cryotherapy followed by exercises. Main Outcome Measure(s): We measured quadriceps Hoffmann reflex, normalized maximal voluntary isometric contraction torque, central activation ratio using the superimposed-burst technique, and patient-reported outcomes before and after the intervention period. Results: After the 2-week intervention period, patients who performed rehabilitation exercises immediately after cryotherapy had higher normalized maximal voluntary isometric contraction torques (P = .002, Cohen d effect size = 1.4) compared with those who received cryotherapy alone (P = .16, d = 0.58) or performed exercise alone (P = .16, d = 0.30). Conclusions: After ACL reconstruction, patients with AMI who performed rehabilitation exercises immediately after cryotherapy experienced greater strength gains than those who performed cryotherapy or exercises alone. PMID:25299442

  12. The immunosuppressive effect of Siglecs on tendon-bone healing after ACL reconstruction.

    PubMed

    Hu, Jiang; Yao, Bin; Yang, Xiao; Ma, Fang

    2015-01-01

    The quality of the bone-tendon healing is very important to the surgery outcome after anterior cruciate ligament reconstruction. The necrosis of autograft and local new blood vessels occur after the surgery. The fibroblasts and mesenchymal cells presenting in the tendon-bone interface as well as the infiltrated of neutrophils and macrophages improve the biomechanical properties of the healing. We hypothesize that immunosuppressive effect of Siglecs which present on the surface of neutrophils and macrophages play the important roles to regulate acute local inflammatory reaction, maintain the physiological environment and induce the differentiation of the pluripotent cells to form the accepted histologic structure healing of the tendon-bone interface. It might be helpful to understand the mechanism of tendon-bone healing.

  13. Effects of Single-Bundle and Double-Bundle ACL Reconstruction on Tibiofemoral Compressive Stresses and Joint Kinematics During Simulated Squatting

    PubMed Central

    Mulcahey, Mary K.; Monchik, Keith O.; Yongpravat, Charlie; Badger, Gary J.; Fadale, Paul D.; Hulstyn, Michael J.; Fleming, Braden C.

    2011-01-01

    The purpose of this study was to compare tibiofemoral (TF) kinematics and TF compressive stresses between single bundle- (SB-) and double bundle-ACL reconstruction (DB-ACLR) during simulated squatting. Twelve matched pairs of fresh frozen cadaver knees were utilized. A simulated squat through 100° of knee flexion was performed in the ACL-intact joint. The ACL was transected and SB- and DB-ACLR procedures were performed in one knee of each pair. The squat was repeated. Knee kinematics were measured using a motion tracking system and the TF compressive forces were measured using thin film pressure sensors. The posterior shifts of the tibia for SB- and DB-ACLR knees were significantly greater than the ACL-intact condition for knee flexion angles 0° to 40° (p<.05). However, there was no difference between the SB- and DB-ACLR knees at any flexion angle (0° to 100°; p=.37). SB- and DB-ACLR knees had greater IE rotation than intact knees from 90° through 50° of flexion (p<.05), but not between 40° and full extension. There was no difference between SB- and DB-ACLR knees (p=.68). The TF compressive stresses of the DB-ACLR were significantly lower than intact for all angles except 10° (p=.06), whereas SB-ACLR knees did not differ from intact at flexion angles between 30° and 50° (p>.32). There were no significant differences between the two reconstruction conditions (p=.74). This study showed that there was no difference in the TF kinematics or compressive stresses between SB- and DB-ACLR, and only minor differences when compared to the intact state. PMID:21696962

  14. Biomechanical Deficiencies in Women with Semitendinosus-Gracilis ACL Reconstruction During Drop Jumps

    PubMed Central

    Ortiz, Alexis; Capo-Lugo, Carmen E.; Venegas-Rios, Heidi L.

    2014-01-01

    Objective To compare landing mechanics and neuromuscular recruitment strategies between women with semitendinosus-gracilis anterior cruciate ligament reconstruction (SG-ACLr) and non-injured women during double and single-legged drop jumps. Design Cross-sectional biomechanical study Setting Single university-based biomechanics laboratory Participants Fourteen women 1–5 years post SG-ACLr and 16 non-injured women participated in this study. Methods After anthropometric measurements, warm-up, and familiarization procedures, participants performed five trials of a double and single-legged drop jumps. Main Outcome Measurements Dynamic knee valgus was measured as the distance between knee joints during the landing phase of the double-leg drop jumps. Medial knee displacement was the outcome considered during the landing phase of the single-leg drop jumps. For both drop jumps tasks neuromuscular recruitment was evaluated through rectified normalized electromyography (EMG) activity of the quadriceps and hamstrings (amplitude and latency), and quadriceps/hamstrings EMG co-contraction ratio. Results Although the SG- ACLr group demonstrated a tendency towards a greater dynamic knee valgus during both drop jumps, these differences did not reach statistical significance. EMG data revealed different neuromuscular strategies for each group depending on the specific jump. Conclusions These findings suggest that women with SG-ACLr have a tendency towards greater dynamic knee valgus which could predispose to additional knee injuries. Rehabilitation specialists need to be aware of existing kinematic and neuromuscular deficiencies years after SG-ACLr. Taking this into consideration will aid in prescribing appropriate interventions designed to prevent re-injury. PMID:25043260

  15. An Australian survey of in-patient protocols for quadriceps exercises following anterior cruciate ligament reconstruction.

    PubMed

    Shaw, T; McEvoy, M; McClelland, J

    2002-12-01

    Current practices regarding in-patient strengthening exercise prescription following anterior cruclate ligament (ACL) reconstruction are scarcely addressed in the literature and remain unreported for Australian hospitals. An observational, questionnaire-based study was used to Investigate in-patient quadriceps strengthening practices in Australian hospitals after ACL reconstruction. Questionnaires were returned by 248 hospitals (76% response rate) and of these 88 hospitals reported performing ACL reconstructions. These hospitals were surveyed to determine the types of quadriceps strengthening exercises prescribed during the in-patient period. Information was sought regarding routine management strengthening practices. A variety of quadriceps exercises such as static quadriceps contractions (SQC), straight leg raises (SLR) and inner range quadriceps (IRQ) were frequently prescribed, although no standard practice currently exists. Static quadriceps exercises were prescribed by 91% of hospitals surveyed, IRQ exercises were used by 30%, and 49% reported using SLR exercises. Current literature tends to support the performance of SQC and SLR exercises during the early postoperative period following ACL reconstruction. Conversely, current clinical practice is incongruent with regard to the scientific recommendations for IRQ performance.

  16. Are Articular Cartilage Lesions and Meniscus Tears Predictive of IKDC, KOOS, and Marx Activity Level Outcomes after ACL Reconstruction? A 6-Year Multicenter Cohort Study

    PubMed Central

    Cox, Charles L.; Huston, Laura J.; Dunn, Warren R.; Reinke, Emily K.; Nwosu, Samuel K.; Parker, Richard D.; Wright, Rick W.; Kaeding, Christopher C.; Marx, Robert G.; Amendola, Annunziata; McCarty, Eric C.; Wolf, Brian R.; Harrell, Frank E.; Spindler, Kurt P.

    2014-01-01

    Background Identifying risk factors for inferior outcomes after ACL reconstruction (ACLR) is important for prognosis and future treatment. The goal of this study was to determine whether articular cartilage and meniscal variables are predictive of 3 validated sports outcome instruments after ACLR. Hypothesis/Purpose We hypothesized that articular cartilage lesions and meniscus tears/treatment would be predictors of the IKDC, KOOS (all 5 subscales), and Marx activity level at 6 years following ACLR. Study Design Prospective cohort, Level 1 Methods Between 2002 and 2004, 1512 ACLR subjects were prospectively enrolled and followed longitudinally with the IKDC, KOOS, and Marx activity score completed at entry, 2, and 6 years. A logistic regression model was built incorporating variables from patient demographics, surgical technique, articular cartilage injuries, and meniscus tears/treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx at 6 years. Results We completed a minimum follow-up on 86% (1307/1512) of our cohort at 6 years. The cohort was 56% male, had a median age of 23 years at the time of enrollment, with 76% reporting a non-contact injury mechanism. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC]-25%, lateral femoral condyle [LFC]-20%, medial tibial plateau [MTP]-6%, lateral tibial plateau [LTP]-12%, patella-20%, trochlear-9%) and meniscal (medial-38%, lateral-46%). Both articular cartilage lesions and meniscal tears were significant predictors of 6-year outcomes on IKDC and KOOS. Grade 3 or 4 articular cartilage lesions (excluding patella) significantly reduced IKDC and KOOS scores at 6 years. IKDC demonstrated worse outcomes with the presence of a grade 3-4 chondral lesion on the MFC, MTP, and LFC. Likewise, KOOS was negatively affected by cartilage injury. The sole significant predictor of reduced Marx activity was the presence of a grade 4 lesion

  17. What I have learned about the ACL: utilizing a progressive rehabilitation scheme to achieve total knee symmetry after anterior cruciate ligament reconstruction.

    PubMed

    Shelbourne, K Donald; Klotz, Christine

    2006-05-01

    Anterior cruciate ligament surgery and rehabilitation have changed drastically during the past 30 years. The patellar tendon autograft fixed with buttons provides tight bone-to-bone placement of the graft and quick bony healing, which allows accelerated rehabilitation to obtain full range of motion and strength. Although surgical stability is easily reproducible, long-term patient satisfaction is difficult to guarantee. Full knee range of motion should be compared to that of the contralateral normal knee, including full hyperextension. We followed the progress of all patients to gauge the utility of our rehabilitation program. In order of importance, the lack of normal knee range of motion (within 2 degrees extension and 5 degrees of flexion compared with that of the normal knee), partial or total medial meniscectomy, partial or total lateral meniscectomy, and articular cartilage damage were related to lower subjective scores. Rehabilitation after ACL reconstruction must first strive to achieve full symmetrical knee range of motion before aggressive strengthening can begin. Our current perioperative rehabilitation starts at the time of injury and preoperatively includes aggressive swelling reduction, hyperextension exercises, gait training, and mental preparation. Goals after surgery are to control swelling while regaining full knee range of motion. After quadriceps strengthening goals are reached, patients can shift to sport-specific exercises. When using a graft from the contralateral knee, the conflicting goals of strengthening the donor site and achieving full knee range of motion are divided between the knees. Thus, normal range of motion and strength can be achieved more easily and more quickly than when using an ipsilateral graft. Regardless of the graft source, a systematic rehabilitation program that emphasizes the return to symmetrical knee motion, including hyperextension, is necessary to achieve the optimum result.

  18. Tibial translation and muscle activation during rehabilitation exercises 5 weeks after anterior cruciate ligament reconstruction.

    PubMed

    Tagesson, S; Oberg, B; Kvist, J

    2010-02-01

    The aim of this study was to compare different rehabilitation exercises with respect to dynamic anterior tibial translation and muscle activation 5 weeks after an anterior cruciate ligament (ACL) reconstruction. Another aim was to compare the ACL-reconstructed knee with the ACL-injured and the uninjured knees for differences in anterior tibial translation and muscle activation during the exercises. Sagittal tibial translation and muscle activation were measured during the Lachman test (static translation) and during seven rehabilitation exercises (dynamic translation) in 19 patients. Results obtained 5 weeks after ACL reconstruction were compared with those obtained before the ACL reconstruction (ACL-deficient and uninjured knee). After ACL reconstruction the seated knee extension produced more anterior tibial translation than the straight leg raise and standing on one leg. The ACL reconstruction reduced the static and the dynamic tibial translation and the tibial translations measured in ACL-reconstructed knees were similar to those measured in uninjured knees. After ACL reconstruction, the patients used a joint stiffening strategy that used more hamstring activation and reduced the dynamic tibial translation. Although all exercises tested are suitable for rehabilitation after ACL reconstruction, to protect the graft from excessive strain, the straight leg raise and squat on one leg are preferable for quadriceps training in the early phase of rehabilitation.

  19. ACL reconstruction - discharge

    MedlinePlus

    ... sleeping without the brace and removing it for showers. When the brace is off for any reason, ... dressing and bandage clean and dry . You can shower again after your dressing is removed. When you ...

  20. Management of ventricular fibrillation or unstable ventricular tachycardia in patients with congenital long-QT syndrome: a suggested modification to ACLS guidelines.

    PubMed

    Homme, Jason H; White, Roger D; Ackerman, Michael J

    2003-10-01

    Prolongation of the QT interval is a known risk factor for syncope, seizures and sudden cardiac death. Most patients with QT prolongation have an acquired cause, but congenital forms of QT prolongation are being increasingly recognized. However, existing advanced cardiac life support (ACLS) treatment algorithms for prolonged QT mediated ventricular fibrillation pertains to acquired long-QT syndrome (LQTS). Here, a young patient with out-of-hospital cardiac arrest secondary to congenital LQTS illustrates critical exceptions to the current ACLS treatment algorithms for ventricular fibrillation and unstable ventricular tachycardia when QT prolongation is congenital in origin. A clarified ACLS algorithm is proposed.

  1. Knee Contact Force Asymmetries in Patients Who Failed Return-to-Sport Readiness Criteria 6 Months After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Gardinier, Emily S.; Di Stasi, Stephanie; Manal, Kurt; Buchanan, Thomas S.; Snyder-Mackler, Lynn

    2015-01-01

    Background After anterior cruciate ligament (ACL) injury, contact forces are decreased in the injured knee when compared with the uninjured knee. The persistence of contact force asymmetries after ACL reconstruction may increase the risk of reinjury and may play an important role in the development of knee osteoarthritis in these patients. Functional performance may also be useful in identifying patients who demonstrate potentially harmful joint contact force asymmetries after ACL reconstruction. Hypothesis Knee joint contact force asymmetries would be present during gait after ACL reconstruction, and performance on a specific set of validated return-to-sport (RTS) readiness criteria would discriminate between those who demonstrated contact force asymmetries and those who did not. Study Design Descriptive laboratory study. Methods A total of 29 patients with ACL ruptures participated in gait analysis and RTS readiness testing 6 months after reconstruction. Muscle and joint contact forces were estimated using an electromyography (EMG)–driven musculoskeletal model of the knee. The magnitude of typical limb asymmetry in uninjured controls was used to define limits of meaningful limb asymmetry in patients after ACL reconstruction. The RTS testing included isometric quadriceps strength testing, 4 unilateral hop tests, and 2 self-report questionnaires. Paired t tests were used to assess limb symmetry for peak medial and tibiofemoral contact forces in all patients, and a mixed-design analysis of variance was used to analyze the effect of passing or failing RTS testing on contact force asymmetry. Results Among all patients, neither statistically significant nor meaningful contact force asymmetries were identified. However, patients who failed RTS testing exhibited meaningful contact force asymmetries, with tibiofemoral contact force being significantly lower for the involved knee. Conversely, patients who passed RTS testing exhibited neither significant nor meaningful

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

    PubMed

    Carter, Thomas R; Rabago, Michael T

    2016-05-01

    Purpose The purpose of this study was to evaluate the outcomes for patients younger than 25 years who had anterior cruciate ligament (ACL) reconstructions with allograft tissue. Methods A total of 52 ACL reconstructions performed with fresh-frozen, nonirradiated tibialis or Achilles allografts in active patients younger than 25 years. Outcome evaluations included the International Knee Documentation Committee (IKDC) objective and subjective forms, KT-1000 arthrometry and Lysholm. Results Forty-two patients were available for follow-up at an average follow-up of 65 months (range, 33-99 months). The average age at surgery was 17 years and 7 months (range, 11 years 10 months-24 years 8 months). Objective and subjective data were obtained from 37 patients with 1 requiring revision, and 5 patients had only subjective data. IKDC objective results were 29-A and 5-B. KT-1000 differences were 0 mm for 4 patients, 1 mm for 23, 2 mm for 8, 3 mm for 1, and > 5 mm for 1 patient. The average IKDC subjective score was 90.2 ± 15.0 and average Lysholm score was 90.0 ± 11. Conclusion The result of our study found that using nonirradiated Achilles or tibialis tendon allografts for ACL reconstructions in active patients younger than 25 years can achieve good outcomes, with a low rate of failure. PMID:26227787

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

    PubMed

    Carter, Thomas R; Rabago, Michael T

    2016-05-01

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

  4. Anterolateral Extra-articular Soft Tissue Reconstruction in Anterolateral Rotatory Instability of the Knee.

    PubMed

    Kernkamp, Willem A; van de Velde, Samuel K; Bakker, Eric W P; van Arkel, Ewoud R A

    2015-12-01

    Anterolateral rotatory instability (ALRI) occurs after injury to the anterior cruciate ligament (ACL) and the anterolateral structures of the knee. We present a technique for anterolateral extra-articular soft-tissue (ALES) reconstruction of the knee that can be used in revision ACL reconstruction cases, cases of persistent ALRI after adequate ACL reconstruction, and cases with severe ALRI after primary ACL rupture. The surgeon performs ALES reconstruction with a strip of iliotibial tract autograft while respecting the anatomic origin and insertion of the anterolateral ligament. The purpose of this reconstruction is to restore the normal anterolateral rotatory stability of the knee in ALES-deficient patients. PMID:27284525

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

    PubMed

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

    2016-02-01

    Outcomes of primary anterior cruciate ligament (ACL) reconstruction have been reported to be far superior to those of revision reconstruction. However, as the incidence of ACL reconstruction is rapidly increasing, so is the number of failures. The subsequent need for revision ACL reconstruction is estimated to occur in up to 13,000 patients each year in the United States. Revision ACL reconstruction can be performed in one or two stages. A two-stage approach is recommended in cases of improper placement of the original tunnels or in cases of unacceptable tunnel enlargement. The aim of this study was to describe the technique for allograft ACL tunnel bone grafting in patients requiring a two-stage revision ACL reconstruction. PMID:27274452

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

    PubMed

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

    2016-02-01

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

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

    PubMed

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

    2015-05-01

    Recent studies have found higher rates of failed reconstruction of the anterior cruciate ligament (ACL) with use of allograft when compared with autograft reconstruction. To evaluate the long-term outcomes of allograft ACL reconstruction, we retrospectively reviewed the cases of all patients who underwent allograft (n=99) or autograft (n=24) ACL reconstruction by 2 senior surgeons at a single institution over an 8-year period. Seventeen (17%) of the 99 allograft reconstructions required additional surgery. Reoperation and revision ACL reconstruction rates (30.8% and 20.5%, respectively) were much higher for patients 25 years of age or younger than for patients older than 25 years. In our cohort of NCAA (National Collegiate Athletic Association) Division I athletes, the revision ACL reconstruction rate was 62% for allograft ACL reconstruction and 0% for autograft reconstruction. Our study found that reoperation and revision rates for irradiated soft-tissue allograft ACL reconstruction were higher than generally quoted for autograft reconstruction. Given the extremely high graft failure rates in patients younger than 25 years, we recommend against routine use of irradiated soft-tissue allograft for ACL reconstruction in younger patients. PMID:25950536

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

    PubMed

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

    2015-05-01

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

  9. Rehabilitation and recovery after anterior cruciate ligament reconstruction: patients' experiences.

    PubMed

    Heijne, A; Axelsson, K; Werner, S; Biguet, G

    2008-06-01

    The aim was to explore patients' experiences of the rehabilitation process after anterior cruciate ligament (ACL) reconstruction. Ten participants were enrolled in the study. Semi-structured interviews were performed, focusing on challenges during the post-operative rehabilitation to 1 year after ACL reconstruction. The participants perceived no real choice between operative and non-operative treatment. Only surgery symbolized a full return to the pre-injury level of sports, and surgery was understood as the only way to become a completely restored "functional human being." A major source of frustration was that the meaning of and progress during the rehabilitation did not match their expectations. Three different responses to the challenge of a prolonged rehabilitation were expressed: "going for it,"being ambivalent," and "giving in." Fear of re-injury was common; however, some participants decided not to return to their pre-injury level of sports due to reasons other than physical limitations or fear of re-injury. From a patient perspective, it seems important that the choice of operative or non-operative treatment should be discussed in terms of the meaning and extent of the post-operative rehabilitation and the expected outcomes. There also seems to be a need for more guidance in realistic goal setting and coaching throughout the rehabilitation process.

  10. Patellar tendon or hamstring graft anterior cruciate ligament reconstructions in patients aged above 50 years

    PubMed Central

    Bali, Tarun; Nagraj, Raghu; Kumar, Malhar N; Chandy, Thomas

    2015-01-01

    Background: The treatment of anterior cruciate ligament (ACL) injury consists of arthroscopic ACL reconstruction with patellar tendon or hamstring graft. Satisfactory results have been reported so far in the younger age group. Dilemma arises regarding the suitability of ACL reconstruction in patients aged 50 years and above. This retrospective analyses the outcome of ACL reconstruction in patients aged 50 years and above. Materials and Methods: 55 patients aged 50 years and above presented to our institution with symptomatic ACL tear and were managed with arthroscopic reconstruction with patellar tendon/hamstring graft. 22 patients underwent ACL reconstruction with bone- patellar tendon-bone graft and the remaining 33 with a hamstring graft. Evaluation of functional outcome was performed using International Knee Documentation Committee (IKDC) and Lysholm scoring in the preoperative period, at the end of 1 year and at the final followup. Radiographic evaluation was performed using the Kellgren–Lawrence grading system. Results: The mean preoperative IKDC score was 39.7 ± 3.3. At the end of 1-year following the operation, the mean IKDC score was 73.6 ± 4.9 and at the final followup was 67.8 ± 7.7. The mean preoperative Lysholm score was 40.4 ± 10.3. At the end of 1-year following the intervention, the mean Lysholm score was 89.7 ± 2.1 and at final followup was 85.3 ± 2.5. Overall, 14 out of 42 patients who underwent radiographic assessment showed progression of osteoarthritis changes at the final followup after the intervention. Conclusion: In our study, there was a statistically significant improvement in the IKDC and Lysholm scores following the intervention. There was a slight deterioration in the scores at the final followup but the overall rate of satisfaction was still high and most of the patients were able to do their routine chores and light exercises suitable for their age group. Around one-third of patients show progression of radiographic changes

  11. Effect of Timing of Surgery in Partially Injured ACLs.

    PubMed

    Li, Bin; Bai, Lunhao; Fu, Yonghui; Wang, Guangbin; He, Ming; Wang, Jiashi

    2012-05-01

    The purpose of this study was to explore the optimal timing for surgical intervention of partially injured anterior cruciate ligaments (ACL). Thirty-eight patients were divided into early (n=17) or delayed (n=21) surgery groups based on the interval between injury and surgery. Minimum follow-up was 2 years. The outcome measures used were the International Knee Documentation Committee score, Lysholm knee score, Tegner activity rating, range of motion, and arthrometer measurements. The findings of this study indicate that early surgical reconstruction of partially ruptured ACLs did not result in arthrofibrosis but may prevent secondary loosening of the intact bundles and further meniscal and chondral injury.

  12. Genital reconstruction in exstrophy patients

    PubMed Central

    Nerli, R. B.; Shirol, S. S.; Guntaka, Ajay; Patil, Shivagouda; Hiremath, Murigendra B.

    2012-01-01

    Introduction: Surgery for bladder exstrophy has been evolving over the last four to five decades. Because survival has become almost universal, the focus has changed in the exstrophy-epispadias complex to improving quality of life. The most prevalent problem in the long-term function of exstrophy patients is the sexual activity of the adolescent and adult males. The penis in exstrophy patients appears short because of marked congenital deficiency of anterior corporal tissue. Many patients approach for genital reconstruction to improve cosmesis as well as to correct chordee. We report our series of male patients seeking genital reconstruction following exstrophy repair in the past. Materials and Methods: Fourteen adolescent/adult male patients attended urology services during the period January 2000-December 2009 seeking genital reconstruction following exstrophy repair in the past. Results: Three patients underwent epispadias repair, four patients had chordee correction with cosmetic excision of skin tags and seven patients underwent chordee correction with penile lengthening. All patients reported satisfaction in the answered questionnaire. Patients undergoing penile lengthening by partial corporal dissection achieved a mean increase in length of 1.614 ± 0.279 cm dorsally and 1.543 ± 0.230 cm ventrally. The satisfactory rate assessed by the Short Form-36 (SF-36) showed that irrespective of the different genital reconstructive procedures done, the patients were satisfied with cosmetic and functional outcome. Conclusions: Surgical procedures have transformed the management in these patients with bladder exstrophy. Bladders can be safely placed within the pelvis, with most patients achieving urinary continence and cosmetically acceptable external genitalia. Genital reconstruction in the form of correction of chordee, excision of ugly skin tags and lengthening of penis can be performed to give the patients a satisfactory cosmetic and functional system. PMID:23204655

  13. Does Gracilis Tendon Harvest During ACL Reconstruction with a Hamstring Autograft Affect Torque of Muscles Responsible for Shin Rotation?

    PubMed Central

    Królikowska, Aleksandra; Czamara, Andrzej; Kentel, Maciej

    2015-01-01

    Background A growing body of evidence indicates that in patients after anterior cruciate ligament reconstruction (ACLR) with a combined semitendinosus and gracilis (STGR) graft there are large deficits in the internal rotation strength, which has led some authors to recommend harvest of only ST tendon whenever possible. The purpose of this study was to assess the isometric (IT) and peak torque (PT) of the muscles responsible for shin rotation in patients after ACLR with an ST or with an STGR graft. Material/Methods Twenty patients with an ST graft and 20 patients with a combined STGR graft underwent a 6-month postoperative rehabilitation program after ACLR. At the end of the rehabilitation program, the IT and PT of the muscles responsible for internal (IR) and external rotation (ER) of the shin were measured. The results were compared to the results of a control group. Additionally, to determine the reliability of the dynamometer for clinical research, a test-retest assessment was performed. Results There were no statistically significant differences between the 3 groups of participants. Nevertheless, in the STGR group there was a statistically significant difference between the IT of muscles internally rotating the shin in the involved knee and uninvolved knee at 25° of the internal shin rotation. Conclusions Comparison of IT and PT measurements performed after 24 weeks of postoperative rehabilitation generally showed no differences between patients after ACLR with the use of ST graft and patients who received a combination graft consisting of STGR. Nevertheless, there was an influence of GR harvest on internal shin rotation torque at a deep internal rotation angle. PMID:26190033

  14. Anterior cruciate ligament tears: reconstruction and rehabilitation.

    PubMed

    Smith, Mary Atkinson; Smith, W Todd; Kosko, Paul

    2014-01-01

    Tears of the anterior cruciate ligament (ACL) are common knee injuries experienced by athletes and people with active lifestyles. It is important for members of the healthcare team to take an evidence-based approach to the diagnosis, surgical management, and postoperative rehabilitation of patients with an ACL-deficient knee. Mechanism of ACL injury and diagnostic testing is consistent throughout the literature. Patients frequently opt for ACL reconstruction, and many surgical techniques for ACL reconstruction are available with no clear consensus regarding superiority. Surgeon preference dictates the type of reconstruction and graft choice utilized. No standardized pre- and postoperative rehabilitation protocol exists. However, rehabilitation plays an important role in functional outcomes. A comprehensive rehabilitation program is needed pre- and postoperatively to produce positive patient outcomes.

  15. Mechanism of quadriceps femoris muscle weakness in patients with anterior cruciate ligament reconstruction.

    PubMed

    Konishi, Y; Fukubayashi, T; Takeshita, D

    2002-12-01

    The purpose of this study was to investigate gamma loop function in the quadriceps femoris muscle in patients who with less than 6 month-history of anterior cruciate ligament (ACL) reconstruction. For this purpose, we compared the response to vibration stimulation in 10 patients with ACL repair and 12 normal healthy subjects, by measuring the maximal voluntary isometric contraction (MVC) and integrated electromyograms (I-EMG) of the quadriceps muscles. Pre-vibration data were obtained from each subject by measuring the MVC of the knee extension and the I-EMG from the vastus medialis, vastus lateralis, and rectus femoris muscles. Vibration stimulation was applied to the infrapatellar tendons, followed immediately by repeating the MVC and I-EMG recording. Prolonged vibration resulted in a significant decrease of both MVC and I-EMG in the control group. In contrast, the same stimulus failed to elicit changes in ACL-repair group. Our results suggest the presence of abnormal gamma loop function in the quadriceps femoris muscle of patients with ACL repair, which may explain the muscle weakness often described in such patients.

  16. Evaluating Simulation-Based ACLS Education on Patient Outcomes: A Randomized, Controlled Pilot Study

    PubMed Central

    Han, Jenny E.; Trammell, Antoine R.; Finklea, James D.; Udoji, Timothy N.; Dressler, Daniel D.; Honig, Eric G.; Abraham, Prasad; Ander, Douglas S.; Cotsonis, George A.; Martin, Greg S.; Schulman, David A.

    2014-01-01

    Background Simulation training is widely accepted as an effective teaching tool, especially for dealing with high-risk situations. Objective We assessed whether standardized, simulation-based advanced cardiac life support (ACLS) training improved performance in managing simulated and actual cardiac arrests. Methods A total of 103 second- and third-year internal medicine residents were randomized to 2 groups. The first group underwent conventional ACLS training. The second group underwent two 2 1/2-hour sessions of standardized simulation ACLS teaching. The groups were assessed by evaluators blinded to their assignment during in-hospital monthly mock codes and actual inpatient code sheets at 3 large academic hospitals. Primary outcomes were time to initiation of cardiopulmonary resuscitation, time to administration of first epinephrine/vasopressin, time to delivery of first defibrillation, and adherence to American Heart Association guidelines. Results There were no differences in primary outcomes among the study arms and hospital sites. During 21 mock codes, the most common error was misidentification of the initial rhythm (67% [6 of 9] and 58% [7 of 12] control and simulation arms, respectively, P  =  .70). There were no differences in primary outcome among groups in 147 actual inpatient codes. Conclusions This blinded, randomized study found no effect on primary outcomes. A notable finding was the percentage of internal medicine residents who misidentified cardiac arrest rhythms. PMID:25210581

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

    PubMed Central

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

    2015-01-01

    A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture. A 35-year old male soccer player with a history of ACL tear from one year ago, who underwent arthroscopic ACL reconstruction and functioned well until another similar injury caused ACL re-rupture. Revision of ACL reconstruction was performed and after failure of graft tension during the pumping, a fluoroscopic assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages first fixation of the fracture and then ACL re-revision after fracture healing was complete. Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction. PMID:26110183

  18. The Effect of Level of Patient Acuity, Critical Care Experience, and ACLS Certification on Clinical Decision Making: Implications for Computer Decision Support Systems

    PubMed Central

    Henry, Suzanne Bakken

    1990-01-01

    This study examined the effect of patient acuity, critical care experience, and ACLS certification on clinical decision making. Each subject (N=68) completed two computerized clinical simulations. Ventricular tachycardia (VT) represented the high acuity situation and atrial flutter (AF) the lower acuity situation. Clinical decision making was measured by proficiency score, patient outcome (cure/die), and amount of data collected. In the AF simulation, proficiency scores were higher (p=.000), more dysrhythmias were cured (p<.005), and more data were collected (p=.040) than in the VT simulation. Experienced and inexperienced nurses did not differ on proficiency score, however, inexperienced nurses collected more data (p=.048) and cured fewer atrial flutter simulations (p=.04). ACLS certified nurses had higher proficiency scores (p=.033) and collected less data (p=.048). Clinical decision making on two simulations was affected by patient acuity, critical care experience, and ACLS certification. These findings have implications for the design and implementation of clinical decision support systems.

  19. The relationship between subjective knee scores, isokinetic testing, and functional testing in the ACL-reconstructed knee.

    PubMed

    Wilk, K E; Romaniello, W T; Soscia, S M; Arrigo, C A; Andrews, J R

    1994-08-01

    It is important to examine the functional relationships between commonly performed clinical tests and to resolve inconsistencies in previous investigative results. The purpose of this study was to determine if a correlation exists between three commonly performed clinical tests: isokinetic isolated knee concentric muscular testing, the single-leg hop test, and the subjective knee score in anterior cruciate ligament reconstructed knees. To determine if a relationship exists would be beneficial to clinicians in determining patient progression, treatment modification, and return-to-sport objective parameters. Several investigators have analyzed two of these parameters, but no one has investigated three parameters to date. Additionally, this study explored the concept of limb acceleration and deceleration during high-speed isokinetics and its relationship to function. Fifty patients were randomly selected (29 males) with a mean age of 23.7 years (range 15-52). The subjects completed a subjective knee score questionnaire that rated symptoms (pain, swelling, giving way) and specific sport function and completed an overall knee score assessment. The patients were then evaluated performing three one-legged functional tests: 1) hop for distance, 2) timed hop, and 3) cross-over triple hop. Isokinetic testing was performed on a Biodex dynamometer at 180, 300, and 450 degrees/sec for knee extension/flexion. The patients' mean value of the self-assessed knee rating was 86 points. Sixty-four percent of the patients exhibited normal limb symmetry (within 85%) on all three single-leg hop tests. Sixteen percent exhibited quadriceps strength at least 90% of the contralateral limb isokinetically. A positive correlation was noted between isokinetic knee extension peak torque (180, 300 degrees/sec) and subjective knee scores, and the three hop tests (p < 0.001). A statistical trend was noted between knee extension acceleration and deceleration range at 180 and 300 degrees/sec for the

  20. 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

  1. A tale of 10 European centres – 2010 APOSSM travelling fellowship review in ACL surgery

    PubMed Central

    2012-01-01

    The purpose of ESSKA- APOSSM Travelling fellowship is to better understand the epidemiology, management and surgical techniques for sports across continents. There has been a progressive evolution in ACL reconstruction and there is variation in technique in ACL reconstruction amongst the most experienced surgeons in different continents. During this one month fellowship, we saw various ACL reconstruction techniques using different graft sources, with a variety of graft fixation methods, with the common aim of recreating an anatomical ACL reconstruction. PMID:22839644

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

    PubMed

    2001-12-01

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

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

    PubMed

    2001-12-01

    In the United States, approximately 50,000 knee surgeries are performed each year for repairing anterior cruciate ligament (ACL) injuries. Tissue allografts frequently are used for ACL reconstruction, and septic arthritis is a rare complication of such procedures. This report describes four patients who acquired postsurgical septic arthritis probably associated with contaminated bone-tendon-bone allografts used for ACL reconstruction. Effective sterilization methods that do not functionally alter musculoskeletal tissue are needed to prevent allograft-related infections. PMID:11770503

  4. Allograft safety in anterior cruciate ligament reconstruction.

    PubMed

    Cohen, Steven B; Sekiya, Jon K

    2007-10-01

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

  5. Allograft safety in anterior cruciate ligament reconstruction.

    PubMed

    Cohen, Steven B; Sekiya, Jon K

    2007-10-01

    Allograft tissue seems to provide an excellent option for reconstruction of the ACL in the primary and revision setting. Although in general the risks of using allograft tissue in ACL reconstruction are low, the consequences of complications associated with disease or infection transmission or of recurrent instability secondary to graft failure are large. Surgeons should provide patients with the information available regarding allograft risks and should have thorough knowledge of the source and preparation of the grafts by their tissue bank before implantation for ACL reconstruction. PMID:17920955

  6. The effect of neuromuscular electrical stimulation on quadriceps strength and knee function in professional soccer players: return to sport after ACL reconstruction.

    PubMed

    Taradaj, J; Halski, T; Kucharzewski, M; Walewicz, K; Smykla, A; Ozon, M; Slupska, L; Dymarek, R; Ptaszkowski, K; Rajfur, J; Pasternok, M

    2013-01-01

    The aim of this study was to assess the clinical efficacy and safety of NMES program applied in male soccer players (after ACL reconstruction) on the quadriceps muscle. The 80 participants (NMES = 40, control = 40) received an exercise program, including three sessions weekly. The individuals in NMES group additionally received neuromuscular electrical stimulation procedures on both right and left quadriceps (biphasic symmetric rectangular pulses, frequency of impulses: 2500 Hz, and train of pulses frequency: 50 Hz) three times daily (3 hours of break between treatments), 3 days a week, for one month. The tensometry, muscle circumference, and goniometry pendulum test (follow-up after 1 and 3 months) were applied. The results of this study show that NMES (in presented parameters in experiment) is useful for strengthening the quadriceps muscle in soccer athletes. There is an evidence of the benefit of the NMES in restoring quadriceps muscle mass and strength of soccer players. In our study the neuromuscular electrical stimulation appeared to be safe for biomechanics of knee joint. The pathological changes in knee function were not observed. This trial is registered with Australian and New Zealand Clinical Trials Registry ACTRN12613001168741.

  7. Indian hedgehog signaling and the role of graft tension in tendon-to-bone healing: Evaluation in a rat ACL reconstruction model.

    PubMed

    Carbone, Andrew; Carballo, Camila; Ma, Richard; Wang, Hongsheng; Deng, Xianghua; Dahia, Chitra; Rodeo, Scott

    2016-04-01

    The structure and composition of the native enthesis is not recapitulated following tendon-to-bone repair. Indian Hedgehog (IHH) signaling has recently been shown to be important in enthesis development in a mouse model but no studies have evaluated IHH signaling in a healing model. Fourteen adult male rats underwent ACL reconstruction using a flexor tendon graft. Rats were assigned to two groups based on whether or not they received 0N or 10N of pre-tension of the graft. Specimens were evaluated at 3 and 6 weeks post-operatively using immunohistochemistry for three different protein markers of IHH signaling. Quantitative analysis of staining area and intensity using custom software demonstrated that IHH signaling was active in interface tissue formed at the healing tendon-bone interface. We also found increased staining area and intensity of IHH signaling proteins at 3 weeks in animals that received a pre-tensioned tendon graft. No significant differences were seen between the 3-week and 6-week time points. Our data suggests that the IHH signaling pathway is active during the tendon-bone healing process and appears to be mechanosensitive, as pre-tensioning of the graft at the time of surgery resulted in increased IHH signaling at three weeks. PMID:26447744

  8. The Effect of NeuroMuscular Electrical Stimulation on Quadriceps Strength and Knee Function in Professional Soccer Players: Return to Sport after ACL Reconstruction

    PubMed Central

    Taradaj, J.; Halski, T.; Kucharzewski, M.; Walewicz, K.; Smykla, A.; Ozon, M.; Slupska, L.; Dymarek, R.; Ptaszkowski, K.; Rajfur, J.; Pasternok, M.

    2013-01-01

    The aim of this study was to assess the clinical efficacy and safety of NMES program applied in male soccer players (after ACL reconstruction) on the quadriceps muscle. The 80 participants (NMES = 40, control = 40) received an exercise program, including three sessions weekly. The individuals in NMES group additionally received neuromuscular electrical stimulation procedures on both right and left quadriceps (biphasic symmetric rectangular pulses, frequency of impulses: 2500 Hz, and train of pulses frequency: 50 Hz) three times daily (3 hours of break between treatments), 3 days a week, for one month. The tensometry, muscle circumference, and goniometry pendulum test (follow-up after 1 and 3 months) were applied. The results of this study show that NMES (in presented parameters in experiment) is useful for strengthening the quadriceps muscle in soccer athletes. There is an evidence of the benefit of the NMES in restoring quadriceps muscle mass and strength of soccer players. In our study the neuromuscular electrical stimulation appeared to be safe for biomechanics of knee joint. The pathological changes in knee function were not observed. This trial is registered with Australian and New Zealand Clinical Trials Registry ACTRN12613001168741. PMID:24381943

  9. Direct Visualization of Existing Footprint and Outside-In Drilling of the Femoral Tunnel in Anterior Cruciate Ligament Reconstruction in the Knee

    PubMed Central

    Sutter, E. Grant; Anderson, John A.; Garrett, William E.

    2015-01-01

    Improper femoral tunnel placement in anterior cruciate ligament (ACL) reconstruction is a significant problem and may be a cause of ACL graft failure and abnormal kinematics, which may lead to late degenerative changes after reconstruction. Recently, there has been concern that the transtibial approach may contribute to nonanatomic placement of the femoral tunnel, resulting in abnormal knee kinematics. Tibial-independent techniques can provide more anatomic placement of the ACL graft, but these can be technically demanding. This technical note describes the senior author's technique to directly identify the femoral ACL remnant and use the center of the femoral ACL footprint and retrograde drilling to create an anatomic femoral socket for single-bundle reconstruction. This technique provides femoral tunnel placement based on identification of a patient-specific ACL footprint instead of averaged anatomic measurements from large groups. This technique has been shown to produce anatomic ACL graft position and orientation and restore more normal knee kinematics. PMID:26052485

  10. The incidence of secondary pathology after anterior cruciate ligament rupture in 5086 patients requiring ligament reconstruction.

    PubMed

    Sri-Ram, K; Salmon, L J; Pinczewski, L A; Roe, J P

    2013-01-01

    We reviewed 5086 patients with a mean age of 30 years (9 to 69) undergoing primary reconstruction of the anterior cruciate ligament (ACL) in order to determine the incidence of secondary pathology with respect to the time between injury and reconstruction. There was an increasing incidence of medial meniscal tears and chondral damage, but not lateral meniscal tears, with increasing intervals before surgery. The chances of requiring medial meniscal surgery was increased by a factor of two if ACL reconstruction was delayed more than five months, and increased by a factor of six if surgery was delayed by > 12 months. The effect of delaying surgery on medial meniscal injury was also pronounced in the patients aged < 17 years, where a delay of five to 12 months doubled the odds of medial meniscal surgery (odds ratio (OR) 2.0, p = 0.001) and a delay of > 12 months quadrupled the odds (OR 4.3, p = 0.001). Increasing age was associated with a greater odds of chondral damage (OR 4.6, p = 0.001) and medial meniscal injury (OR 2.9, p = 0.001), but not lateral meniscal injury. The gender split (3251 men, 1835 women) revealed that males had a greater incidence of both lateral (34% (n = 1114) vs 20% (n = 364), p = 0.001) and medial meniscal tears (28% (n = 924) vs 25% (n = 457), p = 0.006), but not chondral damage (35% (n = 1152) vs 36% (n = 665), p = 0.565). We conclude that ideally, and particularly in younger patients, ACL reconstruction should not be delayed more than five months from injury.

  11. 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

  12. Tripeptide-copper complex GHK-Cu (II) transiently improved healing outcome in a rat model of ACL reconstruction.

    PubMed

    Fu, Sai-Chuen; Cheuk, Yau-Chuk; Chiu, Wai-Yin Vivien; Yung, Shu-Hang; Rolf, Christer G; Chan, Kai-Ming

    2015-07-01

    After anterior cruciate ligament reconstruction (ACLR), the biological healing of the graft is a rate-limiting step which can contribute to graft failure. The tripeptide-copper complex glycyl-L-histidyl-L-lysine-Cu(II) (GHK-Cu) is a well-known activator of tissue remodeling. We investigated whether GHK-Cu can improve graft healing following ACLR. Seventy-two rats underwent unilateral ACLR were randomized to saline, 0.3 or 3 mg/ml GHK-Cu groups (n = 24). Post-operational intra-articular injections were given from week 2, once a week, for 4 weeks. Gait analysis was performed pre-injury and at harvesting time. At 6 or 12 weeks post-operation, knee specimens were harvested for knee laxity test, graft pull-out test, and histology. At 6 weeks post-ACLR, GHK-Cu groups resulted in a smaller side-to-side difference in knee laxity as compared to the saline group (p = 0.009), but there was no significant difference at 12 weeks post-operation. The graft complex in the 0.3 mg/ml GHK-Cu group had higher stiffness than saline group at 6 weeks post-operation (p = 0.026), but there was no significant difference in ultimate load, gait parameters, and histological scores among treatment groups. All grafts failed mid-substance during pull-out test. Intra-articular supplementation with a bioactive small molecule GHK-Cu improved graft healing following ACLR in rat, but the beneficial effects could not last as treatment discontinued. PMID:25731775

  13. Gamma loop dysfunction in the quadriceps femoris of patients who underwent anterior cruciate ligament reconstruction remains bilaterally.

    PubMed

    Konishi, Y; Aihara, Y; Sakai, M; Ogawa, G; Fukubayashi, T

    2007-08-01

    Purpose of this study was to investigate the effects of anterior cruciate ligament (ACL) repair on the gamma loop of the bilateral quadriceps femoris (QF). Maximal voluntary contraction (MVC) of knee extension and integrated electromyogram (I-EMG) of vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF) were examined in uninjured and injured limbs of 18 patients and 10 normal subjects, before and after 20-min vibration applied to the QF. Mean percentage changes were calculated as: (pre-vibration value-post-vibration value)/pre-vibration value x 100. Patients were divided into two groups: short-term-group (tested ACL repair, n=8), long-term-group (tested >/=18 months after ACL repair, n=10). Mean percentage changes of the four groups were compared with those of controls. Results indicated that changes of MVC and I-EMG on the uninjured and injured sides in short-term-group in response to vibration were significantly different from those of controls. There were no significant differences between uninjured sides in long-term and control groups. MVC and I-EMG of VM and RF of injured side in patients in the long-term-group in response to vibration were not different from those of controls. From these results, we concluded that this abnormality of the gamma loop in both injured and uninjured sides did not recover despite ACL reconstruction. However, the abnormality in uninjured side might recover >/=18 months after repair.

  14. Influence of patellar ligament insertion angle on quadriceps usage during walking in anterior cruciate ligament reconstructed subjects.

    PubMed

    Shin, Choongsoo S; Chaudhari, Ajit M; Dyrby, Chris O; Andriacchi, Thomas P

    2009-06-01

    Reduced quadriceps contraction has been suggested as an adaptation to prevent anterior tibial translation in anterior cruciate ligament (ACL)-deficient knees. This theory has been supported by a recent study that peak knee flexion moment (thought to be created by a decrease of quadriceps contraction) during walking was negatively correlated with patellar ligament insertion angle (PLIA) in ACL-deficient knees, but not in contralateral, uninjured knees. In addition, the PLIA was significantly smaller in ACL-deficient knees than in contralateral, uninjured knees. However, it is unknown whether ACL reconstruction restores the PLIA or whether the relationship between the PLIA and knee flexion moments previously observed in ACL-deficient knees disappears. This study tested the following hypotheses: (1) The PLIA of ACL-reconstructed knees is significantly smaller than the PLIA of uninjured contralateral knees; (2) Peak knee flexion moment (balanced by net quadriceps moment) during walking is negatively correlated with the PLIA in ACL-reconstructed knees. The PLIA of 24 ACL-reconstructed and contralateral knees were measured using MRI, and peak knee flexion moments during walking were measured. Results showed that the PLIA of ACL-reconstructed (22.9 +/- 4.4 degrees) knees was not significantly smaller (p = 0.09, power = 0.99) than the PLIA of contralateral (24.1 +/- 4.8 degrees) knees. Peak knee flexion moment was not correlated with the PLIA following ACL reconstruction (R2 = 0.016, power = 0.99). However, the magnitude of the knee flexion moment remained significantly lower in ACL-reconstructed knees. In summary, this study has shown that the PLIA of ACL-reconstructed knees returned to normal and that patients no longer adapt their gait in response to the PLIA, though quadriceps function did not return to normal levels.

  15. The influence of hamstring autograft size on patient reported outcomes and risk of revision following anterior cruciate ligament reconstruction: A MOON cohort study

    PubMed Central

    Mariscalco, Michael W.; Flanigan, David C.; Mitchell, Joshua; Pedroza, Angela D.; Jones, Morgan H.; Andrish, Jack T.; Parker, Richard D.; Kaeding, Christopher C.; Magnussen, Robert A.

    2013-01-01

    Purpose The purpose of this study is to evaluate the effect of graft size on patient-reported outcomes and revision risk following ACL reconstruction. Methods A retrospective chart review of prospectively collected cohort data, 263 of 320 consecutive patients (82.2%) undergoing primary ACL reconstruction with hamstring autograft were evaluated. Graft size, femoral tunnel drilling technique, patient age, sex, and BMI at the time of ACL reconstruction, pre-operative and 2-year post-operative KOOS and IKDC scores, and whether each patient underwent revision ACL reconstruction during the 2 year follow-up period were recorded. Revision was used as a marker for graft failure. The relationship between graft size and patient-reported outcomes was determined by multiple linear regression. The relationship between graft size and risk of revision was determined by dichotomizing graft size at 8mm and stratifying by age. Results After controlling for age, sex, operative side, surgeon, BMI, graft choice, and femoral tunnel drilling technique, a 1 mm increased in graft size was noted to correlate with 3.3-point increase in the KOOS-pain subscale (p = 0.003), a 2.0-point increased in the KOOS activities of daily living subscale (p = 0.034), a 5.2-point increase in the KOOS-sport/recreation function subscale (p = 0.004), and a 3.4-point increase in the subjective IKDC score (p = 0.026). Revision was required in 0 of 64 patients (0.0%) with grafts greater than 8mm in diameter and 14 of 199 patients (7.0%) with 8 mm or smaller grafts (p = 0.037). Among patients age 18 and under, revision was required in 0 of 14 patients (0.0%) with grafts greater than 8mm in diameter and 13 of 71 patients (18.3 %) with 8 mm or smaller grafts. Conclusions Smaller hamstring autograft size is a predictor of poorer KOOS Sport and Recreation function 2 years following primary ACL reconstruction. Larger sample size is required to confirm the relationship between graft size and risk of revision ACL

  16. Repaired ACL More Likely to Tear Again in Young Women

    MedlinePlus

    ... risk for a repeat tear of the knee's anterior cruciate ligament (ACL) after surgery to repair it, a new study says. The study included just over 500 male and female athletes who underwent ACL reconstruction with a hamstring graft and were followed for ...

  17. Anterior cruciate ligament augmentation for rotational instability following primary reconstruction with an accelerated physical therapy protocol.

    PubMed

    Carey, Timothy; Oliver, David; Pniewski, Josh; Mueller, Terry; Bojescul, John

    2013-01-01

    The purpose of the present study is to present the results of anterior cruciate ligament (ACL) augmentation for patients having rotational instability despite an intact vertical graft in lieu of conventional revision ACL reconstruction. ACL augmentation surgery with a horizontal graft was performed to augment a healed vertical graft on five patients and an accelerated rehabilitation protocol was instituted. Functional outcomes were assessed by the Lower Extremity Functional Scale (LEFS) and the Modified Cincinnati Rating System (MCRS). All patients completed physical therapy within 5 months and were able to return to full military duty without limitation. LEFS and MCRS were significantly improved. ACL augmentation with a horizontal graft provides an excellent alternative to ACL revision reconstruction for patients with an intact vertical graft, allowing an earlier return to duty for military service members.

  18. Reduced knee joint moment in ACL deficient patients at a cost of dynamic stability during landing.

    PubMed

    Oberländer, Kai Daniel; Brüggemann, Gert-Peter; Höher, Jürgen; Karamanidis, Kiros

    2012-05-11

    The current study aimed to examine the effect of anterior cruciate ligament deficiency (ACLd) on joint kinetics and dynamic stability control after a single leg hop test (SLHT). Twelve unilateral ACLd patients and a control subject group (n=13) performed a SLHT over a given distance with both legs. The calculation of joint kinetics was done by means of a soft-tissue artifact optimized rigid full-body model. Margin of stability (MoS) was quantified by the difference between the base of support and the extrapolated center of mass. During landing, the ACLd leg showed lower external knee flexion moments but demonstrated higher moments at the ankle and hip compared to controls (p<0.05). The main reason for the joint moment redistribution in the ACLd leg was a more anterior position of the ground reaction force (GRF) vector, which affected the moment arms of the GRF acting about the joints (p<0.05). For the ACLd leg, trunk angle was more flexed over the entire landing phase compared to controls (p<0.05) and we found a significant correlation between moment arms at the knee joint and trunk angle (r² = 0.48;p<0.01). The consequence of this altered landing strategy in ACLd legs was a more anterior position of the center of mass reducing the MoS (p<0.05). The results illustrate the interaction between trunk angle, joint kinetics and dynamic stability during landing maneuvers and provide evidence of a feedforward adaptive adjustment in ACLd patients (i.e. more flexed trunk angle) aimed at reducing knee joint moments at the cost of dynamic stability control. PMID:22440611

  19. Reduced knee joint moment in ACL deficient patients at a cost of dynamic stability during landing.

    PubMed

    Oberländer, Kai Daniel; Brüggemann, Gert-Peter; Höher, Jürgen; Karamanidis, Kiros

    2012-05-11

    The current study aimed to examine the effect of anterior cruciate ligament deficiency (ACLd) on joint kinetics and dynamic stability control after a single leg hop test (SLHT). Twelve unilateral ACLd patients and a control subject group (n=13) performed a SLHT over a given distance with both legs. The calculation of joint kinetics was done by means of a soft-tissue artifact optimized rigid full-body model. Margin of stability (MoS) was quantified by the difference between the base of support and the extrapolated center of mass. During landing, the ACLd leg showed lower external knee flexion moments but demonstrated higher moments at the ankle and hip compared to controls (p<0.05). The main reason for the joint moment redistribution in the ACLd leg was a more anterior position of the ground reaction force (GRF) vector, which affected the moment arms of the GRF acting about the joints (p<0.05). For the ACLd leg, trunk angle was more flexed over the entire landing phase compared to controls (p<0.05) and we found a significant correlation between moment arms at the knee joint and trunk angle (r² = 0.48;p<0.01). The consequence of this altered landing strategy in ACLd legs was a more anterior position of the center of mass reducing the MoS (p<0.05). The results illustrate the interaction between trunk angle, joint kinetics and dynamic stability during landing maneuvers and provide evidence of a feedforward adaptive adjustment in ACLd patients (i.e. more flexed trunk angle) aimed at reducing knee joint moments at the cost of dynamic stability control.

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

    PubMed

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

    2013-10-01

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

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

    PubMed Central

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

    2016-01-01

    Background: Loss of proprioceptive function occurs after anterior cruciate ligament (ACL) rupture. Clinical, motor, and proprioceptive function is known to improve after ACL reconstruction but does not return to normal. While histological studies of human ACL allografts have been unable to demonstrate mechanoreceptor reinnervation, animal data suggest that reinnervation may occur when an autograft is used. Purpose: To compare the presence or absence of mechanoreceptors between allograft versus autograft after ACL reconstruction in humans. Study Design: Cohort study; Level of evidence, 3. Methods: Ten patients with previous ACL reconstruction presenting for either revision ACL surgery or knee arthroscopy for other reasons were enrolled in a prospective, comparative study. Five patients had a previous autograft ACL and 5 patients had an allograft. Biopsies, either from intact or ruptured grafts, were taken from identical locations as close to the femoral and tibial insertions as possible. Specimens were stained with hematoxylin-eosin (H-E) and monoclonal antibodies against neurofilament protein (NFP), known to be present in mechanoreceptor tissue. Immunohistochemical examination was carried out, and the number of NFP+ neural tissue analogs was counted and compared with that of native ACL tissue. Results: The mean time between original graft and biopsy was 6.9 years (range, 0.5-15 years). Histological examination showed significantly less NFP+ neural analogs in allograft and autograft patients than control tissue (mean number of NFP+ analogs per high-power field, 0.7 ± 0.9 [allograft] and 0.5 ± 0.8 [autograft] vs 4.7 ± 0.9 [controls]; P < .0001). There was no significant difference in NFP analogs between autograft and allograft tissue. Conclusion: We found a reduced concentration of NFP+ neural analogs in ACL grafts compared with native ACL tissue. This deficit exists irrespective of whether allograft or autograft is used. These findings may explain the continued

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

    PubMed

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

    2014-03-01

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

  3. Enhancement of tendon-bone healing for anterior cruciate ligament (ACL) reconstruction using bone marrow-derived mesenchymal stem cells infected with BMP-2.

    PubMed

    Dong, Yu; Zhang, Qingguo; Li, Yunxia; Jiang, Jia; Chen, Shiyi

    2012-10-22

    At present, due to the growing attention focused on the issue of tendon-bone healing, we carried out an animal study of the use of genetic intervention combined with cell transplantation for the promotion of this process. Here, the efficacy of bone marrow stromal cells infected with bone morphogenetic protein-2 (BMP-2) on tendon-bone healing was determined. A eukaryotic expression vector containing the BMP-2 gene was constructed and bone marrow-derived mesenchymal stem cells (bMSCs) were infected with a lentivirus. Next, we examined the viability of the infected cells and the mRNA and protein levels of BMP-2-infected bMSCs. Gastrocnemius tendons, gastrocnemius tendons wrapped by bMSCs infected with the control virus (bMSCs+Lv-Control), and gastrocnemius tendons wrapped by bMSCs infected with the recombinant BMP-2 virus (bMSCs+Lv-BMP-2) were used to reconstruct the anterior cruciate ligament (ACL) in New Zealand white rabbits. Specimens from each group were harvested four and eight weeks postoperatively and evaluated using biomechanical and histological methods. The bMSCs were infected with the lentivirus at an efficiency close to 100%. The BMP-2 mRNA and protein levels in bMSCs were significantly increased after lentiviral infection. The bMSCs and BMP-2-infected bMSCs on the gastrocnemius tendon improved the biomechanical properties of the graft in the bone tunnel; specifically, bMSCs infected with BMP-2 had a positive effect on tendon-bone healing. In the four-week and eight-week groups, bMSCs+Lv-BMP-2 group exhibited significantly higher maximum loads of 29.3 ± 7.4 N and 45.5 ± 11.9 N, respectively, compared with the control group (19.9 ± 6.4 N and 21.9 ± 4.9 N) (P = 0.041 and P = 0.001, respectively). In the eight-week groups, the stiffness of the bMSCs+Lv-BMP-2 group (32.5 ± 7.3) was significantly higher than that of the bMSCs+Lv-Control group (22.8 ± 7.4) or control groups (12.4 ± 6.0) (p = 0.036 and 0.001, respectively). Based on the histological

  4. Isokinetic dynamometer evaluation of the effects of early thigh diameter difference on thigh muscle strength in patients undergoing anterior cruciate ligament reconstruction with hamstring tendon graft.

    PubMed

    Kılınç, Bekir Eray; Kara, Adnan; Camur, Savas; Oc, Yunus; Celik, Haluk

    2015-04-01

    After anterior cruciate ligament (ACL) reconstruction, which muscle groups are more affected from frequently developing thigh muscle atrophy is a matter of debate. We evaluate the effect of thigh circumference difference between patients' knees who were administered the ACL reconstruction with hamstring tendon autograft and intact knees, on torque between the hamstring and quadriceps muscles. Fifty-five patients at least 6 months follow-up period available were included in our study. Power measurements of quadriceps and hamstring muscle groups in patients' extremities were done by using isokinetic dynamometer. The maximum torque values at 60°/sec, 240°/sec in frequency, positions of flexion and extension were determined. In accordance with our findings it is still possible to encounter the thigh atrophy in average 28 months after ACL reconstruction surgery even under physical rehabilitation programs and appropriate follow-up. It is inevitable for the clinician to consider these changes in diagnosis and rehabilitation stages. It can't be ignored that muscle weakness mechanisms developing in the thigh circumference vary according to the thigh muscle group and knee flexors play an important role in thigh atrophy when determining an appropriate rehabilitation program after reconstruction application.

  5. The effect of knee brace on coordination and neuronal leg muscle control: an early postoperative functional study in anterior cruciate ligament reconstructed patients.

    PubMed

    Rebel, M; Paessler, H H

    2001-09-01

    Two studies were carried out after anterior cruciate ligament (ACL) reconstruction to determine the effect of a knee brace on coordination (test 1) and electromyographic muscle activity in drop jumps (test 2). Test 1 studied 25 patients with ACL reconstruction under three test conditions (one-leg static, two-legged static, two-legged dynamic) compared with a control (n=30). The results showed highly significant improvements in all braced conditions. In test 2 ten patients with ACL reconstruction and ten healthy subjects performed a two-legged drop-jump; this was repeated 15 times and again 15 times with a knee brace worn on the reconstructed limb. Changes in electromyographically determined muscle activity (vastus medialis, vastus lateralis, biceps femoris, gastrocnemius) were observed, but they were significant in only few cases because of high variability. Drop-jumps with knee brace improved jumping height, increased the maximum knee angle in the ground contact phase, and reduced the maximum knee angle in the landing phase. Patients thus develop an increased confidence in the stability of their knees. We conclude that the benefits of the knee brace are due to the mechanical action, an enhanced coordination, and a psychological effect.

  6. Rehabilitation concerns following anterior cruciate ligament reconstruction.

    PubMed

    Frndak, P A; Berasi, C C

    1991-11-01

    Rehabilitation following anterior cruciate ligament reconstruction is a subject of controversy in the orthopaedic and rehabilitation literature. With an increasing number of these operations currently being performed and with the advent of arthroscopically assisted ACL reconstruction over the past several years, particular rehabilitation needs and problems have been identified in association with these patients. Various authors have stressed one or a combination of a few basic themes which outline the basic rehabilitation concerns following ACL reconstruction. The most fundamental concern is the need to initiate motion very soon after surgery. Prolonged postoperative immobilisation is known to cause serious complications after ACL reconstruction which can be avoided by early motion. Positions or activities which may apply excessive stress to a newly reconstructed ACL must also be considered. The amount of protection required by the graft will vary depending upon the type of graft used and the quality of fixation obtained intraoperatively. Most authors agree that nonweightbearing, active resistive quadriceps exercises should be avoided for an extended period, while closed chain exercises may be initiated much earlier. Strength recovery is obviously important for the quadriceps postoperatively, but maximal strength returns of all of the muscles about the knee must be pursued. Hamstring strength is of particular concern as this may provide an active support to the reconstructed ACL. Sensory loss in the knee after ACL disruption should also be addressed during rehabilitation, prior to a patient's return to full athletic activity. Progressive neuromuscular re-education exercises which rely on sensory input from intact pericapsular structures are encouraged. A final concern is the role of bracing after ACL reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1763251

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

    PubMed

    Grafe, Michael W; Kurzweil, Peter R

    2008-06-01

    We evaluated the results of anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft in revisions and in patients older than 30. Results from 23 consecutive patients (mean age, 43 years) who underwent ACL reconstruction with fresh-frozen, irradiated (22/23) Achilles allografts were retrospectively reviewed. Seven cases were revisions. Patients were evaluated with physical examination, questionnaires, and x-rays. Twenty of the 23 patients were evaluated a mean of 28 months after surgery. There were 5 failures (21%); 3 acute failures were not evaluated at follow-up. One patient had an infection that required graft removal, 2 patients had mechanical failure of the grafts, and 2 had displacements of more than 5.5 mm as measured with a KT-1000 arthrometer. The 18 clinically successful cases had full motion, no thigh atrophy, and no effusion. Pivot shift scores were 55% A and 45% B on the International Knee Documentation Committee (IKDC) scale. Lachman scores were 40% A, 55% B, and 5% C on the IKDC scale. The KT-1000 difference was a mean of 2.9 mm at final follow-up. However, knees loosened a mean of 4.5 mm from the immediate postoperative measurements (P<.0001). Mean Lysholm and Tegner scores were 86.8 and 5.2, respectively. Tibial tunnel diameter increased by 3.1 mm on anteroposterior x-rays and 3.0 mm on lateral x-rays. Five patients developed mild medial compartment arthritis. Four of the 5 grafts with failures were from donors older than 40. Postoperative complications included deep vein thrombosis and inflammatory effusion (white blood cell count, 15,000). Twenty-one percent of ACL reconstructions with Achilles tendon allografts failed. Grafts deemed successful still had significant loosening at final follow-up. Allografts from donors older than 40 may have played a role in these failures. From the data in this study, it appears that surgeons should scrutinize the source of the allograft tissue and the age of the donor.

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

    PubMed

    Grafe, Michael W; Kurzweil, Peter R

    2008-06-01

    We evaluated the results of anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft in revisions and in patients older than 30. Results from 23 consecutive patients (mean age, 43 years) who underwent ACL reconstruction with fresh-frozen, irradiated (22/23) Achilles allografts were retrospectively reviewed. Seven cases were revisions. Patients were evaluated with physical examination, questionnaires, and x-rays. Twenty of the 23 patients were evaluated a mean of 28 months after surgery. There were 5 failures (21%); 3 acute failures were not evaluated at follow-up. One patient had an infection that required graft removal, 2 patients had mechanical failure of the grafts, and 2 had displacements of more than 5.5 mm as measured with a KT-1000 arthrometer. The 18 clinically successful cases had full motion, no thigh atrophy, and no effusion. Pivot shift scores were 55% A and 45% B on the International Knee Documentation Committee (IKDC) scale. Lachman scores were 40% A, 55% B, and 5% C on the IKDC scale. The KT-1000 difference was a mean of 2.9 mm at final follow-up. However, knees loosened a mean of 4.5 mm from the immediate postoperative measurements (P<.0001). Mean Lysholm and Tegner scores were 86.8 and 5.2, respectively. Tibial tunnel diameter increased by 3.1 mm on anteroposterior x-rays and 3.0 mm on lateral x-rays. Five patients developed mild medial compartment arthritis. Four of the 5 grafts with failures were from donors older than 40. Postoperative complications included deep vein thrombosis and inflammatory effusion (white blood cell count, 15,000). Twenty-one percent of ACL reconstructions with Achilles tendon allografts failed. Grafts deemed successful still had significant loosening at final follow-up. Allografts from donors older than 40 may have played a role in these failures. From the data in this study, it appears that surgeons should scrutinize the source of the allograft tissue and the age of the donor. PMID:18716694

  9. 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

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

    PubMed

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

    2012-08-01

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

  11. Gait patterns before and after anterior cruciate ligament reconstruction.

    PubMed

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

    2004-01-01

    The aim of this study is to determine how selected gait parameters may change as a result of anterior cruciate ligament (ACL) deficiency and following ACL reconstruction. The study was performed on 25 ACL-deficient subjects prior to and 6 weeks, 4 months, 8 months and 12 months after ACL reconstructive surgery by the bone-patellar tendon-bone technique. Gait analysis was performed using the zebris three-dimensional ultrasound-based system with surface electromyograph (zebris Medizintechnik GmbH, Germany). Kinematic data were recorded for the lower limb. The muscles examined include vastus lateralis and medialis, biceps femoris and adductor longus. The results obtained from the injured subjects were compared with those of 51 individuals without ACL damage. The acute ACL-deficient patients exhibited a quadriceps avoidance pattern prior to and 6 weeks after surgery. The quadriceps avoidance phenomenon does not develop in chronic ACL-deficient patients. In the individuals operated on, the spatial-temporal parameters and the knee angle had already regained a normal pattern for the ACL-deficient limb during gait 4 months after surgery. However, the relative ACL movement parameter-which describes the tibial translation into the direction of ACL-and the EMG traces show no significant statistical difference compared with the values of healthy control group just 8 months after surgery. The results suggest that: (1) development of a quadriceps avoidance pattern is less common than previously reported, (2) anterior cruciate ligament deficiency and reconstruction significantly alter the lower extremity gait pattern, (3) the gait parameters shift towards the normal value pattern, and (4) the re-establishment of pre-injury gait patterns--including the normal biphase of muscles--takes at least 8 months to occur.

  12. Isokinetic dynamometer evaluation of the effects of early thigh diameter difference on thigh muscle strength in patients undergoing anterior cruciate ligament reconstruction with hamstring tendon graft

    PubMed Central

    Kılınç, Bekir Eray; Kara, Adnan; Camur, Savas; Oc, Yunus; Celik, Haluk

    2015-01-01

    After anterior cruciate ligament (ACL) reconstruction, which muscle groups are more affected from frequently developing thigh muscle atrophy is a matter of debate. We evaluate the effect of thigh circumference difference between patients’ knees who were administered the ACL reconstruction with hamstring tendon autograft and intact knees, on torque between the hamstring and quadriceps muscles. Fifty-five patients at least 6 months follow-up period available were included in our study. Power measurements of quadriceps and hamstring muscle groups in patients’ extremities were done by using isokinetic dynamometer. The maximum torque values at 60°/sec, 240°/sec in frequency, positions of flexion and extension were determined. In accordance with our findings it is still possible to encounter the thigh atrophy in average 28 months after ACL reconstruction surgery even under physical rehabilitation programs and appropriate follow-up. It is inevitable for the clinician to consider these changes in diagnosis and rehabilitation stages. It can’t be ignored that muscle weakness mechanisms developing in the thigh circumference vary according to the thigh muscle group and knee flexors play an important role in thigh atrophy when determining an appropriate rehabilitation program after reconstruction application. PMID:25960982

  13. Should critical care nurses be ACLS-trained?

    PubMed

    Hagyard-Wiebe, Tammy

    2007-01-01

    The aim of resuscitation is to sustain life with intact neurological functioning and the same quality of life previously experienced by the patient. Advanced cardiac life support (ACLS) was designed to achieve this aim. However the requirement for ACLS training for critical care nurses working in Canadian critical care units is inconsistent across the country. The purposes of this article are to explore the evidence surrounding ACLS training for critical care nurses and its impact on resuscitation outcomes, and to review the evidence surrounding ACLS knowledge and skill degradation with strategies to support code blue team efficiency for an effective resuscitation. Using the search terms ACLS training, resuscitation, critical care, and nursing, two databases, CINAHL and MEDLINE, were used. The evidence supports the need for ACLS training for critical care nurses. The evidence also supports organized ongoing refresher courses, multidisciplinary mock code blue practice using technologically advanced simulator mannequins, and videotaped reviews to prevent knowledge and skill degradation for effective resuscitation efforts.

  14. Histological Predictors of Maximum Failure Loads Differ Between the Healing ACL and ACL Grafts After 6 and 12 Months In Vivo

    PubMed Central

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

    2013-01-01

    Background: Bioenhanced anterior cruciate ligament (ACL) repair, where the suture repair is supplemented with a biological scaffold, is a promising novel technique to stimulate healing after ACL rupture. However, the histological properties of a successfully healing ACL and how they relate to the mechanical properties have not been fully described. Purpose: To determine which histological features best correlate with the mechanical properties of the healing ACL repairs and ACL grafts in a porcine model at 6 and 12 months after injury. Study Design: Controlled laboratory study. Methods: A total of 48 Yucatan mini-pigs underwent ACL transection followed by: (1) conventional ACL reconstruction with bone–patellar tendon–bone (BPTB) allograft, (2) bioenhanced ACL reconstruction with BPTB allograft using a bioactive scaffold, or (3) bioenhanced ACL repair using the same bioactive scaffold. After 6 and 12 months of healing, structural properties of the ACL or graft (yield and failure load, linear stiffness) were measured. Following mechanical testing, ACL specimens were histologically analyzed for cell and vascular density and qualitatively assessed using the advanced Ligament Maturity Index. Results: After 6 months of healing, the cellular organization subscore was most predictive of yield load (r 2 = 0.98), maximum load (r 2 = 0.89), and linear stiffness (r 2 = 0.95) of the healing ACL, while at 12 months, the collagen subscore (r 2 = 0.68) became the best predictor of maximum load. For ACL grafts, the reverse was true, with the collagen subscore predictive of yield and maximum loads at 6 months (r 2 = 0.55) and graft cellularity predictive of maximum load of the graft at 12 months (r 2 = 0.50). Conclusion: These findings suggest there may be key biological differences in development and maintenance of ACL tissue after repair or reconstruction, with early ligament function dependent on cellular population of the repair but early graft function dependent on the

  15. 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

  16. KOOS Pain as a Marker for Significant Knee Pain Two and Six Years after Primary ACL Reconstruction: A Multicenter Orthopaedic Outcomes Network (MOON) Prospective Longitudinal Cohort Study

    PubMed Central

    Wasserstein, D; Huston, LJ; Nwosu, S; Spindler, KP

    2015-01-01

    Objective The prevalence of radiographic osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR) approaches 50%, yet the prevalence of significant knee pain is unknown. We applied three different models of Knee injury and Osteoarthritis Outcome Score (KOOS) thresholds for significant knee pain to an ACLR cohort to identify prevalence and risk factors. Design Multicenter Orthopaedic Outcomes Network (MOON) prospective cohort patients with a unilateral primary ACLR and normal contralateral knee were assessed at 2 and 6 years. Independent variables included patient demographics, validated Patient Reported Outcomes (PRO; Marx activity score, KOOS), and surgical characteristics. Models included: (1) KOOS criteria for a painful knee = quality of life subscale <87.5 and ≥2 of: KOOSpain <86.1, KOOSsymptoms <85.7, KOOSADL <86.8, or KOOSsports/rec <85.0; (2) KOOSpain subscale score ≤72 (≥2 standard deviations below population mean); (3) 10-point KOOSpain drop from 2 to 6 years. Proportional odds models (alpha≤0.05) were used. Results 1,761 patients of median age 23 years, median BMI 24.8 kg/m2 and 56% male met inclusion, with 87% (1530/1761) and 86% (1506/1761) follow-up at 2 and 6 years, respectively. At 6 years, n=592 (39%), n=131 (9%) and n=169 (12%) met criteria for models #1 through #3, respectively. The most consistent and strongest independent risk factor at both time-points was subsequent ipsilateral knee surgery. Low 2-year Marx activity score increased the odds of a painful knee at 6 years. Conclusions Significant knee pain is prevalent after ACLR; with those who undergo subsequent ipsilateral surgery at greatest risk. The relationship between pain and structural OA warrants further study. PMID:26072385

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

    PubMed Central

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

    2016-01-01

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

  18. Periocular Reconstruction in Patients with Facial Paralysis.

    PubMed

    Joseph, Shannon S; Joseph, Andrew W; Douglas, Raymond S; Massry, Guy G

    2016-04-01

    Facial paralysis can result in serious ocular consequences. All patients with orbicularis oculi weakness in the setting of facial nerve injury should undergo a thorough ophthalmologic evaluation. The main goal of management in these patients is to protect the ocular surface and preserve visual function. Patients with expected recovery of facial nerve function may only require temporary and conservative measures to protect the ocular surface. Patients with prolonged or unlikely recovery of facial nerve function benefit from surgical rehabilitation of the periorbital complex. Current reconstructive procedures are most commonly intended to improve coverage of the eye but cannot restore blink.

  19. Reconstruction of mandibular defects in irradiated patients

    SciTech Connect

    Klotch, D.W.; Gump, J.; Kuhn, L. )

    1990-10-01

    In this prospective study, mandibular reconstruction using titanium plates was evaluated in 31 patients treated between July 1988 and January 1990. Sixteen patients had prior surgery; 13 had prior radiotherapy. In 11 patients, prior radiation and surgery had failed. Sixteen patients received postoperative radiotherapy either in standard or accelerated fractions. Twelve patients had complications of either intraoral (8), extraoral (5), or combined (1) plate exposure or fistula formation (2). Factors significantly related to complications were poor nutrition, accelerated radiation, and recurrence. Sixty-one percent of all patients healed uneventfully. When patients with complications secondary to recurrence who subsequently died were excluded, the success rate was 73%. Only one patient had an unacceptable result that produced a cosmetic and functional deformity despite secondary repair.

  20. THE EFFECT OF CONSERVATIVELY TREATED ACL INJURY ON KNEE JOINT POSITION Sense

    PubMed Central

    Herrington, Lee

    2016-01-01

    ABSTRACT Background Proprioception is critical for effective movement patterns. However, methods of proprioceptive measurement in previous research have been inconsistent and lacking in reliability statistics making it applications to clinical practice difficult. Researchers have suggested that damage to the anterior cruciate ligament (ACL) can alter proprioceptive ability due to a loss of functioning mechanoreceptors. The majority of patients opt for reconstructive surgery following this injury. However, some patients chose conservative rehabilitation options rather than surgical intervention. Purpose The purpose of this study was to determine the effect of ACL deficiency on knee joint position sense following conservative, non-operative treatment and return to physical activity. A secondary purpose was to report the reliability and measurement error of the technique used to measure joint position sense, (JPS) and comment on the clinical utility of this measurement. Study Design Observational study design using a cross-section of ACL deficient patients and matched uninjured controls. Methods Twenty active conservatively treated ACL deficient patients who had returned to physical activity and twenty active matched controls were included in the study. Knee joint position sense was measured using a seated passive-active reproductive angle technique. The average absolute angle of error score, between 10 °-30 ° of knee flexion was determined. This error score was derived from the difference between the target and repositioning angle. Results The ACL deficient patients had a greater error score (7.9 °±3.6) and hence poorer static proprioception ability that both the contra-lateral leg (2.0 °±1.6; p = 0.0001) and the control group (2.6 °±0.9; p = 0.0001). The standard error of the mean (SEM) of this JPS technique was 0.5 ° and 0.2 ° and the minimum detectable change (MDC) was 1.3 ° and 0.4 ° on asymptomatic and symptomatic subjects

  1. Autograft versus allograft in anterior cruciate ligament reconstruction

    PubMed Central

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

    2016-01-01

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

  2. Osteonecrosis of the Knee After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Lansdown, Drew A.; Shaw, Jeremy; Allen, Christina R.; Ma, C. Benjamin

    2015-01-01

    Background: Anterior cruciate ligament (ACL) reconstruction is performed commonly, with a low risk of complication. Osteonecrosis of the knee is a potentially devastating condition and has been observed both spontaneously and after meniscectomy, although osteonecrosis has not been described as a complication after ACL reconstruction. Purpose: To describe the development of osteonecrosis of the knee in 5 patients after arthroscopic ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: This study involved 5 patients (mean age, 33.2 years) who developed osteonecrosis of the knee after ACL reconstruction. A retrospective chart review was performed to identify clinical characteristics and surgical factors present in each of the 5 cases. Results: In 4 cases, the pathologic changes were present in both the medial and lateral femoral condyles, with isolated lateral condyle changes in the other case. The mean time to diagnosis was 11.6 months. These patients underwent an average of 1.8 additional surgical procedures after the diagnosis of osteonecrosis. Conclusion: Osteonecrosis of the knee is a rare outcome after ACL reconstruction. We are unable to identify clear risk factors for the development of this complication, although we hope the presentation of these cases will help promote the identification of other cases in future studies. PMID:26665035

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

    PubMed Central

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

    2013-01-01

    Background Knees undergoing revision anterior cruciate ligament (ACL) reconstruction typically have more intra-articular injuries than do knees undergoing primary reconstruction. Hypothesis Previous partial meniscectomy (PM) is associated with a higher rate of chondral lesions at revision ACL reconstruction, whereas previous meniscal repair (MR) is not associated with a higher rate of chondral lesions at revision ACL reconstruction, compared with knees undergoing revision ACL with no previous meniscal surgery. Study design Cohort study (Prevalence); Level of evidence, 2. Methods Data from a multicenter cohort was reviewed to determine the history of prior meniscal surgery (PM/MR) and the presence of grade II/III/IV chondral lesions at revision ACL reconstruction. The association between previous meniscal surgery and the incidence of chondral lesions was examined. Patient age was included as a covariate to determine if surgery type contributes predictive information independent of patient age. Results The cohort included 725 ACL revision surgeries. Chondrosis was associated with patient age (P < .0001) and previous meniscal surgery (P < .0001). After adjusting for patient age, knees with previous PM were more likely to have chondrosis than knees with previous MR (P = .003) or no previous meniscal surgery (P < .0001). There was no difference between knees without previous meniscal surgery and knees with previous MR (P = .7). Previous partial meniscectomy was associated with a higher rate of chondrosis in the same compartment compared with knees without previous meniscal surgery (P < .0001) and knees with previous MR (P ≤ .03). Conclusion The status of articular cartilage at the time of revision ACL reconstruction relates to previous meniscal surgery independent of the effect of patient age. Previous partial meniscectomy is associated with a higher incidence of articular cartilage lesions, whereas previous meniscal repair is not. Although this association may

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

    PubMed

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

    2011-05-18

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  7. Ability of a new hop test to determine functional deficits after anterior cruciate ligament reconstruction.

    PubMed

    Augustsson, Jesper; Thomeé, Roland; Karlsson, Jon

    2004-09-01

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

  8. 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.

  9. Ligament-muscle reflex arc after anterior cruciate ligament reconstruction: electromyographic evaluation.

    PubMed

    Biedert, R M; Zwick, E B

    1998-01-01

    The purpose of this study was to determine if a ligament-muscle reflex arc exists between the bone-patellar tendon-bone autograft after anterior cruciate ligament (ACL) reconstruction and the hamstring muscle group. We studied four patients, average age 34.2 years (range 32-36 years). The mean time between the ACL reconstruction and the study examination was 56.2 months (range 5-108 months). All patients underwent a second-look arthroscopy for meniscal injuries, cyclops lesions, or adhesions. Five patients with a normal ACL served as a control group before we performed an arthroscopic meniscectomy. Electromyographic (EMG) activity was measured using fine wire electrodes under two different testing conditions. No unequivocal EMG activity could be detected in the ACL-reconstructed knees when we pulled on the graft or in the controls. Three of four patients and all controls felt pain when we touched the graft or normal ACL or applied strain on it with the hook. In conclusion, the ACL autograft presents a noxious sensory innervation, the Lachman test maneuver stimulates a reflex arc with hamstrings activation, and an unequivocal ligament-muscle reflex arc from the graft to the hamstring muscle group could not be demonstrated. PMID:9833113

  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. High tibial osteotomy in the ACL-deficient knee with medial compartment osteoarthritis.

    PubMed

    Herman, Benjamin V; Giffin, J Robert

    2016-09-01

    High tibial osteotomy (HTO) has traditionally been used to treat varus gonarthrosis in younger, active patients. Varus malalignment increases the risk of progression of medial compartment osteoarthritis and an HTO can be performed to realign the mechanical axis of the lower limb towards the lateral compartment, thereby decreasing contact pressures in the medial compartment. Anterior cruciate ligament (ACL) insufficiency may lead to post-traumatic arthritis due to altered joint loading and associated injuries to the menisci and articular cartilage. Understanding the importance of posterior tibial slope and its role in sagittal knee stability has led to the development of biplane osteotomies designed to flatten the posterior tibial slope in the ACL deficient knee. Altering the alignment in both the sagittal and coronal planes helps improve stability as well as alter the load in the medial compartment. Detailed history, physical exam and radiographic analysis guide treatment decisions in this high demand patient population. Lateral closing wedge (LCW) and medial opening wedge (MOW) HTOs have been performed and their potential advantages and disadvantages have been well described. Given the triangular shape of the proximal tibia, it is imperative that the surgeon pay close attention to the geometry of the osteotomy "gap" when performing MOW HTO to avoid inadvertently increasing the posterior tibial slope. Simultaneous ACL reconstruction may require technique modifications depending on the type of HTO and ACL graft chosen. With appropriate patient selection and good surgical technique, it is reasonable to expect patients to return to activities of daily living and recreational sports without debilitating pain or instability. PMID:27358200

  12. 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

  13. 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

  14. The role of ACL injury in the development of posttraumatic knee osteoarthritis.

    PubMed

    Friel, Nicole A; Chu, Constance R

    2013-01-01

    Acute anterior cruciate ligament (ACL) tears are most frequently sustained by young, physically active individuals. ACL injuries are seen at high incidence in adolescents and young adults performing sports and occupational activities that involve pivoting. Young women participating in pivoting sports have a 3 to 5 times higher risk of ACL injury than men. Studies show that ACL injury increases osteoarthritis (OA) risk with symptomatic OA appearing in roughly half of individuals 10-15 years later. Because the majority of patients sustaining acute ACL tears are younger than 30, this leads to early onset OA with associated pain and disability during premium work and life growth years between ages 30 and 50. Effective strategies to prevent ACL injury and to reduce subsequent OA risk in those sustaining acute ACL tears are needed.

  15. Altered Loading in the Injured Knee after ACL Rupture

    PubMed Central

    Gardinier, Emily S.; Manal, Kurt; Buchanan, Thomas S.; Snyder-Mackler, Lynn

    2012-01-01

    Articular loading is an important factor in the joint degenerative process for individuals with anterior cruciate ligament (ACL) rupture. Evaluation of loading for a population that exhibits neuromuscular compensation for injury requires an approach which can incorporate individual muscle activation strategies in its estimation of muscle forces. The purpose of this study was to evaluate knee joint contact forces for patients with ACL deficiency using an EMG-driven modeling approach to estimate muscle forces. Thirty (30) athletes with acute, unilateral ACL rupture underwent gait analysis after resolving range of motion, effusion, pain and obvious gait impairments. Electromyography was recorded bilaterally from 14 lower extremity muscles and input to a musculoskeletal model for estimation of muscle forces and joint contact forces. Gait mechanics were consistent with previous reports for individuals with ACL-deficiency. Our major finding was that joint loading was altered in the injured limb after acute ACL injury; patients walked with decreased contact force on their injured knee compared to their uninjured knee. Both medial and lateral compartment forces were reduced without a significant change in the distribution of tibiofemoral load between compartments. This is the first study to estimate medial and lateral compartment contact forces in patients with acute ACL rupture using an approach which is sensitive to individual muscle activation patterns. Further work is needed to determine whether this early decreased loading of the injured limb is involved in the development of osteoarthritis in these patients. PMID:23097309

  16. 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

  17. Choosing a Graft for Anterior Cruciate Ligament Reconstruction: Surgeon Influence Reigns Supreme.

    PubMed

    Salminen, Matthew; Kraeutler, Matthew J; Freedman, Kevin B; Tucker, Brad S; Salvo, John P; Ciccotti, Michael G; Cohen, Steven B

    2016-01-01

    Selection of a graft type is an important decision for patients undergoing reconstructive surgery for a ligamentous injury. The purpose of this study was to determine the weight of key factors affecting patient selection of graft type for anterior cruciate ligament (ACL) reconstruction and to assess patients' knowledge of their particular graft type. We prospectively enrolled 304 patients who underwent primary ACL reconstruction. Patients filled out questionnaires at their first follow-up appointment after surgery and at least 1 year postoperatively. Questionnaires asked which type of graft was used and why they chose that graft. At their first postoperative appointment, 88% of autograft patients and 71% of allograft patients were accurate in stating their graft type and harvest location. The most common factor influencing graft selection was physician recommendation (81.6%). At the time of follow-up, 96% of patients were satisfied with their graft choice. There is a high rate of accuracy with which patients remember the type of graft used for their ACL reconstruction. The majority of patients undergoing ACL reconstruction are primarily influenced by the physician's recommendation. PMID:27327925

  18. Lower Limb Kinematics and Dynamic Postural Stability in Anterior Cruciate Ligament-Reconstructed Female Athletes

    PubMed Central

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

    2013-01-01

    Context: Deficits in lower limb kinematics and postural stability are predisposing factors to the development of knee ligamentous injury. The extent to which these deficits are present after anterior cruciate ligament (ACL) reconstruction is still largely unknown. The primary hypothesis of the present study was that female athletes who have undergone ACL reconstruction and who have returned to sport participation would exhibit deficits in dynamic postural stability as well as deficiencies in hip- and knee-joint kinematics when compared with an age-, activity-, and sex-matched uninjured control group. Objective: To investigate dynamic postural stability as quantified by the Star Excursion Balance Test (SEBT) and simultaneous hip- and knee-joint kinematic profiles in female athletes who have undergone ACL reconstruction. Design: Descriptive laboratory study. Setting: University motion-analysis laboratory. Patients or Other Participants: Fourteen female athletes who had previously undergone ACL reconstruction (ACL-R) and 17 age- and sex-matched uninjured controls. Intervention(s): Each participant performed 3 trials of the anterior, posterior-medial, and posterior-lateral directional components of the SEBT. Main Outcome Measure(s): Reach distances for each directional component were quantified and expressed as a percentage of leg length. Simultaneous hip- and knee-joint kinematic profiles were recorded using a motion-analysis system. Results: The ACL-R group had decreased reach distances on the posterior-medial (P < .01) and posterior-lateral (P < .01) directional components of the SEBT. During performance of the directional components of the SEBT, ACL-R participants demonstrated altered hip-joint frontal-, sagittal-, and transverse-plane kinematic profiles (P < .05), as well as altered knee-joint sagittal-plane kinematic profiles (P < .05). Conclusions: Deficits in dynamic postural stability and concomitant altered hip- and knee-joint kinematics are present after ACL

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

    PubMed

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

    2014-10-01

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

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

    PubMed

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

    2014-10-01

    Combined anterior cruciate ligament (ACL) and posterolateral injury of the knee can result in significant functional instability for the affected individual. Both components of the instability must be treated to maximize the probability of success for the surgical procedure. Higher failure rates of the ACL reconstruction have been reported when the posterolateral instability has been left untreated. The purpose of this article is to describe our surgical technique, and present the results of 34 chronic combined ACL posterolateral reconstructions in 34 knees using allograft tissue, and evaluating these patient outcomes with KT 1000 knee ligament arthrometer, Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales. In addition, observations regarding patient demographics with combined ACL posterolateral instability, postoperative range of motion loss, postinjury degenerative joint disease, infection rate, return to function, and the use of radiated and nonirradiated allograft tissues will be presented. PMID:24949986

  1. Failure of Anterior Cruciate Ligament Reconstruction.

    PubMed

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

    2015-10-01

    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

  2. Post-operative imaging of anterior cruciate ligament reconstruction techniques across the spectrum of skeletal maturity.

    PubMed

    Zbojniewicz, Andrew M; Meyers, Arthur B; Wall, Eric J

    2016-04-01

    Due to an increased frequency of anterior cruciate ligament (ACL) injuries in young patients and improved outcomes in athletic performance following ACL reconstruction, surgery is increasingly being performed across the spectrum of skeletal maturity. We present a review of the range of reconstruction techniques performed in skeletally immature patients (physeal sparing techniques, which may involve epiphyseal tunnels or the utilization of an iliotibial band autograft), those performed in patients nearing skeletal maturity (transphyseal techniques), and the more conventional ACL reconstruction techniques performed in skeletally mature adolescents. It is important that radiologists be aware of the range of techniques being performed throughout the spectrum of skeletal maturity in order to accurately characterize the expected post-operative appearance as well as to identify complications, including those unique to this younger population. PMID:26646675

  3. Graft impingement in anterior cruciate ligament reconstruction.

    PubMed

    Iriuchishima, Takanori; Shirakura, Kenji; Fu, Freddie H

    2013-03-01

    Anterior cruciate ligament (ACL) graft impingement is one of the most troubling complications in ACL reconstruction. In the previous strategy of isometric "non-anatomical" ACL reconstruction, posterior tibial tunnel placement and notchplasty were recommended to avoid graft impingement. Recently, the strategy of ACL reconstruction is shifting towards "anatomical" reconstruction. In anatomical ACL reconstruction, the potential risk of graft impingement is higher than in non-anatomical reconstruction because the tibial tunnel is placed at a more anterior portion on the tibia. However, there have been few studies reporting on graft impingement in anatomical ACL reconstruction. This study will provide a review of graft impingement status in both non-anatomical and the more recent anatomical ACL reconstruction techniques. In conclusion, with the accurate creation of bone tunnels within ACL native footprint, the graft impingement might not happen in anatomical ACL reconstruction. For the clinical relevance, to prevent graft impingement, surgeons should pay attention of creating correct anatomical tunnels when they perform ACL reconstruction. Level of evidence IV.

  4. Lateral Knee Pain after Outside-in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using the TightRope RT

    PubMed Central

    Kuribayashi, So; Nakayama, Shuichi; Nakazato, Keisuke; Fukubayashi, Toru; Okinaga, Shuji

    2016-01-01

    The anterior cruciate ligament (ACL) TightRope RT (TR) was recently introduced as a novel cortical suspension device for ACL reconstruction. It has an adjustable graft loop that gives the surgeon some advantages during ACL reconstruction. We report three patients who required removal of the TR after an outside-in anatomical ACL reconstruction because of lateral knee pain. We assumed that the knee pain was associated with friction between the TR button of the posterolateral bundle and iliotibial band (ITB). Placing the TR button close to the lateral epicondyle and tissue interposition between the TR button and lateral femoral cortex may be potential risk factors for ITB irritation. Therefore, we recommend not placing the TR button close to the top of the lateral epicondyle and reducing the tissue interposition between the TR button and lateral femoral cortex as much as possible. PMID:26955618

  5. Lateral Knee Pain after Outside-in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using the TightRope RT.

    PubMed

    Kawaguchi, Kohei; Kuribayashi, So; Nakayama, Shuichi; Nakazato, Keisuke; Fukubayashi, Toru; Okinaga, Shuji

    2016-03-01

    The anterior cruciate ligament (ACL) TightRope RT (TR) was recently introduced as a novel cortical suspension device for ACL reconstruction. It has an adjustable graft loop that gives the surgeon some advantages during ACL reconstruction. We report three patients who required removal of the TR after an outside-in anatomical ACL reconstruction because of lateral knee pain. We assumed that the knee pain was associated with friction between the TR button of the posterolateral bundle and iliotibial band (ITB). Placing the TR button close to the lateral epicondyle and tissue interposition between the TR button and lateral femoral cortex may be potential risk factors for ITB irritation. Therefore, we recommend not placing the TR button close to the top of the lateral epicondyle and reducing the tissue interposition between the TR button and lateral femoral cortex as much as possible. PMID:26955618

  6. Anterior Cruciate Ligament (ACL) Injuries

    MedlinePlus

    ... get ACL injuries usually play contact sports (like football) or sports that feature swift, abrupt movements such ... the things you love — like running or playing football, field hockey, or softball — can be frustrating. Recovering ...

  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. 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

  9. Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon autograft: clinical outcome in 4-7 years.

    PubMed

    Chen, Chih-Hwa; Chuang, Tai-Yuan; Wang, Kun-Chuang; Chen, Wen-Jer; Shih, Chun-Hsiung

    2006-11-01

    Surgical reconstruction of the anterior cruciate ligament (ACL) is indicated in the ACL-deficient knee with symptomatic instability and multiple ligaments injuries. In the present study, we describe the clinical results of quadriceps tendon-patellar bone autograft for ACL reconstruction. From 1996 to 1998, the graft has been used in 38 patients. Thirty-four patients with complete final follow-up for 4-7 years were analyzed. The average follow-up time was 62 (48-84) months. Thirty-two patients (94%) achieved good or excellent results by Lysholm knee rating. Twenty-six patients (76%) could return to moderate or strenuous activity after reconstruction. Twenty-eight patients (82%) had ligament laxity of less than 2 mm. Finally; 31 patients (91%) were assessed as normal or nearly normal rating by IKDC guideline. Twenty-five patients (73%) had less than 10 mm difference in thigh girth between their reconstructed and normal limbs. Thirty-two (94%) and 31 (91%) patients could achieve recovery of the extensor and flexor muscle strength in the reconstructed knee to 80% or more of normal knee strength, respectively. A statistically significant difference exists in thigh girth difference, extensor strength ratio, and flexor strength ratio before and after reconstruction. Tunnel expansion with more than 1 mm was identified in 2 (6%) tibial tunnels. Our study revealed satisfactory clinical subjective and objective results at 4-7 years follow-up. Quadriceps tendon autograft has the advantage of being self-available, relatively easier arthroscopic technique, and having a suitable size, making it an acceptable graft choice for ACL reconstruction. There is little quadriceps muscle strength loss after quadriceps harvest. A quadriceps tendon-patellar autograft is an adequate graft choice to ACL reconstruction.

  10. Force Production and Reactive Strength Capabilities After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Flanagan, Eamonn P; Galvin, Lorcan; Harrison, Andrew J

    2008-01-01

    Context: Ambiguity exists in the literature regarding whether individuals can restore function to 100% after anterior cruciate ligament (ACL) reconstruction. The response of force production and reactive strength in stretch-shortening cycle activities after surgery has not been established. Objective: To compare reactive strength and force production capabilities between the involved and uninvolved legs of participants who had undergone ACL reconstruction and rehabilitation with the reactive strength and force production capabilities of a control group. Design: Repeated measures, cross-sectional. Setting: Research laboratory. Patients or Other Participants: Ten participants with ACL reconstructions who had returned to their chosen sports and 10 age-matched and activity-matched control subjects. Intervention(s): We screened the ACL group with the International Knee Documentation Committee Subjective Knee Evaluation Form and functional performance tests to measure a basic level of function. We assessed force production capabilities and reactive strength using squat, countermovement, drop, and rebound jump protocols on a force sledge apparatus. Main Outcome Measure(s): The dependent variables were flight time, peak vertical ground reaction force, leg spring stiffness, and reactive strength index. Results: No participant in the ACL group exhibited functional deficits in comparison with normative values or the control group. Using the force sledge apparatus, we found no notable differences in force production capabilities and reactive strength in the ACL group when comparing the involved with uninvolved legs or the degree of difference between legs with the control group. Conclusions: After ACL reconstruction, rehabilitated participants did not exhibit deficits in force production or reactive strength capabilities. Our results suggest that force production and reactive strength capabilities can be restored to levels comparable with the uninjured control limb and may not

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

    PubMed

    Wee, James; Lee, Keng Thiam

    2014-04-01

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

  12. 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

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

    PubMed

    Wee, James; Lee, Keng Thiam

    2014-04-01

    Septic arthritis following arthroscopic anterior cruciate ligament reconstruction (ACL) is a rare complication and associated with severe morbidity. Its risk factors include (1) concomitant procedures during the reconstruction, (2) previous knee surgery, (3) allograft usage, (4) peri-operative wound contamination, and (5) presence of intra-articular foreign bodies. We present a series of 3 men and one woman aged 22 to 35 years who developed septic arthritis following ACL reconstruction. The risk factors identified were local infection (n=2), previous ipsilateral knee surgery (n=2), and the use of an allograft (n=1). All patients underwent emergency knee washout and debridement with graft retention within 24 hours, together with a course of intravenous antibiotic therapy. All the patients achieved eradication of their infections (with intact ACL grafts) and satisfactory functional outcome at a mean follow-up of 32 (range, 25-45) months. PMID:24781628

  14. Short-term recovery after anterior cruciate ligament reconstruction: a prospective comparison of three autografts.

    PubMed

    Joseph, Michael; Fulkerson, John; Nissen, Carl; Sheehan, T Joseph

    2006-03-01

    Sixty-four patients with three different autografts were prospectively evaluated following anterior cruciate ligament (ACL) reconstruction for motion return, thigh girth, quadriceps activity, assistive device usage, and duration of pain medication usage. The quadriceps tendon group achieved knee extension sooner than the patellar tendon group. The hamstring group used assistive devices for less time than the patellar tendon group. The quadriceps group required less pain medication than either of the groups. There are significant differences in short-term pain medication requirements and restoration of function among patients following ACL reconstruction using different autografts.

  15. 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.

  16. 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

  17. Outcome of Simultaneous Arthroscopic Anterior Cruciate Ligament and Posterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: A Multicenter Prospective Study

    PubMed Central

    Panigrahi, Ranajit; Kumari Mahapatra, Amita; Priyadarshi, Ashok; Singha Das, Dibya; Palo, Nishit; Ranjan Biswal, Manas

    2016-01-01

    Background: Multiligamentous injuries of knee are a complex problem in orthopaedics. Combined ACL-PCL injuries are uncommon, usually associated with knee dislocations. Extremity vascular status is essential because of possible arterio-venous compromise. These complex injuries require a systematic evaluation and treatment. Single setting simultaneous arthroscopic ACL and PCL reconstruction or a staged approach can be adopted to treat these cases. Objectives: To evaluate functional outcome of simultaneous arthroscopic ACL and PCL reconstruction with hamstring tendon autograft in multiligamentous knee injuries. Patients and Methods: This prospective study was performed on 20 patients with combined ACL-PCL injuries who underwent simultaneous arthroscopic ACL-PCL reconstruction with hamstring tendon. Evaluation of functional outcome was by IKDC and Lysholm-Tegner scores. Results: In 20 patients, mean age 34 years, return to full-time work and to full sports was 8 weeks and 6.2 months respectively. All patients had full range of motion except 2 patients with < 5 degrees flexion loss; 90% had negative Lachmann test; 95% had negative pivot shift and 10% patients had mild posterior drawer at 90 degrees (1+) at final follow up. Mean IKDC score was 90 (range 81 - 94); mean Tegner activity score was 7 and mean Lysholm knee score was 89. 85% returned to preinjury activity level and a 90% satisfaction rate. Conclusions: Simultaneous arthroscopic ACL and PCL reconstructions using hamstring tendon for combined ACL and PCL injuries is a clinically effective, safe, time saving and cost-effective procedure with better patient compliance and reproducible for a timely return of motion, strength, and function with favorable outcome. PMID:27217932

  18. Prediction of angular deformity and leg-length discrepancy after anterior cruciate ligament reconstruction in skeletally immature patients.

    PubMed

    Wester, W; Canale, S T; Dutkowsky, J P; Warner, W C; Beaty, J H

    1994-01-01

    Injuries to the anterior cruciate ligament (ACL) in young children and adolescents are becoming more common as more youngsters participate in organized sports. The dilemma for the orthopaedic surgeon is that untreated ACL ruptures may result in meniscal damage and joint degeneration, whereas surgical treatment may result in physeal arrest, with shortening and angular deformity. To help determine the appropriate timing for ACL repair in skeletally immature patients, graphs have been developed to predict the amount of shortening and angular deformity to expect after repair.

  19. 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

  20. 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

  1. Factors Associated with Infection Following Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Brophy, Robert H.; Wright, Rick W.; Huston, Laura J.; Nwosu, Samuel K.; Spindler, Kurt P.

    2015-01-01

    Background: Although rare, infection can be devastating after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to test the association between infection after ACL reconstruction and potential risk factors such as age, body mass index (BMI), smoking, diabetes, and graft choice. Methods: We reviewed the Multicenter Orthopaedic Outcomes Network (MOON) cohort from 2002 to 2005 to identify patients with a postoperative infection. The age, BMI, smoking status, history of diabetes, and graft choice were recorded for each patient. A multivariable regression analysis was constructed to examine which baseline risk factors were independently associated with postoperative infection after ACL reconstruction requiring surgical intervention. Results: There were 2198 eligible patients in the cohort, with seventeen (0.8%) reporting a postoperative infection. Diabetes was found to be a significant risk factor for infection (odds ratio [OR] = 18.8; 95% confidence interval [CI] = 3.8 to 94.0; p < 0.001). Compared with bone-tendon-bone autograft, both hamstring autograft and other grafts (e.g., the majority of allografts, with some that were both autograft and allograft) also increased the risk of infection (OR = 4.6 [95% CI = 1.2 to 17.9; p = 0.026] for hamstrings and 4.3 [95% CI = 1.0 to 18.1; p = 0.047] for other grafts). Although the OR for infection in smokers was 2.5, this finding did not reach significance. Conclusions: Patients with diabetes undergoing ACL reconstruction have a significantly elevated risk of postoperative infection (18.8-times higher odds) compared with that for patients without diabetes. Use of bone-tendon-bone autograft is associated with a lower risk of infection after ACL reconstruction. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:25788300

  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. 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

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

    PubMed

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

    2012-12-01

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

  5. Tennis specific limitations in players with an ACL deficient knee

    PubMed Central

    Maquirriain, J; Megey, P J

    2006-01-01

    Background Complete rupture of the anterior cruciate ligament (ACL) causes significant alteration of knee joint kinematics. Untreated patients often develop joint instability, chronic articular degeneration, and knee dysfunction. Demands on the ACL produced by playing tennis have not been investigated. Objective To identify subjective sport‐specific limitations in tennis players with isolated unilateral ACL deficiency. Study design Prospective case–control study. Methods 16 players (mean (SD) age, 39.9 (2.3) years; 14 men) with a chronic unilateral ACL deficient knee and 16 healthy controls (38.25 (8.47) years; 14 men) were recruited. ACL deficiency was confirmed by clinical and magnetic resonance imaging. A Lysholm score was obtained in all patients, together with subjective evaluation of their current tennis performance compared with pre‐injury levels, applying a 0–100% visual scale. Both groups completed a questionnaire on tennis specific abilities. Results Lysholm scores were: 85.6 (10.3) points in the study group and 100 (0) points in the control group (p<0.001, t test for independent samples). Injured players evaluated their current tennis performance as 66.8 (15.2)% compared with 100% pre‐injury level (p<0.005, t test for dependent samples). Abilities affected in the ACL deficient group were landing after a smash stroke (p<0.001); stopping abruptly and changing (p<0.001); playing a three set singles match (p<0.05); and playing on a hard court surface (p<0.001, Kolmogorov‐Smirnov test). Conclusions There are specific limitations associated with complete isolated ACL rupture, including subjective tennis performance impairment, limitations landing after a smash, stopping and changing step direction, difficulties playing a three set singles match, and playing on hard court surfaces. PMID:16632578

  6. Anterior cruciate ligament reconstruction with allograft tendons.

    PubMed

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

    2003-01-01

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

  7. Anterior cruciate ligament reconstruction with allograft tendons.

    PubMed

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

    2003-01-01

    Allograft tissue allows reconstruction of the ACL without the donor site morbidity that can be caused by autograft harvesting. Patients who must kneel as a part of their occupation or chosen sport are particularly good candidates for allograft reconstruction. Patients over 45 years of age and those requiring revision ACL surgery can also benefit from the use and availability of allograft tendons. In some cases, patients or surgeons may opt for allograft tendons to maximize the result or morbidity ratio. Despite advances in cadaver screening and graft preparation, there remain risks of disease transmission and joint infection after allograft implantation. Detailed explanation and informed consent is vitally important in cases in which allograft tissue is used. PMID:12735200

  8. Predictors for Reconstruction and Mood Disorder Associated With Reconstruction in Patients With Breast Cancer and Mastectomy

    PubMed Central

    Pan, Hsueh-Hsing; Chu, Chun-Hui; Wu, Li-Fen; Hsieh, Pi-Ching; Chang, Kun-Chia; Li, Chung-Yi

    2016-01-01

    Abstract This study used Taiwan's National Health Insurance medical claims to investigate the predictors for operative modes chosen by early-stage breast cancer patients; as well as to assess whether operative modes are associated with risk of mood disorder. We included 36,377 patients with breast cancer who received surgery between 2000 and 2008, and were followed to the end of 2010; they were further classified into 3 groups: mastectomy alone (n = 34,900), along with early reconstruction (n = 1080), and along with delayed reconstruction (n = 397). The results showed that age, insurance premium, urbanization level, and postsurgery chemotherapy and radiotherapy were all significant predictors for the selection of operative modes. Breast cancer patients with mastectomy alone, early reconstruction, and delayed reconstruction showed a cumulative incidence rate of mood disorder of 36.90%, 41.56%, and 33.89%, respectively. The multiple cox proportional model further revealed that early (hazard ratio [HR] = 1.06, 95% confidence interval (CI) = 0.93–1.21) and delayed (HR = 1.17, 95% CI = 0.96–1.42) reconstruction were associated with a slightly higher but insignificant risk of mood disorder, as compared to the patients received no reconstruction. PMID:26817890

  9. Comparison of preoperative anxiety in reconstructive and cosmetic surgery patients.

    PubMed

    Sönmez, Ahmet; Bişkin, Nurdan; Bayramiçli, Mehmet; Numanoğlu, Ayhan

    2005-02-01

    Surgery is a serious stressor and a cause of anxiety for the patients. Reconstructive surgery patients are mostly operated on because of certain functional impairment or disability; on the contrary, cosmetic surgery patients do not have any physical impairment and they are operated on because of mostly psychologic reasons. The aim of this study was to compare the anxiety levels in the reconstructive surgery patients and cosmetic surgery patients preoperatively. Thirty-two patients in the reconstructive surgery group and 30 patients in the cosmetic surgery group were included in the study. State Trait Anxiety Inventory was used to measure the anxiety levels in these 2 groups preoperatively. The 2 groups were similar in characteristics such as age, gender distribution, number of previous operations, and trait anxiety scores. Mean state anxiety scores obtained for the reconstructive surgery group was 38.0 +/- 8.7, while it was 44.2 +/- 10.79 for the cosmetic surgery group (t test, degrees of freedom = 60, P = 0.015). This study reveals that preoperative anxiety levels in the cosmetic surgery patients are higher than those of the reconstructive surgery patients. Therefore, adequate preoperative preparation for cosmetic surgery should include attempts to cope with anxiety. Anxiolytics may be used more liberally and professional psychologic assistance may be required.

  10. 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

  11. 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

  12. 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

  13. 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

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

    PubMed Central

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

    2016-01-01

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

  15. Change in knee kinematics during gait after eccentric isokinetic training for quadriceps in subjects submitted to anterior cruciate ligament reconstruction.

    PubMed

    Coury, H J C G; Brasileiro, J S; Salvini, T F; Poletto, P R; Carnaz, L; Hansson, G A

    2006-11-01

    Knee kinematics after anterior cruciate ligament (ACL) reconstruction is of interest in studies evaluating the effect of training programs. Many studies have addressed knee flexion/extension but not valgus/varus movements. Considering that joint stability is a major concern in ACL reconstruction surgery, movements occurring in the frontal plane of the knee also deserve attention. Knee extensor torque was analyzed by an isokinetic dynamometer and the angular amplitudes and velocities of flexion/extension and valgus/varus movements were analyzed by goniometry during gait 9 months after ACL reconstruction. The analysis was repeated after 3 months of eccentric isokinetic training of the quadriceps in five patients. The gait pattern was also recorded for 10 healthy controls. The knee extensor torque and flexion/extension range of movement during gait increased significantly after training. However, an unexpectedly increased valgus, most pronounced during the swing phase, which may imply adverse effects on the knee, was also observed in the ACL reconstructed knee. The recorded valgus angles may however be overestimated due to crosstalk. Thus, the extent of the increased valgus, as well as the mechanisms involved and the functional and clinical implications, need clarification before eccentric training after ACL reconstruction can be generally recommended.

  16. The ACL Message Passing Library

    SciTech Connect

    Painter, J.; McCormick, P.; Krogh, M.; Hansen, C.; Colin de Verdiere, G.

    1995-09-01

    This paper presents the ACL (Advanced Computing Lab) Message Passing Library. It is a high throughput, low latency communications library, based on Thinking Machines Corp.`s CMMD, upon which message passing applications can be built. The library has been implemented on the Cray T3D, Thinking Machines CM-5, SGI workstations, and on top of PVM.

  17. Sex, Age, and Graft Size as Predictors of ACL Re-tear

    PubMed Central

    Nguyen, Duong

    2016-01-01

    Objectives: The minimum size required for a successful quadrupled hamstring autograft ACL reconstruction remains controversial. The risks of ACL re-tear in younger patients who tend to participate in a higher level of sports activity, and female athletes who have numerous predisposing factors, are poorly defined. Purpose: To identify risk factors for graft re-tears within 2 years of ACL surgery. The hypotheses are that female sex, a smaller size graft, and younger patients will increase the odds of failure. Study Design Cohort Study. Level of evidence, 3. Methods: A cohort of 503 athletes undergoing primary, autograft hamstring ACL reconstruction, performed by a single surgeon using the same surgical technique and rehabilitation protocol, between September-December 2012, was followed for a total duration of 2 years. Return to play was allowed between 6 and 12 months post-surgery upon completion of functional testing. Exclusion criteria included infections, revisions, double bundle techniques, multi-ligament injuries, non-compliance, BTB/allografts/hybrid grafts. Primary outcome consisted of binary data (ACL graft re-tear or no tear) as measured on physical exam (Lachman and pivot shift) and MRI. Multivariate logistic regression statistical analysis with model fitting was used to investigate the predictive value of sex, age, and graft size on ACL re-tear. Secondary sensitivity analyses were performed on the adolescent subgroup, age and graft size as categorical variables, and testing for interactions among variables. Sample size was calculated based on the rule of 10 events per independent variable for logistic regression. Results: The mean age of the 503 athletes was 27.5 (SD 10.6; range = 12-61). There were 235 females (47%) and 268 males (53%) with a 6% rate of re-tears (28 patients; 17 females). Mean graft size was 7.9 (SD 0.6; range = 6-10). Univariate analyses of graft size, sex, and age only in the model showed that younger age (odds ratio [OR] = 0.86; 95

  18. 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

  19. Gait and Neuromuscular Asymmetries after Acute ACL Rupture

    PubMed Central

    Gardinier, Emily S.; Manal, Kurt; Buchanan, Thomas S.; Snyder-Mackler, Lynn

    2012-01-01

    The decreased internal knee extensor moment is a significant gait asymmetry among patients with anterior cruciate ligament (ACL) deficiency, yet the muscular strategy driving this altered moment for the injured limb is unclear. Purpose To determine whether patients with ACL deficiency and characteristic knee instability would demonstrate normal extensor and increased flexor muscle force to generate a decreased internal extensor moment (i.e. employ a hamstring facilitation strategy). Methods Gait analysis was performed on 31 athletes with acute ACL rupture who exhibited characteristic knee instability after injury. Peak internal knee extensor moment was calculated using inverse dynamics and muscle forces were estimated using an EMG-driven modeling approach. Comparisons were made between the injured and contralateral limbs. Results As expected, patients demonstrated decreased peak knee flexion (p=0.028) and internal knee extensor moment (p=0.0004) for their injured limb, but exhibited neither an isolated decrease in extensor force (quadriceps avoidance), nor an isolated increase in flexor force (hamstring facilitation) at peak knee moment. Instead, they exhibited decreased muscle force from both flexor (p=0.0001) and extensor (p=0.0103) groups. This strategy of decreased muscle force may be explained in part by muscle weakness which frequently accompanies ACL injury, or by apprehension, low confidence and fear of further injury. Conclusions This is the first study to estimate muscle forces in the ACL-deficient knee using an EMG-driven approach. These results affirm the existence of neuromuscular asymmetries in the individuals with ACL deficiency and characteristic knee instability. PMID:22330021

  20. Reconstruction of the anterior cruciate ligament in the skeletally immature athlete: a review of current concepts: AAOS exhibit selection.

    PubMed

    Fabricant, Peter D; Jones, Kristofer J; Delos, Demetris; Cordasco, Frank A; Marx, Robert G; Pearle, Andrew D; Warren, Russell F; Green, Daniel W

    2013-03-01

    Intrasubstance tears of the anterior cruciate ligament (ACL) were once considered a rare injury in skeletally immature athletes but are now observed with increasing frequency. Treatment strategies have evolved as recent studies have identified unique considerations specific to the skeletally immature patient. The current literature now supports the trend toward early operative treatment to restore knee stability and prevent progressive meniscal and/or articular cartilage damage, but the optimal approach to ACL reconstruction in this age group remains controversial. Despite the reported clinical success of transphyseal reconstruction, iatrogenic growth disturbance secondary to physeal damage remains a genuine concern. The reluctance to place drill-holes across open physes has led to the development of numerous "physeal-sparing" reconstruction techniques using anatomic femoral and tibial footprints that have adequately restored anteroposterior and rotational knee stability in biomechanical studies but have demonstrated mixed results in the clinical setting. The intent of this review is to (1) highlight the unique anatomic considerations pertaining to ACL reconstruction in the skeletally immature athlete, (2) discuss preoperative clinical and radiographic assessment of the pediatric patient with a suspected ACL injury, (3) review transphyseal and physeal-sparing reconstruction techniques and highlight surgical technical considerations, (4) present clinical outcomes according to patient and technique-specific factors, and (5) review age-specific injury prevention treatment strategies and a novel treatment algorithm based on skeletal maturity. ACL reconstruction in the skeletally immature athlete typically results in a successful clinical outcome, yet the optimal surgical technique is still controversial. This review will help guide the management of ACL injuries in the pediatric athlete. PMID:23467876

  1. [Reconstruction of a cheek defect in three patients].

    PubMed

    Juten, P G; Mureau, M A M; Hofer, S O P

    2007-05-19

    A woman aged 62 and two men aged 52 and 26 all with a cheek defect following resection of a recurrence of a lentigo maligna, a recurrence of a basal-cell carcinoma of the wispy type and a dermatofibrosarcoma protuberans respectively, all underwent cheek reconstruction. The rotation flap technique was used in the first two patients. The third patient was treated with a cervicofacial musculocutaneous transposition flap and underwent postoperative radiotherapy due to the high risk of recurrence. All 3 patients made a good recovery. Defects after radical resection of malignant head and neck skin tumours can be treated by several reconstruction techniques depending on the site, size, and shape of the defect. A local transposition flap is the preferred method of reconstruction. It is important to respect the aesthetic units of the face in order to achieve the best aesthetic and functional results. PMID:17557671

  2. Precision of ACL tunnel placement using traditional and robotic techniques.

    PubMed

    Burkart, A; Debski, R E; McMahon, P J; Rudy, T; Fu, F H; Musahl, V; van Scyoc, A; Woo, S L

    2001-01-01

    The objective of this study was to examine the precision of ACL tunnel placement using: (1) CASPAR (orto MAQUET GmbH Co. KG)--an active robotic system, and (2) four orthopedic surgeons with various levels of experience (between 100 and 3,500 ACL reconstructions). The robotic system and each surgeon drilled tunnels for ACL reconstruction in 10 plastic knees (total n = 50) that included a reference cube in the medial aspect of the proximal tibia and distal femur. For the robotic system, the placement of each tunnel was planned preoperatively using custom software and CT data for each femur and tibia. The robotic system then drilled the tunnels in the femur and tibia based on the preoperative plan. For the surgeons, tunnel placement was accomplished using their preferred technique, which was based on the one-incision arthroscopic technique. The distribution of intra-articular points on the tibia was contained within a sphere of radius 2.0 mm (robot system), 2.1 mm (Fellow 1), 2.4 mm (Fellow 2), 3.4 mm (Experienced Surgeon 1), or 2.0 mm (Experienced Surgeon 2). On the femur, no significant differences in the distribution of intra-articular points could be demonstrated between the robotic system (2.1 mm), Fellow 1 (4.5 mm), Fellow 2 (4.1 mm), Experienced Surgeon 1 (2.3 mm), and Experienced Surgeon 2 (3.0 mm). The direction of the tunnels drilled in the femur and tibia was different with the robotic and traditional techniques. However, the robotic system had the most consistent tunnel directions, while the surgeons' tunnels were more dispersed. Variation in surgeon precision of tunnel placement for ACL reconstruction is greater on the femur than the tibia, and this can be correlated with experience. Our data also suggest that the robotic system has the same precision as the most experienced surgeons. PMID:11892003

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

    PubMed Central

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

    2016-01-01

    Background: Rupture of the anterior cruciate ligament (ACL) is a common sports injury and is known to be associated with an increased risk of knee osteoarthritis. Several studies have indicated that the risk of additional injuries to the menisci and articular cartilage increases with delays in the treatment of ACL tears. However, no consensus has been reached regarding the ideal timing for ACL reconstruction in terms of preventing secondary lesions. Purpose: To determine how the time elapsed between an ACL lesion and its reconstruction affects the incidence of meniscal and chondral lesions. Study Design: Case series; Level of evidence, 4. Methods: Medical records of 764 patients who underwent primary ACL reconstruction were reviewed. Data from arthroscopic findings that included information about meniscal lesions and full-thickness articular cartilage lesions at the time of surgery were collected. The association between time elapsed between ACL lesion and reconstruction surgery and incidence of articular cartilage and meniscal lesions was analyzed by chi-square or Fisher exact test. The risk of secondary lesion was calculated by odds ratios (ORs) obtained from simple logistic regression analysis. Results: A positive correlation was observed between time after injury and the presence of any articular lesions (P = .003), cartilage lesions (P = .01), and medial meniscus lesions (P < .001). When analyzing the risk of secondary lesion relative to the reference period (<2 months), it was observed that the odds of finding any articular injury at the time of ACL reconstruction increased when the time from ACL injury to surgery was between 12 and 24 months (OR = 2.62) and >24 months (OR = 5.88). Furthermore, the odds of lesions on the medial meniscus increased when the timing between injury and surgery was 6 to 12 months (OR = 2.71) and continued to increase when the timing was 12 to 24 months (OR = 3.78) and >24 months (OR = 9.07). Conclusion: Associated articular lesions

  4. 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

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

    PubMed

    Kim, Sung-Jae; Kumar, Praveen; Kim, Sung-Hwan

    2010-09-01

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

  6. The female ACL: why is it more prone to injury?

    PubMed

    Ireland, Mary Lloyd

    2002-10-01

    Multiple factors are responsible for ACL tears. The key factor in the gender discrepancy appears to be dynamic, not static, and proximal, not distal. The factors involved in evaluating the female ACL are multiple. However, it is the dynamic movement patterns ot hip and knee position with increased flexion and a coordinated proximal muscle firing pattern to keep the body in a safe landing position that are the most critical factors. An ACL injury at an early age is a life-changing event. We can very successfully reconstruct and rehabilitate an ACL, but we cannot stop there. We must now go into the prevention arena. In the United States there is tremendous variation in the exposure and acquisition of skills of physical activities in our youth. Today, children are often playing inside, using computers and watching television-missing out on the opportunity to learn safe movement patterns. Therefore, physical movement classes should occur very early in life, teaching children to land safely and in control, similar to the cry of "get down, stay down" routinely heard during youth soccer. Similarly, specific strength training programs can address landing as well as foot movements during cutting in basketball. Coaches should issue stern warnings when athletes demonstrate a high-risk movement patterns such as one-leg landings, out-of-control baseline landings, or straight-leg landings. The warnings may serve to keep the athlete from "touching the hot stove again" for fear of getting burned. No athlete feels she will be the one to get injured. Therefore, prospective analysis is likely to be received more warmly by the athletes if the program is presented with an emphasis on performance improvement rather than injury prevention. With increased participation in these programs, multiple-center analysis will have the power necessary to determine which factors significantly predispose athletes to ACL injury. The future for injury prevention is bright. We must rise to the challenge.

  7. Human knee laxity in ACL-deficient and physiological contralateral joints: intra-operative measurements using a navigation system

    PubMed Central

    2014-01-01

    Background The comprehension of human knee laxity and of the failures of relevant surgical reconstructions of the anterior cruciate ligament (ACL) can be enhanced by the knowledge of the laximetric status of the contralateral healthy knee (CHK). Rarely this is available in patients, directly from the skeletal structures, and for a number of the standard clinical tests. The general aim of this study was to measure the extent to which laxity occurs immediately before surgery in the ACL deficient knee (ADK) with respect to CHK, in a number of standard clinical evaluation tests. Method Thirty-two patients with ACL deficiency were analyzed at ADK and at CHK by a navigation system immediately before reconstructions. Knee laxity was assessed based on digitized anatomical references during the antero-posterior drawer, Lachman, internal-external rotation, varus-valgus, and pivot-shift tests. Antero-posterior laxity was normalized based on patient-specific length of the tibial plateau. Results In the drawer test, statistical significance (p < 0.05) was found for the larger antero-posterior laxity in ADK than in CHK, on average, of 54' in the medial and 47' in the lateral compartments, when measured in normalized translations. In the Lachman test, these were about 106' and 68'. The pivot-shift test revealed a significant 70' larger antero-posterior central laxity and a 32' larger rotational laxity. No statistically relevant differences were observed in the other tests. Conclusion The first conclusion is that it is important to measure also the antero-posterior and rotational laxity of the uninjured contralateral knee in assessing the laxity of the injured knee. A second is that the Lachman test shows knee laxity better than the AP drawer, and that the pivot-shift test was the only one able to reveal rotational instability. The present original measurements and analyses contribute to the knowledge of knee joint mechanics, with possible relevant applications in biomedical

  8. 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

  9. Does the posterolateral bundle influence rotational movement more than the anteromedial bundle in anterior cruciate ligament reconstruction?: a clinical study.

    PubMed

    Komzák, M; Hart, R; Okál, F; Safi, A

    2012-10-01

    The biomechanical function of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) remains controversial. Some studies report that the AM bundle stabilises the knee joint in anteroposterior (AP) translation and rotational movement (both internal and external) to the same extent as the PL bundle. Others conclude that the PL bundle is more important than the AM in controlling rotational movement. The objective of this randomised cohort study involving 60 patients (39 men and 21 women) with a mean age of 32.9 years (18 to 53) was to evaluate the function of the AM and the PL bundles of the ACL in both AP and rotational movements of the knee joint after single-bundle and double-bundle ACL reconstruction using a computer navigation system. In the double-bundle group the patients were also randomised to have the AM or the PL bundle tensioned first, with knee laxity measured after each stage of reconstruction. All patients had isolated complete ACL tears, and the presence of a meniscal injury was the only supplementary pathology permitted for inclusion in the trial. The KT-1000 arthrometer was used to apply a constant load to evaluate the AP translation and the rolimeter was used to apply a constant rotational force. For the single-bundle group deviation was measured before and after ACL reconstruction. In the double-bundle group deviation was measured for the ACL-deficient, AM- or PL-reconstructed first conditions and for the total reconstruction. We found that the AM bundle in the double-bundle group controlled rotation as much as the single-bundle technique, and to a greater extent than the PL bundle in the double-bundle technique. The double-bundle technique increases AP translation and rotational stability in internal rotation more than the single-bundle technique.

  10. Unilateral Stance Strategies of Athletes With ACL Deficiency

    PubMed Central

    Di Stasi, Stephanie L.; Hartigan, Erin H.; Snyder-Mackler, Lynn

    2013-01-01

    Aberrant movement strategies are characteristic of ACL-deficient athletes with recurrent knee instability (non-copers), and may instigate premature or accelerate joint degradation. Biomechanical evaluation of kinematic changes over time may elucidate noncopers’ responses to neuromuscular intervention and ACL reconstruction (ACLR). Forty noncopers were randomized into a perturbation group or a strength training only group. We evaluated the effects of perturbation training, and then gender on knee angle and tibial position during a unilateral standing task before and after ACLR. No statistically significant interactions were found. Before surgery, the strength training only group demonstrated knee angle asymmetry, but 6 months after ACLR, both groups presented with similar knee flexion between limbs. Aberrant and asymmetrical tibial position was found only in females following injury and ACLR. Neither treatment group showed distinct unilateral standing strategies following intervention; however, males and female noncopers appear to respond uniquely to physical therapy and surgery. PMID:22983931

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

    NASA Astrophysics Data System (ADS)

    Garcia, Vanessa Lizeth

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

  12. ACL-Injured Subjects Have Smaller ACLs Than Matched Controls: An MRI Study

    PubMed Central

    Chaudhari, Ajit M.W.; Zelman, Eric A.; Flanigan, David C.; Kaeding, Christopher C.; Nagaraja, Haikady N.

    2013-01-01

    Background Very few studies examining the predisposing anatomical factors leading to anterior cruciate ligament (ACL) injuries have examined the ACL itself, and none of these directly examined the difference in ACL properties between injured and matched control subjects. Hypothesis ACL total volume of people who have experienced a non-contact ACL injury is smaller than that of matched controls. Methods Contours of the ACL were manually identified in sagittal MR images and volumes were calculated for 27 contralateral, healthy knees of individuals after non-contact ACL injury and for 27 control subjects matched for gender, height, age, and weight. Validation of this method was performed on 5 porcine knees. Stepwise multiple regression was used to determine the difference in ACL volume between injured and control subjects while considering gender, height, weight, and age as potential covariates. Results Contralateral ACL volume for injured subjects was significantly smaller than non-injured subjects (p=0.0208) by 231 mm3 after adjusting for weight, which was also a significant contributor to ACL volume (p<0.0001). At the average body mass of 72.7kg, subjects with a non-contact ACL injury had an average contralateral ACL volume of 1921 mm3, while the corresponding control group had an average volume of 2151 mm3. Gender, height, and age were not significant when weight was included in the regression model. Conclusions This study shows that there are anthropometric differences between the knees of subjects with a non-contact ACL injury and those without an ACL injury, suggesting that ACL volume may play a direct role in non-contact ACL injury. PMID:19307330

  13. Proximal femoral reconstruction with a constrained acetabulum in oncologic patients.

    PubMed

    Jawad, Muhammad Umar; Brien, Earl W

    2014-02-01

    Metallic endoprostheses are used for oncological reconstruction around the proximal femur and hip joint. Common modes of failure with hemiarthroplasty or standard hip arthroplasty after proximal femoral replacement include dislocation, late hip pain, and infection. The authors reviewed hospital records to identify patients undergoing constrained tripolar hip arthroplasty for oncological reasons between 2002 and 2012. Inclusion criterion was at least 12-cm proximal femoral resection, including patients with total femur reconstruction. A total of 33 patients were reviewed. Information regarding demographics, length of follow-up, treatment characteristics, and patient outcomes was extracted. Average follow-up for all patients was 912.33 days (30.4 months). Average follow-up was 1396.1 days for living patients and 428.6 days for deceased patients. Average estimated blood loss was 462.12 cc: an average of 1080 cc for patients undergoing total femoral resection and replacement and 315.8 cc for patients undergoing proximal femoral resection and replacement. Average operative time was 137.7 minutes: an average of 205 minutes for patients undergoing total femoral resection and replacement and 119.1 minutes for patients undergoing proximal femoral resection and replacement. Average Musculoskeletal Tumor Society score was 21.7. There were no dislocations in the cohort. A constrained tripolar device can be safely used for oncological proximal femoral reconstructions while minimizing the risk of dislocation. Positioning of the acetabular implant in neutral anatomic version in conjunction with a neutral-placed femoral component provides the greatest range of motion, reduction of liner impingement, and improved hip stability.

  14. Patient Race and Provider Predict Patient Satisfaction Following Post-Mastectomy Breast Reconstruction

    PubMed Central

    Shaterian, Ashkaun; Gandy, Jessica; Lalezari, Shadi; Smith, Sarah; Paydar, Keyianoosh

    2016-01-01

    BACKGROUND Post-mastectomy breast reconstruction is commonly performed in the United States with numerous options available to patients and providers. This study evaluated patient race and provider in prediction of patient satisfaction following post-mastectomy breast reconstruction. METHODS The patient satisfaction for women who underwent post mastectomy breast reconstruction at University of California, Irvine Medical Center was evaluated between 2012 and 2014, randomly using Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Patient demographics and surgery related variables including type of reconstruction received were determined. RESULTS Between 2012 and 2014, ninety breast reconstruction patients completed a HCAHPS satisfaction survey. Average satisfaction score was 9.67/10. Multivariate linear regression analyses revealed that 34% of the variability in satisfaction scores was accounted for by the variables included in our statistical model. Analyses revealed race/ethnicity and provider to be independent predictors of satisfaction (p<0.05). Satisfaction scores ranged from 6-10 and varied by 11.7% across different providers and 8.9% across different races. The following variables were included, but did not influence patient satisfaction: type, timing, or laterality of reconstruction, presence of post-operative complication, body mass index (BMI), age, presence of comorbidity, and insurance type. CONCLUSION Achieving patient satisfaction is an important outcome of breast reconstruction. This study is one of the first to identify provider and race/ethnicity as predictors of patient satisfaction following breast reconstruction. The information provided here can help inform providers and improve satisfaction for patients undergoing breast reconstruction. PMID:27579266

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

    PubMed

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

    2010-09-01

    Based on biomechanical cadaver studies, anatomic double-bundle reconstruction of the anterior cruciate ligament (ACL) was introduced to achieve better stability in the knee, particularly in respect of rotatory loads. Previously, the success of ACL reconstruction was believed to be mainly dependent on correct positioning of the graft, irrespective of the number of reconstructed bundles for which computer-assisted surgery was developed to avoid malpositioning of the tunnel. The aim of the present study is to compare rotational and translational stability after computer-navigated standard single-bundle, and anatomic double-bundle ACL reconstruction. The authors investigated 55 consecutive patients who had undergone the single-bundle or double-bundle ACL reconstruction procedure with the use of autogenous hamstring tendon grafts and EndoButton fixation, and the patients had been followed for a minimum period of 24 months. Intraoperative, anteroposterior and rotational laxity was measured with the computer navigation system, and compared between groups. Both surgical procedures significantly reduced anteroposterior displacement (AP) and internal rotation (IR) of the tibia compared to the pre-operative ACL-deficient knee (P < 0.05). No significant differences were registered between groups with regard to anteroposterior displacement of the tibia. A significantly greater reduction in internal rotation was noted in the double-bundle group (15.6 degrees) compared to the single-bundle group (7.1 degrees). The IKDC and Lysholm score were significantly higher in the double-bundle group. However, the results were excellent in both groups. The use of a computer-assisted ACL reconstruction, which is a highly accurate method of graft placement, could be useful for inexperienced surgeons to avoid malposition. Whether double-bundle ACL reconstruction, which was associated with improved rotational laxity and significantly better IKDC and Lysholm scores compared to the standard single

  16. 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.

  17. 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

  18. 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

  19. ACLS.

    PubMed

    Handley, A J

    2001-09-01

    It must be emphasised that the published International Guidelines 2000 contain an in-depth presentation of the scientific evidence behind advanced life support. The exact interpretation of this evidence, and the algorithms adopted by a national resuscitation council will depend upon various factors such as local interpretation of the evidence, local practice and availability of drugs. The ERC is publishing its own summaries of the guideline changes and the sequences of action for both BLS and ALS and these papers are recommended for further reading.

  20. 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.

  1. 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

  2. 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

  3. Patient Satisfaction and Quality of Life in DIEAP Flap versus Implant Breast Reconstruction

    PubMed Central

    Sgarzani, Rossella; Negosanti, Luca; Morselli, Paolo Giovanni; Vietti Michelina, Veronica; Lapalorcia, Luigi Maria; Cipriani, Riccardo

    2015-01-01

    The psychological impact of breast reconstruction has widely been described, and multiple studies show that reconstruction improves the well-being and quality of life of patients. In breast reconstruction, the goal is not only the morphological result, but mainly the patient's perception of it. The objective of our study is to compare the physical and psychosocial well-being and satisfaction concerning the body image of patients who had reconstruction with breast implants to those of patients who had reconstruction with deep inferior epigastric artery perforator flaps. Our results demonstrated a similar quality of life between the two groups, but the satisfaction level was significantly higher in patients who had reconstruction with autologous tissue. Feedback from patients who have already received breast reconstruction may be useful in the decision-making process for future patients and plastic surgeons, enabling both to choose the reconstructive technique with the best long-term satisfaction. PMID:26649331

  4. 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

  5. Chest wall reconstruction. Experience with 100 consecutive patients.

    PubMed Central

    Arnold, P G; Pairolero, P C

    1984-01-01

    Experience with 100 consecutive chest wall reconstructions during the past 7 years was reviewed. There were 52 female and 48 male patients with ages ranging from 13 to 78 years (average 53). Of the 100 patients, 42 had tumors of the chest wall, 19 had radiation necrosis, 24 had infected median sternotomies , and 15 had combinations of the three. Seventy-six patients underwent skeletal resection of the chest wall. An average of 5.7 ribs were resected in 63 patients. Total or partial sternectomies were performed in 29. Ninety-two patients underwent 142 muscle flaps: 77 pectoralis major, 29 latissimus dorsi, and 36 other muscles, including serratus anterior, rectus abdominis, and external oblique muscles. The omentum was transposed in ten patients. Chest wall skeletal defects were closed with Prolene mesh in 29 patients and with autogenous ribs in 11. Eighty-nine patients underwent primary closure of the skin. The 100 patients underwent an average of 2.1 operations. Hospitalization averaged 17.5 days. There was one perioperative death (29 days). Two patients required tracheostomy. Follow-up averaged 21.6 months. There were 24 late deaths. All 99 patients who were alive 30 days after operation had excellent results at the time of death or last follow-up. Images Figs. 2A-D. Figs. 3A-F. Figs. 4A-D. Figs. 4A-D. Fig. 5. Fig. 5. PMID:6732314

  6. Iliotibial band friction syndrome after anterior cruciate ligament reconstruction using the transfix device: report of two cases and review of the literature.

    PubMed

    Pelfort, Xavier; Monllau, Joan C; Puig, Lluís; Cáceres, Enric

    2006-06-01

    The use of hamstrings is increasing as a treatment for anterior cruciate ligament (ACL) injuries. There are a lot of new devices and techniques that try to fix the graft without causing further injury or increased morbidity. We report two cases in relation to the transfix device for reconstructing the ACL. The first case is a 38-year-old female who was treated with an autologous hamstring graft for chronic ACL instability brought on by a sport trauma. The patient developed iliotibial band friction syndrome 3 months after the operation. MRI showed incorrect positioning and a rupture of the femoral bio-absorbable cross-pin. The hamstring graft always had good fixation and did not produce instability of the knee. We removed the cross-pin fragment in a second surgery and the patient returned to her daily lifestyle after 3 weeks. The second case is a 52-year-old female with a painful and unstable knee due to a previous lateral meniscectomy and failure of an ACL reconstruction. We performed an ACL reconstruction with an autologous hamstring graft and a lateral meniscus transplantation. Some months after the procedure she also developed this syndrome. MRI showed the same features as shown in the first case and a second surgery was needed. To our knowledge this clinical and technical problem has not been previously described.

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

    PubMed

    Nín, J R; Leyes, M; Schweitzer, D

    1996-01-01

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

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

    PubMed

    Nín, J R; Leyes, M; Schweitzer, D

    1996-01-01

    A prospective study was performed on 101 patients who underwent an arthroscopic anterior cruciate ligament (ACL) reconstruction with fresh-frozen patellar tendon allograft (bone-patellar tendon-bone). We present the results of the first 60 patients with a minimum follow-up of 2 years. Thirty-four were men and 26 women with a mean age of 23. In 45 patients, a postoperative arthroscopy was performed, and tissue biopsies of the reconstructed ACL were obtained. Patients were evaluated according to the International Knee Documentation Committee evaluation form. After a mean follow-up of 47 months, the overall results were normal or nearly normal in 85%. Under postoperative arthroscopy, the macroscopic appearance of the implant was similar to that of a normal ligament. The ACL allograft was covered with a normal, well-vascularized synovium. There were no cases of infection, disease transmission or tissue rejection. We conclude that the use of fresh-frozen patellar tendon allografts is a good method of ACL reconstruction. PMID:8961227

  9. Regaining Native Knee Kinematics Following Joint Arthroplasty: A Novel Biomimetic Design with ACL and PCL Preservation.

    PubMed

    Zumbrunn, Thomas; Varadarajan, Kartik Mangudi; Rubash, Harry E; Malchau, Henrik; Li, Guoan; Muratoglu, Orhun K

    2015-12-01

    Lack of ACL and non-anatomic articular surfaces in contemporary total knee implants result in kinematic abnormalities. We hypothesized that such abnormalities may be addressed with a biomimetic bi-cruciate retaining (BCR) design having anatomical articular surfaces. We used dynamic computer simulations to compare kinematics among the biomimetic BCR, a contemporary BCR and cruciate-retaining implant for activities of daily living. During simulated deep knee bend, chair-sit and walking, the biomimetic BCR implant showed activity dependent kinematics similar to healthy knees in vivo. Restoring native knee geometry together with ACL preservation provided these kinematic improvements over contemporary ACL-preserving and ACL-sacrificing implants. Further clinical studies are required to determine if such biomimetic implants can result in more normal feeling knees and improve quality of life for active patients.

  10. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction.

    PubMed

    Kvist, Joanna; Ek, Anna; Sporrstedt, Katja; Good, Lars

    2005-07-01

    Unrestricted participation in sports activities and return to the pre-injury level is often reported as an indicator of the success of ACL reconstruction. The athletes' choice not to return to their pre-injury level may depend on the knee function, but some times, social reasons or psychological hindrances such as fear of re-injury may influence their return to sports. The aim of this study was to investigate whether fear of re-injury due to movement is of significance for returning to previous level of activity in patients who have undergone anterior cruciate ligament reconstruction. The Tampa Scale of Kinesiophobia (TSK), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and some general questions were mailed to 87 patients who underwent ACL reconstruction 3-4 years before the study was conducted. Sixty-two patients (74%) answered the questionnaires (34 men and 28 women). Fifty-three percent of the patients returned to their pre-injury activity level. The patients who did not return to their pre-injury activity level had more fear of re-injury, which was reflected in the TSK. In addition, high fear of re-injury was correlated with low knee-related quality of life. Fear of re-injury must be considered in the rehabilitation and evaluation of the effects of an ACL reconstruction.

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

    PubMed

    Alrowaili, Majed

    2016-04-26

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

  12. 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

  13. Comparison of volumetric bone mineral density in the operated and contralateral knee after anterior cruciate ligament and reconstruction: A 1-year follow-up study using peripheral quantitative computed tomography.

    PubMed

    Mündermann, Annegret; Payer, Nina; Felmet, Gernot; Riehle, Hartmut

    2015-12-01

    The purpose of this study was to quantify changes in volumetric bone mineral density (vBMD) in the tibial plateau of the operated and contralateral leg measured using peripheral quantitative computed tomography (pQCT) before and 3, 6, and 12 months after anterior cruciate ligament (ACL) reconstruction. The ACL was reconstructed with a hamstring tendon autograft using press-fit fixation. pQCT measurements of the proximal tibia were obtained in 61 patients after ACL reconstruction, and total, cortical, and trabecular vBMD were calculated. vBMD in the operated leg decreased from baseline to 3 months (-12% [total], -11% [cortical], and -12.6% [trabecular]; p<0.001) and remained below baseline for 12 months after surgery (6 months: -9.5%, -9.4%, and -9.6%, p<0.001; 12 months: -8%, -5%, and -11%, p<0.001). vBMD in the contralateral leg was slightly reduced only 6 months after surgery. Including age and sex as covariates into the analysis did not affect the results. ACL reconstruction contributed to loss in bone mineral density within the first year after surgery. The role of factors such as time of weight-bearing, joint mechanics, post-traumatic inflammatory reactions, or genetic predisposition in modulating the development of posttraumatic knee osteoarthritis after ACL injury should be further elucidated. PMID:26123943

  14. Comparison of volumetric bone mineral density in the operated and contralateral knee after anterior cruciate ligament and reconstruction: A 1-year follow-up study using peripheral quantitative computed tomography.

    PubMed

    Mündermann, Annegret; Payer, Nina; Felmet, Gernot; Riehle, Hartmut

    2015-12-01

    The purpose of this study was to quantify changes in volumetric bone mineral density (vBMD) in the tibial plateau of the operated and contralateral leg measured using peripheral quantitative computed tomography (pQCT) before and 3, 6, and 12 months after anterior cruciate ligament (ACL) reconstruction. The ACL was reconstructed with a hamstring tendon autograft using press-fit fixation. pQCT measurements of the proximal tibia were obtained in 61 patients after ACL reconstruction, and total, cortical, and trabecular vBMD were calculated. vBMD in the operated leg decreased from baseline to 3 months (-12% [total], -11% [cortical], and -12.6% [trabecular]; p<0.001) and remained below baseline for 12 months after surgery (6 months: -9.5%, -9.4%, and -9.6%, p<0.001; 12 months: -8%, -5%, and -11%, p<0.001). vBMD in the contralateral leg was slightly reduced only 6 months after surgery. Including age and sex as covariates into the analysis did not affect the results. ACL reconstruction contributed to loss in bone mineral density within the first year after surgery. The role of factors such as time of weight-bearing, joint mechanics, post-traumatic inflammatory reactions, or genetic predisposition in modulating the development of posttraumatic knee osteoarthritis after ACL injury should be further elucidated.

  15. Neuromuscular function after reconstruction of anterior cruciate ligament--a case study using evoked electromyography.

    PubMed

    Daikuya, S; Suzuki, T; Yabe, K

    2008-01-01

    To clarify the neuro-muscular function of a lower extremity after reconstruction of anterior cruciate ligament (ACL), we studied the alteration of H reflex and Silent period (SP) from the soleus muscle in a patient with ACL reconstruction. Subject was an eighteen year-old male and high school basketball player after a reconstruction of right ACL. Recording of H reflex and SP was started at one month after operation, and ended at six months post operation with a test at every month. As a result of this study, the amplitude ratio of H/M(max) was increased at post four months after ACL reconstruction on operative side. Little variation of SP was acquired in non-operative side. However, that in operative side was increased compared with non-operative side and gradually decreased until post six months. Post six months, the variation of SP in operative side was recovered as that of non-operative side. And, on the operation side, long-latency reflex (LLR) was appeared during SP from one month to five months after, especially its appearance pattern was most markedly post four months. However, post six months, LLR disappeared during SP. The result of H reflex, SP and LLR appearance suggested a following hypothesis; until post six months after ACL reconstruction, even the small and simple task (i.e. an ankle planter flexion with a slight effort) needs to an intervention of a various supra-spinal function. In this case, autonomy of central nervous system related to an out-put mechanism in lower-extremity was acquired post six months.

  16. Pre-operative planning for mandibular reconstruction - A full digital planning workflow resulting in a patient specific reconstruction

    PubMed Central

    2011-01-01

    Objectives Reconstruction of large mandiblular defects following ablative oncologic surgery could be done by using vascularized bone transfer or, more often, primarily with simultaneous or delayed bone grafting, using load bearing reconstruction plates. Bending of these reconstruction plates is typically directed along the outer contour of the original mandible. Simultaneously or in a second operation vascularized or non-vascularized bone is fixed to the reconstruction plate. However, the prosthodontic-driven backward planning to ease bony reconstruction of the mandible in terms of dental rehabilitation using implant-retained overdentures might be an eligible solution. The purpose of this work was to develop, establish and clinically evaluate a novel 3D planning procedure for mandibular reconstruction. Materials and methods Three patients with tumors involving the mandible, which included squamous cell carcinoma in the floor of the mouth and keratocystic odontogenic tumor, were treated surgically by hemimandibulectomy. Results In primary alloplastic mandible reconstruction, shape and size of the reconstruction plate could be predefined and prebent prior to surgery. Clinical relevance This study provides modern treatment strategies for mandibular reconstruction. PMID:21968330

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

    PubMed

    Simpfendorfer, Claus; Miniaci, Anthony; Subhas, Naveen; Winalski, Carl S; Ilaslan, Hakan

    2015-08-01

    Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is a common surgical procedure, particularly in young athletes. Although the procedure has excellent success rates, complications such as mechanical impingement, graft rupture, and arthrofibrosis can occur, often necessitating additional surgery. Magnetic resonance (MR) imaging has become a valuable tool in evaluating complications after ACL reconstruction. We report two cases of ACL reconstruction complicated by arthroscopically proven partial graft tears. In both cases the torn anterior graft fibers were flipped into the intercondylar notch, mimicking anterior arthrofibrosis, i.e., a "cyclops lesion," on MR imaging. Careful review of the direction of graft fibers on MR imaging in the "pseudocyclops" lesions can help differentiate these partial tears from the fibrosis of a true cyclops. The "pseudocyclops" lesion is a previously undescribed MR imaging sign of partial ACL graft tear. Larger studies are required to determine the sensitivity and specificity of the sign, as well as the clinical importance of these partial graft tears. PMID:25620690

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

    PubMed

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

    2015-06-01

    Trauma to the anterior cruciate ligament (ACL) is a season-ending injury and involves months of activity modification and rehabilitation. The annual incidence of ACL tears in the United States is approximately 200,000, which allows for a broad range of individualized treatment options. Various surgical techniques, including transtibial and independent tunnel drilling, allograft and autograft tissue, and various implants, have been described in the literature. This article describes the indications and technique for a hybrid soft tissue graft for ACL reconstruction. Autologous grafts eliminate the risk of disease transmission and have recently been shown to have a lower rerupture rate, particularly in younger, active patients; however, the harvesting of autologous hamstring grafts carries a risk of donor-site morbidity, iatrogenic injury of the graft, and inadequate graft size. In contrast to a traditional autologous soft tissue graft, the hybrid graft allows for graft size customization for a desired reconstruction, especially in cases where autograft hamstrings may be iatrogenically damaged or of inadequate size when harvested. The goal of a hybrid graft ACL reconstruction is to provide a favorable-sized graft with clinical outcomes comparable with autologous soft tissue grafts. In contrast to a traditional autologous soft tissue graft, this technique provides another option in the event of unforeseen deficiencies or complications associated with harvesting and preparation of the autologous gracilis and semitendinosis soft tissue graft. PMID:26091219

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

    PubMed

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

    2015-06-01

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

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

    PubMed

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

    2016-01-01

    Patients after anterior cruciate ligament (ACL) reconstruction surgery commonly encounters graft failure in the initial phase of rehabilitation. The inhibition of graft degradation is crucial for the successful reconstruction of the ACL. Here, we used biodegradable high-purity magnesium (HP Mg) screws in the rabbit model of ACL reconstruction with titanium (Ti) screws as a control and analyzed the graft degradation and screw corrosion using direct pull-out tests, microCT scanning, and histological and immunohistochemical staining. The most noteworthy finding was that tendon graft fixed by HP Mg screws exhibited biomechanical properties substantially superior to that by Ti screws and the relative area of collagen fiber at the tendon-bone interface was much larger in the Mg group, when severe graft degradation was identified in the histological analysis at 3 weeks. Semi-quantitative immunohistochemical results further elucidated that the MMP-13 expression significantly decreased surrounding HP Mg screws with relatively higher Collagen II expression. And HP Mg screws exhibited uniform corrosion behavior without displacement or loosening in the femoral tunnel. Therefore, our results demonstrated that Mg screw inhibited graft degradation and improved biomechanical properties of tendon graft during the early phase of graft healing and highlighted its potential in ACL reconstruction. PMID:27210585

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

    NASA Astrophysics Data System (ADS)

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

    2016-05-01

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

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

    PubMed Central

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

    2016-01-01

    Patients after anterior cruciate ligament (ACL) reconstruction surgery commonly encounters graft failure in the initial phase of rehabilitation. The inhibition of graft degradation is crucial for the successful reconstruction of the ACL. Here, we used biodegradable high-purity magnesium (HP Mg) screws in the rabbit model of ACL reconstruction with titanium (Ti) screws as a control and analyzed the graft degradation and screw corrosion using direct pull-out tests, microCT scanning, and histological and immunohistochemical staining. The most noteworthy finding was that tendon graft fixed by HP Mg screws exhibited biomechanical properties substantially superior to that by Ti screws and the relative area of collagen fiber at the tendon-bone interface was much larger in the Mg group, when severe graft degradation was identified in the histological analysis at 3 weeks. Semi-quantitative immunohistochemical results further elucidated that the MMP-13 expression significantly decreased surrounding HP Mg screws with relatively higher Collagen II expression. And HP Mg screws exhibited uniform corrosion behavior without displacement or loosening in the femoral tunnel. Therefore, our results demonstrated that Mg screw inhibited graft degradation and improved biomechanical properties of tendon graft during the early phase of graft healing and highlighted its potential in ACL reconstruction. PMID:27210585

  3. A Systematic Review of Failed Anterior Cruciate Ligament Reconstruction With Autograft Compared With Allograft in Young Patients

    PubMed Central

    Wasserstein, David; Sheth, Ujash; Cabrera, Alison; Spindler, Kurt P.

    2015-01-01

    Context: The advantages of allograft anterior cruciate ligament reconstruction (ACLR), which include shorter surgical time, less postoperative pain, and no donor site morbidity, may be offset by a higher risk of failure. Previous systematic reviews have inconsistently shown a difference in failure prevalence by graft type; however, such reviews have never been stratified for younger or more active patients. Objective: To determine whether there is a different ACLR failure prevalence of autograft compared with allograft in young, active patients. Data Sources: EMBASE, MEDLINE, Cochrane trials registry. Study Selection: Comparative studies of allograft versus autograft primary ACL reconstruction in patients <25 years of age or of high-activity level (military, Marx activity score >12 points, collegiate or semiprofessional athletes). Study Design: Systematic review with meta-analysis. Level of Evidence: Level 3. Data Extraction: Manual extraction of available data from eligible studies. Quantitative synthesis of failure prevalence and Lysholm score (outcomes in ≥3 studies) and I2 test for heterogeneity. Assessment of study quality using CLEAR NPT and Newcastle-Ottawa Scale (NOS). Results: Seven studies met inclusion criteria (1 level 1; 2 level 2, 4 level 3), including 788 patients treated with autograft tissue and 228 with various allografts. The mean age across studies was 21.7 years (64% male), and follow-up ranged between 24 and 51 months. The pooled failure prevalence was 9.6% (76/788) for autografts and 25.0% (57/228) for allografts (relative risk, 0.36; 95% CI, 0.24-0.53; P < 0.00001; I2 = 16%). The number needed to benefit to prevent 1 failure by using autograft was 7 patients (95% CI, 5-10). No difference between hamstrings autograft and patella tendon autograft was noted. Lysholm score was reported in 3 studies and did not differ between autograft and allograft. Conclusion: While systematic reviews comparing allograft and autograft ACLR have been equivocal

  4. All-inside anterior cruciate ligament reconstruction.

    PubMed

    Blackman, Andrew J; Stuart, Michael J

    2014-10-01

    All-inside anterior cruciate ligament (ACL) reconstruction has undergone a series of modifications over the past 20 years. Current techniques offer the advantages of improved cosmesis, less postoperative pain, decreased bone removal, and gracilis preservation. Few all-inside ACL reconstruction outcome studies are available; therefore, additional research is necessary to compare the results to conventional techniques. The purpose of this article is to review the evolution of all-inside ACL reconstruction, the advantages and disadvantages, our preferred technique, and clinical experience to date.

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

    PubMed

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

    2009-07-01

    We retrospectively reviewed the long-term clinical outcome of unilateral arthroscopic anterior cruciate ligament (ACL) allograft reconstruction. From October 1995 to December 1997, 64 arthroscopic ACL reconstructions were performed. Multiligamentous knee injuries and ACL injuries in polytrauma patients were excluded and out of the remaining 60 patients 55 were available for follow-up. Three patients had suffered a rerupture caused by major trauma. One patient had a rerupture without significant trauma and one failure was caused by deep infection. These five patients were revised. Fifty patients (36 males, 14 females) were included in the final follow-up. At the time of evaluation, the mean duration of follow-up was 10 years and 6 months. All patients were examined by an independent examiner. Seven patients had an extension lag (<5 degrees) and all patients had a knee flexion of at least 120 degrees, with a mean flexion of 135 +/- 5 degrees compared to 135 +/- 8 degrees. At the time of follow-up, the median IKDC score was 97 (74-100). The Lysholm scoring scale had a median value of 95 (76-100). The median sports level on the Tegner scale was 6 (4-9). The one-leg-hop test showed a mean value of 95 +/- 5%. One patient did not perform the one-leg-hop test because of recent surgery to the Achilles tendon. In conclusion, the tibialis anterior or tibialis posterior tendon allograft ACL reconstruction produced good clinical results in the majority of patients at long-term follow-up.

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

    PubMed

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

    2009-07-01

    We retrospectively reviewed the long-term clinical outcome of unilateral arthroscopic anterior cruciate ligament (ACL) allograft reconstruction. From October 1995 to December 1997, 64 arthroscopic ACL reconstructions were performed. Multiligamentous knee injuries and ACL injuries in polytrauma patients were excluded and out of the remaining 60 patients 55 were available for follow-up. Three patients had suffered a rerupture caused by major trauma. One patient had a rerupture without significant trauma and one failure was caused by deep infection. These five patients were revised. Fifty patients (36 males, 14 females) were included in the final follow-up. At the time of evaluation, the mean duration of follow-up was 10 years and 6 months. All patients were examined by an independent examiner. Seven patients had an extension lag (<5 degrees) and all patients had a knee flexion of at least 120 degrees, with a mean flexion of 135 +/- 5 degrees compared to 135 +/- 8 degrees. At the time of follow-up, the median IKDC score was 97 (74-100). The Lysholm scoring scale had a median value of 95 (76-100). The median sports level on the Tegner scale was 6 (4-9). The one-leg-hop test showed a mean value of 95 +/- 5%. One patient did not perform the one-leg-hop test because of recent surgery to the Achilles tendon. In conclusion, the tibialis anterior or tibialis posterior tendon allograft ACL reconstruction produced good clinical results in the majority of patients at long-term follow-up. PMID:19421736

  7. Clinical outcomes of second-look arthroscopic evaluation after anterior cruciate ligament augmentation: comparison with single- and double-bundle reconstruction.

    PubMed

    Nakamae, A; Ochi, M; Deie, M; Adachi, N; Shibuya, H; Ohkawa, S; Hirata, K

    2014-10-01

    We report the clinical outcome and findings at second-look arthroscopy of 216 patients (mean age 25 years (11 to 58)) who underwent anterior cruciate ligament (ACL) reconstruction or augmentation. There were 73 single-bundle ACL augmentations (44 female, 29 male), 82 double-bundle ACL reconstructions (35 female, 47 male), and 61 single-bundle ACL reconstructions (34 female, 27 male). In 94 of the 216 patients, proprioceptive function of the knee was evaluated before and 12 months after surgery using the threshold to detect passive motion test. Second-look arthroscopy showed significantly better synovial coverage of the graft in the augmentation group (good: 60 (82%), fair: 10 (14%), poor: 3 (4%)) than in the other groups (p = 0.039). The mean side-to-side difference measured with a KT-2000 arthrometer was 0.4 mm (-3.3 to 2.9) in the augmentation group, 0.9 mm (-3.2 to 3.5) in the double-bundle group, and 1.3 mm (-2.7 to 3.9) in the single-bundle group: the result differed significantly between the augmentation and single-bundle groups (p = 0 .013). No significant difference in the Lysholm score or pivot-shift test was seen between the three groups (p = 0.09 and 0.65, respectively). In patients with good synovial coverage, three of the four measurements used revealed significant improvement in proprioceptive function (p = 0.177, 0.020, 0.034, and 0.026). We conclude that ACL augmentation is a reasonable treatment option for patients with favourable ACL remnants.

  8. 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

  9. [The ACL tear from the pre-operative analysis to a 2-year follow-up, influence of the graft choice on the subjective and objective evaluation].

    PubMed

    Dejour, D; Potel, J-F; Gaudot, F; Panisset, J-C; Condouret, J

    2008-12-01

    This study is a synthesis of three series. The first study was prospective on 418 patients with an anterior cruciate ligament (ACL) tear (group I). Two population of ACL ruptures were identified. One population with a postero-lateral bundle preserved in 16%, the mean medial anterior tibial translation side to side was 4.97 mm, the Lachman test was delayed in 40% with no or glide pivot shift in 73%. The second population with a complete ACL tear had a mean medial anterior tibial translation side to side of 7.93 mm, the Lachman test was soft in 98% with gross pivot shift in 80%. The second study was a retrospective study on 258 patients (group II) at 26 months follow-up, it correlated the impact of the type of graft on the clinical objective and subjective results. Twenty-eight percent had anterior knee pain, 33% for the patellar tendon and 25% for the hamstrings, the subjective IKDC was significantly lower for the painful knees, and 68% of the patellar tendon had a hypoesthesia and only 32% for the hamstrings. The ability to walk on the knee was 68% for the hamstrings and 35% for the patellar tendon. The third study was retrospective on 127 patients, 24 months after ACL reconstruction (group III), all were tested on a isokinetic machine for the extensor, the flexor and the internal rotator. In the total population, a 10% extensor and flexor deficit and a 5% rotator deficit was noted. A significant difference between patellar tendon and hamstrings in terms of muscular recovery was found. It pointed out that a more specific rehabilitation should be done on the hamstring group. The muscular recovery was correlated to the highest subjective score. This study allowed the surgeon to be more specific in the ACL tear definition, to adapt the graft choice to the type of sport activity but also to the type of work the patient does and finally to modify the rehabilitation protocol for the hamstring technique.

  10. 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

  11. Multi-rater Agreement in the Assessment of Anterior Cruciate Ligament Reconstruction Failure. A Radiographic and Video Analysis of the MARS Cohort

    PubMed Central

    Matava, Matthew J.; Arciero, Robert A.; Baumgarten, Keith M.; Carey, James L.; DeBerardino, Thomas M.; Hame, Sharon L.; Hannafin, Jo A.; Miller, Bruce S.; Nissen, Carl W.; Taft, Timothy N.; Wolf, Brian R.; Wright, Rick W.

    2015-01-01

    Background ACL reconstruction failure occurs in up to 10% of cases. Technical errors are considered the most common cause of graft failure despite the absence of validated studies. There is limited data regarding the agreement among orthopedic surgeons in terms of the etiology of primary ACL reconstruction failure and accuracy of graft tunnel placement. Purpose The purpose of this study is to test the hypothesis that experienced knee surgeons have a high level of inter-observer reliability in the agreement of the etiology of the primary ACL reconstruction failure, anatomical graft characteristics, tunnel placement. Methods Twenty cases of revision ACL reconstruction were randomly selected from the MARS database. Each case included the patient's history, standardized radiographs, and a concise 30-second arthroscopic video taken at the time of revision demonstrating the graft remnant and location of the tunnel apertures. 10 MARS surgeons not involved with the primary surgery reviewed all 20 cases. Each surgeon completed a two-part questionnaire dealing with each surgeon's training and practice as well as the placement of the femoral and tibial tunnels, condition of the primary graft, and the surgeon's opinion as to the etiology of graft failure. Inter-rater agreement was determined for each question. Inter-rater agreement was determined for each question with the kappa coefficient and prevalence adjusted bias adjusted kappa (PABAK). Results The 10 reviewers were in practice an average of 14 years. All performed at least 25 ACL reconstructions per year and 9 were fellowship-trained in sports medicine. There was wide variability in agreement among knee experts as to the specific etiology of ACL graft failure. When specifically asked about technical error as the cause for failure, inter-observer agreement was only slight (prevalence adjusted bias adjusted kappa [PABAK]: 0.26). There was fair overall agreement on ideal femoral tunnel placement (PABAK: 0.55), but only

  12. Amiodarone for ACLS: a critical evaluation.

    PubMed

    Stewart, C E

    2001-09-01

    Years ago, William Osler taught physicians, "Be not the first nor the last to adopt a therapy." This continues to be sage advice. Clinicians should be cautious in considering the use of amiodarone in a field setting for cardiac arrest until studies clearly show a benefit over drugs currently in use. The endpoint of the only cardiac arrest study available shows improved survival when amiodarone is combined with other drugs over placebo until the patient gets to the emergency department, but is not a comparison with other current drugs nor had any effect on long-term survival or functioning neurologic status. As previously cited, amiodarone was comparable with bretylium in treating recurrent VT/VF in one controlled study. Further study of this and other ACLS drugs is imperative. In summary, amiodarone should be reclassified as either a class indeterminate agent when used alone ("no harm but no benefit ... evidence insufficient to support final class decision") or a class IIb agent ("acceptable and useful ... supported by fair to good evidence") when used in addition to other therapies in the treatment of ventricular fibrillation and pulseless ventricular tachycardia. There is not sufficient evidence to move amiodarone to first-line therapy in the "out-of-hospital" cardiac arrest. This evidence may be available in the future and would then change this recommendation.

  13. Patients undergoing reconstructive surgery versus unburned children as "controls" in studies of pediatric patients with burns.

    PubMed

    Neely, A N; Rieman, M T; Warden, G D

    1995-01-01

    A valid control group is an essential part of any patient study. We asked whether burned children returning for reconstructive surgery could be used as "controls" in a study of seven proteolytic elements in the circulation. Functional levels of elastase, plasminogen, prekallikrein, antithrombin, alpha 2-antiplasmin, alpha 2-macroglobulin, and total proteolytic activity in 30 healthy unburned children were compared with levels in 29 patients admitted for reconstructive surgery an average of 7.9 years after burn. The two groups were not statistically different in distributions of sex and race but differed in mean age. Levels of six of the seven parameters were equal in the two groups. However, even when correction for the age difference was done between the groups, alpha 2-macroglobulin in the patients undergoing reconstructive surgery still was significantly less (p < 0.021) than in the unburned group. Therefore caution may be needed when readily available patients undergoing reconstructive surgery are used as "controls" in studies of patients with acute burns.

  14. Tracking patient outcomes after anterior cruciate ligament reconstruction.

    PubMed

    Cupido, Colleen; Peterson, Devin; Sutherland, Melanie Stevens; Ayeni, Olufemi; Stratford, Paul W

    2014-01-01

    Objet: Modéliser comment l'amplitude du mouvement (ADM) du genou des patients, la douleur et l'état fonctionnel autodéclaré des membres inférieurs (MI) changent au cours des 26 premières semaines suivant la reconstruction du ligament croisé antérieur (LCA) et estimer la fiabilité de test-retest de ces mesures. Méthodes: On a évalué les patients une fois par semaine pendant les 26 semaines qui ont suivi une reconstruction du LCA. L'ADM du genou, l'état fonctionnel des MI mesuré en fonction de l'échelle fonctionnelle des membres inférieurs (EFMI) et la douleur mesurée par le questionnaire sur l'intensité de la douleur à quatre questions (P4) ont constitué les résultats. Nous avons appliqué un modèle non linéaire pour décrire le changement de chaque résultat. Nous avons aussi appliqué des coefficients de corrélation intra-classe et les erreurs de mesure types pour estimer la fiabilité de test-retest et le changement détectable minimal. Résultats: Un modèle non linéaire a produit les valeurs suivantes d'adaptation du modèle (R(2)): P4=0,71, ADM extension=0,51, ADM flexion=0,99, EFMI=0,97. Dans le cas de la douleur et de l'ADM, les valeurs maximales ont été atteintes vers la 12(e) semaine suivant la reconstruction et les valeurs EFMI ont continué d'augmenter jusqu'à 26 semaines. Les coefficients de fiabilité de test-retest ont varié de 0,85 à 0,95. Conclusions: L'amélioration la plus importante s'est produite au cours des huit semaines suivant l'intervention chirurgicale. Le rétablissement était presque complet à 12 semaines en ce qui a trait à la douleur et à l'ADM, même si l'état fonctionnel des membres inférieurs a continué de s'améliorer durant toute la période d'étude. Les résultats de toutes les mesures ont démontré de la fiabilité, ce qui appuie leur utilisation avec des patients particuliers.

  15. Restriction in Hip Internal Rotation is Associated with an Increased Risk of ACL Injury in NFL Combine Athletes: A Clinical and Biomechanical Study

    PubMed Central

    Bedi, Asheesh; Warren, Russell F.; Oh, Youkeun K.; Wojtys, Edward M.; Oltean, Hanna N.; Ashton-Miller, James A.; Kelly, Bryan T.

    2013-01-01

    the risk of ACL injury due to the increased resistance to femoral internal axial rotation during a dynamic maneuver such as a pivot landing. This insight may lead to better interventions to prevent ACL injury and improved understanding of ACL reconstruction failure in the absence of clear technical errors.

  16. Effect of High-Grade Pre-operative Knee Laxity on Outcomes of Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Magnussen, Robert A.; Reinke, Emily; Huston, Laura J.; Group, MOON knee; Hewett, Timothy E.; Spindler, Kurt P.

    2015-01-01

    Objectives: Knee laxity in the setting of suspected anterior cruciate ligament (ACL) injury is frequently assessed through physical examination using the Lachman, pivot-shift, and anterior drawer tests. The degree of laxity noted on these examinations may influence treatment decisions and prognosis. We hypothesized that increased pre-operative knee laxity (Grade 3+ pivot-shift, Lachman > 10mm, or anterior drawer greater than 10mm) are associated with increased risk of revision ACL reconstruction and poorer patient-reported outcomes at two years post-operative. Methods: From an ongoing prospective cohort study, 1394 patients that underwent primary isolated ACL reconstruction within 3 months of injury with autograft tissue without medial collateral, lateral collateral, or posterior cruciate injury requiring treatment or prior contralateral ACL injury were identified. Demographic data, physical examination findings under anesthesia at the time of ACL reconstruction, information regarding meniscus status and treatment, and pre-operative and 2 year post-operative International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score Knee Related Quality of Life subscale (KOOS-QOL), and Marx activity scores were collected. Patients reported by the operating surgeons as having a Lachman or anterior drawer examination at least 10mm greater than the contralateral side were classified as having a high grade Lachman or anterior drawer respectively. Patients reported by the operating surgeon as having a 3+ pivot-shift were classified as having a high-grade pivot-shift. Patients demonstrating high-grade laxity on any of these examinations were classified as having high-grade pre-operative knee laxity. Multiple logistic regression modeling was used to evaluate whether having high-grade pre-operative laxity was associated with increased odds of undergoing revision ACL reconstruction within 2 years of the index procedure, controlling for patient age, sex

  17. [The effect of central anatomical single-bundle versus anatomical double-bundle reconstruction of the anterior cruciate ligament on knee stability. a clinical study].

    PubMed

    Komzák, M; Hart, R; Smíd, P; Puskeiler, M

    2014-01-01

    PURPOSE OF THE STUDY A comparison of the efficacy of central anatomical single-bundle (CASB) reconstruction with that of double-bundle (DB) repair of the anterior cruciate ligament (ACL) in relation to knee stability in anteroposterior translation (APT), internal rotation (IR) and external rotation (ER) of the joint. MATERIAL AND METHODS A total of 40 patients were evaluated; 20 had ACL reconstruction by the CASB technique using hamstrings and 20 underwent DB repair surgery. The average age was 31.3 years, and the group included 22 men and 18 women with 19 right and 21 left knees. The KT-1000 test was used to assess the amount of APT in the knee and rotational deviations were measured by the Rolimeter. In the DB patients, measurements were performed before surgery (on joints with ACL injury), then after reconstruction of the anteromedial (AM) or the posterolateral (PL) bundle and subsequently after repair of both ACL bundles. The CASB patients were assessed before and after graft insertion. RESULTS The average APT value was 18.5 mm for the pre-operative knees and it fell to 8.9 mm after AM bundle reconstruction. However, when the PL bundle was inserted in the first place, the average APT value was 13.1 mm only. The average values recorded after the DB and CASB reconstructions were 6.1 mm and 9.1 mm, respectively. The average IR range of motion in the pre-operative joints was 18.6 degrees. After AM bundle reconstruction it was 13.9 degrees and after PL bundle repair it was 15.3 degrees. In DB reconstruction the average IR value achieved 10.4 degrees, and in CASB repair surgery it was 13.7 degrees. The average ER range of motion in the pre-operative joints was 17.8 degrees. After AM bundle reconstruction it was 14.5 degrees and after PL bundle repair it was 14.9 degrees. In DB reconstruction the average ER value achieved 11.4 degrees, and in CASB repair surgery it was 14.5 degrees. DISCUSSION Rotational stability of the knee after ACL reconstruction is one of the

  18. ACLS 2000: overview of changes to the guidelines.

    PubMed

    Cleland, Michelle A; Hynes-Gay, Patricia

    2002-01-01

    Emergency treatment measures in the setting of a cardiopulmonary arrest have recently been reclassified according to the strength of evidence in support of their use. As a result, there are new recommendations that must be incorporated, both in the management of patients in cardiac arrest and those with clinical findings that have the potential to deteriorate and become life-threatening. This article provides an overview of the 2000 ACLS guidelines, with particular emphasis on new developments in the management of patients with acute coronary syndromes, changes in the tachycardia algorithms, and recommendations pertaining to endotracheal intubation.

  19. Return to sport following anterior cruciate ligament reconstruction.

    PubMed

    Feller, Julian; Webster, Kate E

    2013-02-01

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

  20. 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

  1. Patient-Physician Communication in Breast Reconstructive Surgery

    PubMed Central

    Maly, Rose C; Liu, Yihang; Kwong, Elaine; Thind, Amardeep; Diamant, Allison L

    2011-01-01

    Purpose Breast reconstructive surgery (BRS) can improve mastectomy patients’ emotional relationships and social functioning, but it may be underutilized in low-income, medically underserved women. This study assessed the impact of patient-physician communication on rates of BRS in low-income breast cancer (BC) women receiving mastectomy. Methods A cross-sectional, California statewide survey was conducted of women with income less than 200% of the Federal Poverty Level and receiving BC treatment through the Medicaid Breast and Cervical Cancer Treatment Program. A subset of 327 women with non-metastatic disease who underwent mastectomy was identified. Logistic regression was used for data analysis. The chief dependent variable was receipt of or planned BRS by patient report at 6 months after diagnosis; chief independent variables were physician interactive information-giving and patient perceived self-efficacy in interacting with physicians. Results Greater physician information-giving about BC and its treatment and greater patient perceived self-efficacy positively predicted BRS (OR=1.12, P=0.04; OR=1.03, P=0.01, respectively). The observed negative effects of language barriers and less acculturation among Latinas and lower education at the bivariate level were mitigated in multivariate modeling with the addition of the patient-physician communication and self-efficacy variables. Conclusion Empowering aspects of patient-physician communication and self-efficacy may overcome the negative effects of language barriers and less acculturation for Latinas, as well as of lower education generally, on receipt of or planned BRS among low-income women with BC. Intervening with these aspects of communication could result in BRS rates more consistent with the general population and in improved quality of life among this disadvantaged group. PMID:19626696

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

    PubMed

    Winiarski, Sławomir; Czamara, Andrzej

    2012-01-01

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

  3. Correlation Analysis of Potential Factors Influencing Graft Maturity After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Li, Hong; Chen, Shuang; Tao, Hongyue; Li, Hongyun; Chen, Shiyi

    2014-01-01

    Background: Postoperatively, signal changes of the reconstructed anterior cruciate ligament (ACL) graft on magnetic resonance imaging (MRI) images commonly occurs, which may be a cause for concern. The signal intensity changes are usually expressed by signal/noise quotient (SNQ) value, representing graft maturity. To date, little is known about the factors influencing the SNQ value of the reconstructed ACL graft. Purpose: To evaluate ACL graft SNQ value and associated factors after ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Male patients who underwent ACL reconstruction using autograft or allograft tendon from September 2004 to September 2011 were randomly invited to take part in this investigation, including functional scores, physical examination, and MRI scan. The femoral side graft was fixed with Endobutton CL or Rigidfix pins, and the tibial side graft was fixed with a bio-intrafix. SNQ values of each graft were measured on MRI to represent graft maturity. Sagittal ACL angle, ACL–Blumensaat line angle, and medial and lateral posterior tibial slope (PTS) were measured using MRI 3-dimensional dual-echo steady-state images. Potential risk factors, including age, body mass index, postoperative time, Tegner activity scale (TAS), sagittal ACL angle, ACL–Blumensaat line angle, medial PTS, lateral PTS, and primary graft diameter, were tested for their association with the graft SNQ value by multivariate stepwise regression analysis. Results: A total of 104 male subjects (mean follow-up, 30.7 months) were examined, including 62 allograft and 42 autograft reconstructions. There was a significant association between graft SNQ and postoperative time (r = −0.431, P < .001), TAS (r = 0.295, P = .002), and ACL–Blumensaat line angle (r = −0.304, P = .002). Univariate regression analysis showed that TAS (β = 6.15, P < .001) positively correlated, postoperative time (β = −0.26, P < .001) negatively correlated, and ACL

  4. Knee-laxity measurements examined by a left-hand- and a right-hand-dominant physiotherapist, in patients with anterior cruciate ligament injuries and healthy controls.

    PubMed

    Sernert, Ninni; Helmers, Janett; Kartus, Catarina; Ejerhed, Lars; Kartus, Jüri

    2007-10-01

    The purpose of the study was to analyse and compare KT-1000 knee laxity as examined by a left-hand- and a right-hand-dominant physiotherapist in a group of patients with an anterior cruciate ligament (ACL) injury and a group of patients, 2 years after ACL reconstruction. The other aim was to measure and analyse knee laxity in a group of persons without any known knee problems. A cross-sectional examination of two groups of patients pre-operatively and post-operatively after ACL reconstruction and examination of healthy controls on two different occasions was performed. Fifty-three patients who were scheduled for ACL reconstruction and 39 patients who attended a 2-year follow-up examination were included in the study. In the ACL-deficient group, 32 patients had a right-sided ACL injury and 21 patients a left-sided ACL injury. The corresponding figures in the post-operative group were 21 patients with a right-sided ACL injury and 18 patients with a left-sided ACL injury. Twenty-eight healthy persons without any known knee problems served as controls. One left-hand- and one right-hand-dominant experienced physiotherapist performed all the examinations. To be able to evaluate the intra and inter-reliability of the examiners the controls were examined at two occasions. The left-hand-dominant physiotherapist measured significantly higher absolute laxity values in the left knee, both injured and non-injured ones, compared with the right-hand-dominant physiotherapist. This was found irrespectively of whether the patients belonged to the ACL deficient or the post-operative group. In the healthy control group, the right-hand-dominant physiotherapist measured significantly higher knee-laxity values in the right knee compared with the left-hand-dominant physiotherapist. Correspondingly, the left-hand-dominant physiotherapist measured significantly higher knee laxity values in the left knee. We conclude that KT-1000 arthrometer laxity measurements can be affected by the hand

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

    PubMed Central

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

    2016-01-01

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

  6. 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

  7. 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

  8. Defining the Relationship between Patient Decisions to Undergo Breast Reconstruction and Contralateral Prophylactic Mastectomy

    PubMed Central

    Agarwal, Shailesh; Kidwell, Kelley M.; Kraft, Casey T.; Kozlow, Jeffrey H.; Sabel, Michael S.; Chung, Kevin C.; Momoh, Adeyiza O.

    2016-01-01

    BACKGROUND Recent studies suggest that the decision to undergo breast reconstruction and contralateral prophylactic mastectomy (CPM) are closely related. Here we describe the relationship between method of reconstruction and decision to undergo CPM. We also evaluate recent trends in CPM use in the context of literature questioning its oncologic benefit. STUDY DESIGN Female patients with unilateral breast cancer were identified and data extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 through 2010. Logistic regression analyses were performed to study the relationship between having CPM and key demographic, oncologic and reconstructive factors among women with unilateral breast cancer. RESULTS A total of 157,042 patients with unilateral breast cancer were included. CPM rate increased from 7.7% to 28.3% during the study period, and the proportion of reconstructed patients who underwent CPM increased from 19% to 46%. Reconstruction was associated with higher odds of CPM (odds ratio (OR) 2.79, 95% CI 2.70-2.88, p<0.0001) after controlling for oncologic and demographic factors. Among women who had reconstruction, implant-based reconstruction was associated with significantly higher odds of CPM than autologous tissue reconstruction (OR 1.38, p<0.0001). Over the study period Implant reconstruction rates increased from 28.2% to 43.5% while autologous reconstruction rates decreased from 32.2% to 27.3% in CPM patients. CONCLUSIONS The frequency of CPM continues to increase in spite of literature questioning its oncologic benefit. Our study confirms that reconstruction and the decision to undergo CPM are closely related, with implant reconstruction dominating in patients who undergo CPM. Given the relationship between reconstruction and the choice for CPM, plastic surgeons should play an active role in educating patients to avoid decisions made based on inaccurate information. PMID:25719688

  9. Reconstruction of the anterior cruciate ligament: a comparison between bone-patellar tendon-bone grafts and fourstrand hamstring grafts

    PubMed Central

    Razi, Mohammad; Sarzaeem, Mohammad Mahdi; Kazemian, Gholam Hossein; Najafi, Farideh; Najafi, Mohammad Amin

    2014-01-01

    Background: Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The choice of graft for (ACL) reconstruction remains controversial. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (ST) grafts for ACL reconstruction over a 3-year follow-up interval. Methods: Seventy-one patients with an average age of 29± 4.5yearswere treated for torn ACL between 2008 and 2009. Forty-sixpatients underwent reconstruction with BPTB autograft, and 41 were treated with ST autograft. At the time of final follow-up, 37 patients in patella group and 34 patients in hamstring group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC (International Knee Documentation Committee) score and complications. Results: At 36thmonth of follow-up, 34 (92%) and 28 (82%) patients in BPTB and ST group, respectively had good-to-excellent IKDC score (p > 0.05). The activity levels were higher in BPTB group (p> 0.05). At 3rd yearof follow up, the Lachman test was graded normal, for 23 (62%) and 11 (32%) patients in BPTB and ST group, respectively (p=0.019). Regarding the pivot-shift test, 29 (79%) and 15 (44%) patients in patella and hamstring group, respectively had normal test at the latest follow-up (p=0.021).There were no significant differences in terms of thigh circumference difference, effusion, knee range of motion, pain and complications. Conclusion: The results indicate a trend toward increased graft laxity and pivot-shift grades in patients undergoing reconstruction with hamstring autograft compared with patella tendon. However, the two groups had comparable results in terms of activity level and knee function. PMID:25694992

  10. Reducing the Risk of ACL Injury in Female Athletes

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  11. Electromyographic biofeedback and recovery of quadriceps femoris muscle function following anterior cruciate ligament reconstruction.

    PubMed

    Draper, V

    1990-01-01

    The purpose of this study was to compare the effects of biofeedback-facilitated exercise with exercise alone on the recovery rate of quadriceps femoris muscle function following anterior cruciate ligament (ACL) reconstruction. Functional measures included 1) a dynamometric test of quadriceps femoris muscle isometric peak torque during the 12th postoperative week and 2) the number of days post-operatively that a patient achieved full active extension of the knee. Twenty-two patients with acute ACL injury were randomly assigned to a Treatment (biofeedback) Group (n = 11) or a Control (nonfeedback) Group (n = 11) during the first therapy session one week after reconstructive surgery. After the patients had completed the 12-week exercise program, the quadriceps femoris muscle isometric peak torque in the operative limb was compared with that in the nonoperative limb at three angles (90 degrees, 60 degrees, and 45 degrees) of extension. An analysis of variance revealed significant differences between the Treatment and Control Groups at all three angles. Mean recovery time was calculated for each group, and a t test for independent samples indicated a significant difference between the groups. These results demonstrate that the addition of biofeedback to muscle strengthening exercises facilitates the rate of recovery of quadriceps femoris muscle function following ACL reconstruction.

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

    PubMed

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

    2015-04-01

    Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding procedure with outcomes that generally fail to reach those seen with primary ACL reconstruction. With most index procedures using autograft tissue, it is not uncommon for allograft tissue to be required for revision ACL reconstruction. Compared with autografts, allografts take longer to incorporate and lead to more episodes of instability. In this article, we describe ipsilateral iliotibial band tenodesis performed to augment use of bone-patellar tendon-bone allograft in revision ACL reconstruction. This technique adds rotational stability to protect the allograft tissue while it incorporates. PMID:25844596

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

    PubMed

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

    2015-04-01

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

  14. Anterior cruciate ligament reconstruction by using otogenous [correction of otogeneous] hamstring tendons with home-based rehabilitation.

    PubMed

    Ugutmen, E; Ozkan, K; Kilincoglu, V; Ozkan, F U; Toker, S; Eceviz, E; Altintas, F

    2008-01-01

    We investigated patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction using otogenous hamstring tendons with a cross-pin technique to compare a post-operative home-based rehabilitation programme with a clinic-based programme. ACL reconstruction was performed on 104 patients (103 male) by the same surgeon. The mean age of the patients was 31.5 years (range 18 - 43 years) and the mean time interval between injury and operation was 34.3 months. Patients were randomly allocated to either a home-based (n = 52) or clinic-based rehabilitation programme (n = 52). Mean follow-up was 31.1 months (range 12 - 66 months). Patients underwent a series of examinations before and after surgery in order to evaluate functional recovery of their injured knee. The results demonstrated that using otogeneous hamstring tendons for ACL reconstruction was safe and produced satisfactory results. The study also demonstrated that a home-based rehabilitation programme was as effective as a clinic-based programme.

  15. Advanced Cardiac Life Support (ACLS) utilizing Man-Tended Capability (MTC) hardware onboard Space Station Freedom

    NASA Technical Reports Server (NTRS)

    Smith, M.; Barratt, M.; Lloyd, C.

    1992-01-01

    Because of the time and distance involved in returning a patient from space to a definitive medical care facility, the capability for Advanced Cardiac Life Support (ACLS) exists onboard Space Station Freedom. Methods: In order to evaluate the effectiveness of terrestrial ACLS protocols in microgravity, a medical team conducted simulations during parabolic flights onboard the KC-135 aircraft. The hardware planned for use during the MTC phase of the space station was utilized to increase the fidelity of the scenario and to evaluate the prototype equipment. Based on initial KC-135 testing of CPR and ACLS, changes were made to the ventricular fibrillation algorithm in order to accommodate the space environment. Other constraints to delivery of ACLS onboard the space station include crew size, minimum training, crew deconditioning, and limited supplies and equipment. Results: The delivery of ACLS in microgravity is hindered by the environment, but should be adequate. Factors specific to microgravity were identified for inclusion in the protocol including immediate restraint of the patient and early intubation to insure airway. External cardiac compressions of adequate force and frequency were administered using various methods. The more significant limiting factors appear to be crew training, crew size, and limited supplies. Conclusions: Although ACLS is possible in the microgravity environment, future evaluations are necessary to further refine the protocols. Proper patient and medical officer restraint is crucial prior to advanced procedures. Also emphasis should be placed on early intubation for airway management and drug administration. Preliminary results and further testing will be utilized in the design of medical hardware, determination of crew training, and medical operations for space station and beyond.

  16. 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

  17. Changes of muscle mechanics associated with anterior cruciate ligament deficiency and reconstruction.

    PubMed

    Hsiao, Shih-Fen; Chou, Pei-Hsi; Hsu, Horng-Chaung; Lue, Yi-Jing

    2014-02-01

    Isometric and isokinetic knee strength deficits were examined on patients with anterior cruciate ligament (ACL) injury before and after ACL reconstruction. Muscle strengths of the uninjured and injured knees were measured from an ACL injured (n = 12) and a control (n = 15) group. Five isometric (10, 30, 50, 70, and 90° of knee flexion) and 5 isokinetic (50, 100, 150, 200, and 250°·s) strengths of quadriceps and hamstrings were measured prereconstruction and postreconstruction (3 and 6 months). Compared with the controls, the uninjured knee showed normal strength and patterns of length-tension and force-velocity relationships. Compared with the uninjured knee, the injured knees showed a generally 25-30% decrease in quadriceps and hamstrings strength with normal patterns of length-tension and force-velocity relationships. By 3 months of reconstruction, weakness of quadriceps of the injured knees was exacerbated, particularly at lengthened positions (∼ 40% of the uninjured knees at knee flexion 70 and 90°) and at slower velocities (∼35% of the uninjured knees at the 50 and 100°·s, p < 0.05), with flattened patterns of mechanical output. By 6 months of reconstruction, the quadriceps of the injured knees still showed significant weakness (∼50% of the uninjured knees) in both contraction types (isometric at knee flexion 90° and isokinetic at 50°·s, p < 0.05). The hamstrings of the injured knees had not shown significant changes after reconstruction. A strengthening program placing emphasis on greater knee flexion angles and slower movement speed with sufficient training duration post ACL reconstruction is recommended because of long-lasting and exacerbated weakness during 3 and 6 months postreconstruction.

  18. Effect of whole body vibration frequency on neuromuscular activity in ACL-deficient and healthy males

    PubMed Central

    Giombini, A; Menotti, F; Piccinini, A; Fagnani, F; Di Cagno, A; Macaluso, A; Pigozzi, F

    2015-01-01

    Whole-body vibration (WBV) has been shown to enhance muscle activity via reflex pathways, thus having the potential to contrast muscle weakness in individuals with rupture of the anterior cruciate ligament (ACL). The present study aimed to compare the magnitude of neuromuscular activation during WBV over a frequency spectrum from 20 to 45 Hz between ACL-deficient and healthy individuals. Fifteen males aged 28±4 with ACL rupture and 15 age-matched healthy males were recruited. Root mean square (RMS) of the surface electromyogram from the vastus lateralis in both limbs was computed during WBV in a static half-squat position at 20, 25, 30, 35, 40 and 45 Hz, and normalized to the RMS while maintaining the half-squat position without vibration. The RMS of the vastus lateralis in the ACL-deficient limb was significantly greater than in the contralateral limb at 25, 30, 35 and 40 Hz (P<0.05) and in both limbs of the healthy participants (dominant limb at 25, 30, 35, 40 and 45 Hz, P<0.05; non dominant limb at 20, 25, 30, 35, 40 and 45 Hz, P<0.05). The greater neuromuscular activity in the injured limb compared to the uninjured limb of the ACL-deficient patients and to both limbs of the healthy participants during WBV might be due to either augmented excitatory or reduced inhibitory neural inflow to motoneurons of the vastus lateralis through the reflex pathways activated by vibratory stimuli. The study provides optimal WBV frequencies which might be used as reference values for ACL-deficient patients. PMID:26424928

  19. Reconstructive Surgery for Head and Neck Cancer Patients

    PubMed Central

    Hanasono, Matthew M.

    2014-01-01

    The field of head and neck surgery has gone through numerous changes in the past two decades. Microvascular free flap reconstructions largely replaced other techniques. More importantly, there has been a paradigm shift toward seeking not only to achieve reliable wound closure to protect vital structures, but also to reestablish normal function and appearance. The present paper will present an algorithmic approach to head and neck reconstruction of various subsites, using an evidence-based approach wherever possible. PMID:26556426

  20. Reconstruction of the anterior cruciate ligament with the tendons of the semitendinosus and gracilis doubled: a comparison with reconstruction using the patellar tendon.

    PubMed

    Iorio, R; Ciardini, R; Russo, A; Conteduca, F; Ferretti, A

    2005-01-01

    differences in medium-term results. In a recent meta-analysis of the most important international literature, to this regard Freedman et al. concluded that despite a significant major presence of anterior pain reconstruction with BPTB is capable of guaranteeing better joint stability and patient satisfaction, with a minor incidence of transplant failure. Nonetheless, if methods of reconstruction with BPTB seem to be rather standardized in terms of the method used to obtain the specimen and that used for stabilization (with very few differences between interference screws and transverse stabilization), and in postoperative rehabilitation (so-called accelerated), when DGST is used there are many technical variables capable of influencing the final results (choice of methods of stabilization, postoperative rehabilitation in particular). For this reason we still cannot obtain an absolute comparison of the two methods, but can only compare reconstruction with BPTB and a particular method used with DGST. It is the purpose of this study to present the medium-term results not so much of ACL reconstruction with the semitendinosus and gracilis doubled, but as a more articulate approach to the pathology of the ACL, so that DGST is only one phase, even if it is the most important one. Because we wished to verify whether it is possible, even in terms of joint stability and patient satisfaction, to improve the results of the so-called gold standard for reconstruction of the ACL, reconstruction by BPTB with transverse femoral reconstruction and accelerated postoperative rehabilitation protocol was chosen as a term of paragon.

  1. 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

  2. Three-Dimensional MRI-Based Statistical Shape Model and Application to a Cohort of Knees with Acute ACL Injury

    PubMed Central

    Pedoia, Valentina; Lansdown, Drew A.; Zaid, Musa; McCulloch, Charles E.; Souza, Richard; Ma, C. Benjamin; Li, Xiaojuan

    2016-01-01

    Objective The aim of this study is to develop a novel 3D magnetic resonance imaging (MRI)-based Statistical Shape Modeling (SSM) and apply it in knee MRIs in order to extract and compare relevant shapes of the tibia and femur in patients with and without acute ACL injuries. Methods Bilateral MR images were acquired and analyzed for 50 patients with acute ACL injuries and for 19 control subjects. A shape model was extracted for the tibia and femur using an SSM algorithm based on a set of matched landmarks that are computed in a fully automatic manner. Results Shape differences were detected between the knees in the ACL-injury group and control group, suggesting a common shape feature that may predispose these knees to injury. Some of the detected shape features that discriminate between injured and control knees are related to intercondylar width and posterior tibia slope, features that have been suggested in previous studies as ACL morphological risk factors. However, shape modeling has the great potential to quantify these characteristics with a comprehensive description of the surfaces describing complex 3D deformation that cannot be represented with simple geometric indexes. Conclusions 3D MRI-based bone shape quantification has the ability to identify specific anatomic risk factors for ACL injury. A better understanding of the role in bony shape on ligamentous injuries could help in the identification of subjects with an increased risk for an ACL tear and to develop targeted prevention strategies, including education and training. PMID:26050865

  3. 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

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

    PubMed

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

    2009-05-01

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

  5. Prehospital ACLS--does it work?

    PubMed

    Maheshwari, Alok; Mehrotra, Avanti; Gupta, Anoop K; Thakur, Ranjan K

    2002-11-01

    Cardiac disease is the most common cause of death in the United States, and sudden cardiac arrest frequently claims the lives of men and women during their most productive years. It is believed that much better survival rates can be achieved for victims of cardiac arrest through optimizing the "chain of survival" as described by the American Heart Association. The relative and incremental benefit of full prehospital ACLS over basic life support and defibrillation is unproven, however. This is an important issue in this era of cost containment. Some of the ongoing studies including the OPALS study may clarify the cost effectiveness and relative efficacy of rapid defibrillation and full ACLS programs for victims of prehospital cardiac arrest [6].

  6. Helping patients make choices about breast reconstruction: a decision analysis approach.

    PubMed

    Sun, Clement S; Cantor, Scott B; Reece, Gregory P; Fingeret, Michelle C; Crosby, Melissa A; Markey, Mia K

    2014-10-01

    Decision analysis can help breast reconstruction patients and their surgeons to methodically evaluate clinical alternatives and make hard decisions. The purpose of this article is to help plastic surgeons guide patients in making decisions though a case study in breast reconstruction. By making good decisions, patient outcomes may be improved. This article aims to illustrate decision analysis techniques from the patient perspective, with an emphasis on her values and preferences. The authors introduce normative decision-making through a fictional breast reconstruction patient and systematically build the decision basis to help her make a good decision. The authors broadly identify alternatives of breast reconstruction, propose types of outcomes that the patient should consider, discuss sources of probabilistic information and outcome values, and demonstrate how to make a good decision. The concepts presented here may be extended to other shared decision-making problems in plastic and reconstructive surgery. In addition, the authors discuss how sensitivity analysis may test the robustness of the decision and how to evaluate the quality of decisions. The authors also present tools to help implement these concepts in practice. Finally, the authors examine limitations that hamper adoption of patient decision analysis in reconstructive surgery and health care in general. In particular, the authors emphasize the need for routine collection of quality-of-life information, out-of-pocket expense, and recovery time.

  7. Iliotibial band irritation caused by the EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction: report of two cases.

    PubMed

    Taketomi, Shuji; Inui, Hiroshi; Hirota, Jinso; Nakamura, Kensuke; Sanada, Takaki; Masuda, Hironari; Tanaka, Sakae; Nakagawa, Takumi

    2013-08-01

    Two patients underwent arthroscopic anatomic double-bundle anterior cruciate ligament (ACL) reconstruction using the EndoButton for femoral fixation. The femoral tunnels were created by the inside-out technique through a far anteromedial portal. The patients postoperatively developed moderate lateral knee pain without instability. At the second-look arthroscopic evaluation, the two EndoButtons were removed. Both patients were completely asymptomatic several months after implant removal, implying that the EndoButtons caused the mechanical irritation in the iliotibial band. This is the first report describing removal of EndoButtons because of pain caused by friction with the iliotibial band. In anatomic ACL reconstruction, if the femoral tunnel exit is positioned near the lateral femoral epicondyle, care should be taken to prevent iliotibial band friction syndrome that could result because of the EndoButton.

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

    PubMed Central

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

    2013-01-01

    Context: Quadriceps and hamstrings weakness occurs frequently after anterior cruciate ligament (ACL) injury and reconstruction. Evidence suggests that knee injury may precipitate hip and ankle muscle weakness, but few data support this contention after ACL injury and reconstruction. Objective: To determine if hip, knee, and ankle muscle weakness present after ACL injury and after rehabilitation for ACL reconstruction. Design: Case-control study. Setting: University research laboratory. Patients or Other Participants: Fifteen individuals with ACL injury (8 males, 7 females; age = 20.27 ± 5.38 years, height = 1.75 ± 0.10 m, mass = 74.39 ± 13.26 kg) and 15 control individuals (7 men, 8 women; age = 24.73 ± 3.37 years, height = 1.75 ± 0.09 m, mass = 73.25 ± 13.48 kg). Intervention(s): Bilateral concentric strength was assessed at 60°/s on an isokinetic dynamometer. The participants with ACL injury were tested preoperatively and 6 months postoperatively. Control participants were tested on 1 occasion. Main Outcome Measures: Hip-flexor, -extensor, -abductor, and -adductor; knee-extensor and -flexor; and ankle–plantar-flexor and -dorsiflexor strength (Nm/kg). Results: The ACL-injured participants demonstrated greater hip-extensor (percentage difference = 19.7, F1,14 = 7.28, P = .02) and -adductor (percentage difference = 16.3, F1,14 = 6.15, P = .03) weakness preoperatively than postoperatively, regardless of limb, and greater postoperative hip-adductor strength (percentage difference = 29.0, F1,28 = 10.66, P = .003) than control participants. Knee-extensor and -flexor strength were lower in the injured than in the uninjured limb preoperatively and postoperatively (extensor percentage difference = 34.6 preoperatively and 32.6 postoperatively, t14 range = −4.59 to −4.23, P ≤ .001; flexor percentage difference = 30.6 preoperatively and 10.6 postoperatively, t14 range = −6.05 to −3.24, P < .05) with greater knee-flexor (percentage difference = 25.3, t14 =

  9. CLARIFYING THE EXPECTATIONS OF PATIENTS UNDERGOING IMPLANT BREAST RECONSTRUCTION: A QUALITATIVE STUDY

    PubMed Central

    Snell, L; McCarthy, C.; Klassen, A.; Cano, S.; Rubin, Lisa; Hurley, K.; Montgomery, G.H.; Cordeiro, P.G.; Pusic, A.

    2015-01-01

    Background Unfulfilled expectations can lead to patient dissatisfaction with surgical outcomes. Understanding expectations allows surgeons to identify those patients who hold inaccurate expectations preoperatively, and to reset those expectations through focused pre-operative education. The purpose of this study is to investigate preoperative expectations of women undergoing implant breast reconstruction. Identifying inaccurate or unfulfilled expectations is a critical step towards the advancement of preoperative education and subsequently improving patient satisfaction with surgical outcomes. Methods In-depth, open-ended interviews were conducted with 28 women undergoing implant breast reconstruction. The interviews were recorded, transcribed, and data were coded using standard qualitative techniques. Results Interviews ascertained that implant-based breast reconstruction patients may have inaccurate expectations regarding the results of their surgery despite having received standard preoperative teaching. Specifically, patients often had unclear expectations regarding the appearance and physical outcome of the reconstructed breast(s). Some patients were surprised by the “flatness” of the tissue expander immediately following its insertion. Most patients felt unprepared for the “unnatural” final appearance of the breast(s). Furthermore, they did not expect many of the physical outcomes, including loss of sensation, firmness of the reconstructed breast(s), and lack of movement of the reconstructed breast(s). Inaccurate expectations corresponded to areas of dissatisfaction highlighted by the patients in postoperative interviews. Conclusion This study has important implications for preoperative education of women undergoing implant breast reconstruction. Physicians and nurses involved in the preoperative preparation process should take care to explore patients’ expectations regarding the look, feel, sensation, and movement of reconstructed breasts to

  10. Influence of the crosshead rate on the mechanical properties of fixation systems of ACL tendon grafts.

    PubMed

    Martel, Oscar; Cárdenes, Juan F; Garcés, Gerardo; Carta, José A

    2009-11-01

    Anterior cruciate ligament (ACL) reconstruction is one of the most important aspects of knee surgery. For this purpose, several fixation devices have been developed, although the interference screw is the most frequently used. The most typical biomechanical test of these devices consists of placing them in a testing machine and subjecting them to a pull-out test. However, insufficient attention has been paid to the influence of the displacement test rate on the mechanical properties of the fixation system. The aim of this study is to compare the influence of the crosshead rate in the biomechanical test of two different devices for the fixation of ACL tendon grafts. One hundred in vitro tests were performed using porcine tibiae and bovine tendons. The fixation devices used were (1) an interference screw and (2) a new expansion device. All ACL reconstructions were subjected to pull-out test to failure. Five crosshead rates were employed in a range from 30 mm/min to 4000 mm/min. Statistical analyses of the results show that, for the two devices, the rate has a significant effect on both maximum force and stiffness. Moreover, the new expansion device showed lesser dependency on the crosshead rate than the interference screw.

  11. Neuromuscular Evaluation With Single-Leg Squat Test at 6 Months After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Hall, Michael P.; Paik, Ronald S.; Ware, Anthony J.; Mohr, Karen J.; Limpisvasti, Orr

    2015-01-01

    Background: Criteria for return to unrestricted activity after anterior cruciate ligament (ACL) reconstruction varies, with some using time after surgery as the sole criterion—most often at 6 months. Patients may have residual neuromuscular deficits, which may increase the risk of ACL injury. A single-leg squat test (SLST) can dynamically assess for many of these deficits prior to return to unrestricted activity. Hypothesis: A significant number of patients will continue to exhibit neuromuscular deficits with SLST at 6 months after ACL reconstruction. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients using a standardized accelerated rehabilitation protocol at their 6-month follow-up after primary ACL reconstruction were enrolled. Evaluation included bilateral SLST, single-leg hop distance, hip abduction strength, and the subjective International Knee Documentation Committee (IKDC) score. Results: Thirty-three patients were enrolled. Poor performance of the operative leg SLST was found in 15 of 33 patients (45%). Of those 15 patients, 7 (45%) had concomitant poor performance of the nonoperative leg compared with 2 of 18 patients (11%) in those who demonstrated good performance in the operative leg. The poor performers were significantly older (33.6 years) than the good performers (24.2 years) (P = .007). Those with poor performance demonstrated decreased hip abduction strength (17.6 kg operative leg vs 20.5 kg nonoperative leg) (P = .024), decreased single-leg hop distance (83.3 cm operative leg vs 112.3 cm nonoperative leg) (P = .036), and lower IKDC scores (67.9 vs 82.3) (P = .001). Conclusion: Nearly half of patients demonstrated persistent neuromuscular deficits on SLST at 6 months, which is when many patients return to unrestricted activity. Those with poor performance were of a significantly older age, decreased hip abduction strength, decreased single-leg hop distance, and lower IKDC subjective scores. Clinical Relevance: The SLST

  12. Esthetic and functional reconstruction after parotidectomy in pediatric patients - A case series.

    PubMed

    Bryant, Lucas M; Cognetti, David; Baker, Adam; Roy, Sudeep; Johnston, Douglas R; Curry, Joseph; Krein, Howard

    2015-12-01

    Parotidectomy is a mainstay of treatment for benign and malignant parotid lesions in children and adults. Depending on surgical methods used and tumor size, parotidectomy may result in significant facial disfigurement as well as functional challenges. We describe a series of four pediatric patients, ages 13-16 who presented to our clinic with a parotid mass. All patients underwent parotidectomy with immediate reconstruction by local tissue rearrangement or free fat graft. Esthetic and functional reconstruction after parotidectomy is not well described in pediatric otolaryngology literature. A review of current literature and description of reconstructive methods is included. PMID:26474834

  13. Computer-Assisted Mandibular Reconstruction using a Patient-Specific Reconstruction Plate Fabricated with Computer-Aided Design and Manufacturing Techniques

    PubMed Central

    Wilde, Frank; Cornelius, Carl-Peter; Schramm, Alexander

    2014-01-01

    We investigated the workflow of computer-assisted mandibular reconstruction that was performed with a patient-specific mandibular reconstruction plate fabricated with computer-aided design and computer-aided manufacturing (CAD/CAM) techniques and a fibula flap. We assessed the feasibility of this technique from virtual planning to the completion of surgery. Computed tomography (CT) scans of a cadaveric skull and fibula were obtained for the virtual simulation of mandibular resection and reconstruction using ProPlan CMF software (Materialise®/DePuy Synthes®). The virtual model of the reconstructed mandible provided the basis for the computer-aided design of a patient-specific reconstruction plate that was milled from titanium using a five-axis milling machine and CAM techniques. CAD/CAM techniques were used for producing resection guides for mandibular resection and cutting guides for harvesting a fibula flap. Mandibular reconstruction was simulated in a cadaveric wet laboratory. No problems were encountered during the procedure. The plate was fixed accurately to the residual bone without difficulty. The fibula segments were attached to the plate rapidly and reliably. The fusion of preoperative and postoperative CT datasets demonstrated high reconstruction precision. Computer-assisted mandibular reconstruction with CAD/CAM-fabricated patient-specific reconstruction plates appears to be a promising approach for mandibular reconstruction. Clinical trials are required to determine whether these promising results can be translated into successful practice and what further developments are needed. PMID:25045420

  14. Synchronous quadriceps tendon rupture and unilateral ACL tear in a weightlifter, associated with anabolic steroid use.

    PubMed

    Fenelon, Christopher; Dalton, David M; Galbraith, John G; Masterson, Eric L

    2016-05-06

    Synchronous quadriceps tendon rupture is rare. A 29-year-old man, an amateur weight lifter, taking androgenic-anabolic steroids (AAS), developed sudden onset bilateral pain and swelling of his anterior thighs when attempting to squat 280 kg (620 lb). Examination revealed gross swelling superior to the patella and palpable gaps in both quadriceps tendons. He underwent successful operative repair. MRI revealed a partial tear of the anterior cruciate ligament (ACL) of the right knee. This was not reconstructed. Only a few case reports of the association between AAS and quadriceps rupture exist in the literature, with none to the best of our knowledge in the past 10 years. ACL rupture coexisting is very rare, with only two reported cases.

  15. Synchronous quadriceps tendon rupture and unilateral ACL tear in a weightlifter, associated with anabolic steroid use.

    PubMed

    Fenelon, Christopher; Dalton, David M; Galbraith, John G; Masterson, Eric L

    2016-01-01

    Synchronous quadriceps tendon rupture is rare. A 29-year-old man, an amateur weight lifter, taking androgenic-anabolic steroids (AAS), developed sudden onset bilateral pain and swelling of his anterior thighs when attempting to squat 280 kg (620 lb). Examination revealed gross swelling superior to the patella and palpable gaps in both quadriceps tendons. He underwent successful operative repair. MRI revealed a partial tear of the anterior cruciate ligament (ACL) of the right knee. This was not reconstructed. Only a few case reports of the association between AAS and quadriceps rupture exist in the literature, with none to the best of our knowledge in the past 10 years. ACL rupture coexisting is very rare, with only two reported cases. PMID:27154985

  16. 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

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

    PubMed Central

    Wang, Lei

    2016-01-01

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

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

    PubMed

    Wang, Lei

    2016-07-01

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

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

    PubMed

    Wang, Lei

    2016-07-01

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

  20. The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for 'isolated' anterior cruciate ligament rupture.

    PubMed

    Bourke, H E; Gordon, D J; Salmon, L J; Waller, A; Linklater, J; Pinczewski, L A

    2012-05-01

    The purpose of this study was to report the outcome of 'isolated' anterior cruciate ligament (ACL) ruptures treated with anatomical endoscopic reconstruction using hamstring tendon autograft at a mean of 15 years (14.25 to 16.9). A total of 100 consecutive men and 100 consecutive women with 'isolated' ACL rupture underwent four-strand hamstring tendon reconstruction with anteromedial portal femoral tunnel drilling and interference screw fixation by a single surgeon. Details were recorded pre-operatively and at one, two, seven and 15 years post-operatively. Outcomes included clinical examination, subjective and objective scoring systems, and radiological assessment. At 15 years only eight of 118 patients (7%) had moderate or severe osteo-arthritic changes (International Knee Documentation Committee Grades C and D), and 79 of 152 patients (52%) still performed very strenuous activities. Overall graft survival at 15 years was 83% (1.1% failure per year). Patients aged < 18 years at the time of surgery and patients with > 2 mm of laxity at one year had a threefold increase in the risk of suffering a rupture of the graft (p = 0.002 and p = 0.001, respectively). There was no increase in laxity of the graft over time. ACL reconstructive surgery in patients with an 'isolated' rupture using this technique shows good results 15 years post-operatively with respect to ligamentous stability, objective and subjective outcomes, and does not appear to cause osteoarthritis.

  1. Factors affecting return to sports after anterior cruciate ligament reconstruction with patellar tendon and hamstring graft: a prospective clinical investigation.

    PubMed

    Gobbi, Alberto; Francisco, Ramces

    2006-10-01

    In athletes, anterior cruciate ligament (ACL) reconstruction is recommended after injury to restore the normal knee function and allow subsequent return to sport. Successful ACL reconstruction with patellar tendon (PT) and hamstring tendon (HT) grafts combined with a well-structured rehabilitation program could bring athletes back to their previous level of sport activities. We prospectively followed-up 100 athletes who underwent ACL reconstruction with either PT (n=50) or HT grafts (n=50). Evaluation was done pre-operatively and post-operatively (3, 6, 12, and 24 months) using International Knee Documentation Committee (IKDC), Lysholm, Noyes, and Tegner scales. Subjective assessment numeric evaluation (SANE), knee activity rating scale (Marx) and a psychological profile questionnaire (psychovitality) were also utilized. Objective evaluations included isokinetic tests and computerized knee motion analysis. Data gathered were statistically analyzed using the Mann-Whitney non-parametric U-test. Among the 100 patients who have undergone ACL reconstruction, 65% returned to the same level of sports, 24% changed sports and 11% ceased sport activities. No significant difference (P>0.05) in outcome between PT and HT grafts were observed. No significant differences (P>0.05) were noted between athletes who "returned" to their previous sport and those who "did not return" to sports at the same level when using the IKDC, Lysholm, Noyes, and Tegner knee evaluation scales. However, significant difference was observed with the knee scores obtained by those who returned and those who completely ceased participation in sport activities. Computerized laxity test revealed that 90% of these patients have less than 3 mm side-to-side difference with no significant difference between HT and PT groups. Patients who "returned to sports" obtained significantly better scores with the Marx scale (P=0.001) and the psychovitality questionnaire (P=0.001) than those who did not. Conventional knee

  2. SU-E-J-128: 3D Surface Reconstruction of a Patient Using Epipolar Geometry

    SciTech Connect

    Kotoku, J; Nakabayashi, S; Kumagai, S; Ishibashi, T; Kobayashi, T; Haga, A; Saotome, N; Arai, N

    2014-06-01

    Purpose: To obtain a 3D surface data of a patient in a non-invasive way can substantially reduce the effort for the registration of patient in radiation therapy. To achieve this goal, we introduced the multiple view stereo technique, which is known to be used in a 'photo tourism' on the internet. Methods: 70 Images were taken with a digital single-lens reflex camera from different angles and positions. The camera positions and angles were inferred later in the reconstruction step. A sparse 3D reconstruction model was locating by SIFT features, which is robust for rotation and shift variance, in each image. We then found a set of correspondences between pairs of images by computing the fundamental matrix using the eight-point algorithm with RANSAC. After the pair matching, we optimized the parameter including camera positions to minimize the reprojection error by use of bundle adjustment technique (non-linear optimization). As a final step, we performed dense reconstruction and associate a color with each point using the library of PMVS. Results: Surface data were reconstructed well by visual inspection. The human skin is reconstructed well, althogh the reconstruction was time-consuming for direct use in daily clinical practice. Conclusion: 3D reconstruction using multi view stereo geometry is a promising tool for reducing the effort of patient setup. This work was supported by JSPS KAKENHI(25861128)

  3. How to avoid the risk of intraoperative cartilage damage in anatomic four tunnel double bundle anterior cruciate ligament reconstruction.

    PubMed

    Siebold, Rainer; Benetos, Ioannis S; Sartory, Nico; He, Zhenming; Hariri, Nawid; Pässler, Hans H

    2010-01-01

    Double bundle (DB) anterior cruciate ligament (ACL) reconstruction is technically demanding. In order to create four anatomical anteromedial (AM) and posterolateral (PL) bone tunnels many surgeons adopt new ways of tibial and femoral bone tunnel drilling. From surgical experience, these technical changes might increase the risk for intraoperative pitfalls. An intraoperative articular cartilage damage to the medial femoral condyle or the medial tibial plateau could be disastrous for the patient. It may be caused by an insufficient anteromedial portal technique for femoral AM and PL bone tunnel drilling or flat tibial AM or PL bone tunnel reaming. Potential pitfalls may be avoided by small modifications to the surgical technique. In this present technical note, a sequence of surgical steps are described, which may help to avoid articular cartilage damage to the medial femoral condyle and medial tibial plateau in anatomical four tunnel DB ACL reconstruction.

  4. A new skin flap method for total auricular reconstruction in microtia patients with a reconstructed ear canal: extended scalp and extended mastoid postauricular skin flaps.

    PubMed

    Hwang, Euna; Kim, Young Soo; Chung, Seum

    2014-06-01

    Before visiting a plastic surgeon, some microtia patients may undergo canaloplasty for hearing improvement. In such cases, scarred tissues and the reconstructed external auditory canal in the postauricular area may cause a significant limitation in using the posterior auricular skin flap for ear reconstruction. In this article, we present a new method for auricular reconstruction in microtia patients with previous canaloplasty. By dividing a postauricular skin flap into an upper scalp extended skin flap and a lower mastoid extended skin flap at the level of a reconstructed external auditory canal, the entire anterior surface of the auricular framework can be covered with the two extended postauricular skin flaps. The reconstructed ear shows good color match and texture, with the entire anterior surface of the reconstructed ear being resurfaced with the skin flaps. Clinical question/level of evidence; therapeutic level IV.

  5. 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

  6. 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

  7. Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Arcuri, Francisco; Barclay, Fernando; Nacul, Ivan

    2015-01-01

    Introduction: The most recent advances in ACL reconstruction try to reproduce the anatomic femoral and tibial footprints as close as possible. Creating independent tunnels would allow an optimal of the entry point and the femoral tunnel obliquity, and together with an adequate reamer diameter they wouldreproduce with greater certainty the anatomy. Objective: To compare the radiographic parameters of the femoral and tibial tunnel positions in two groups of patients, one operated with a transtibial and other with transportal anatomic techniques. Materials and Methods: From December 2012 to December 2013, 59 patients with a primary ACL reconstruction divided in two groups, a trans tibial technique (TT), 19 patients, and an transportal one (TP) with 40 patients were prospectively evaluated with AP and lateral X-rays. The femoral tunnel angle, the insertion site with respect of the Blumensaat line, the trans osseous distance, the tibial tunnel position as a percentage of the tibial plateau in the AP and lateral views. And finally the tibial tunnel angle in the AP and Lateral views. Results: The femoral tunnel angle was in the TP group of 45,92º and in the TT one 24,53º, p 0,002. The insertion site percentage of the Blumensaat line was of 20,96 in TP and 20,74 in the TT, p 0,681.Trans osseous distance was in the TP of 3,43 cm and in the TT of 4,79 cm, p <0,000. The tibial tunnel position as a percentage in the AP tibial plateau was of 44,35 in TP and of 40,80 TT with a p of 0,076. The tibial tunnel position as a percentage of the lateral tibial plateau was of 28,70 in TP and 34,53 in TT with a p 0,367. Tibial tunnel angle in the AP was of 73,48º in TP and 62,81 in TT with a p of 0,002, and in the lateral plateau of 114,69º in TP and 112,79º in TT with a p of 0,427. Conclusion: It is possible to create tibial and femoral tunnel in optimal positions but not equal between both groups. Creating independent tunnels allow a more anterior and vertical tibial tunnel

  8. Graft selection in anterior cruciate ligament reconstruction.

    PubMed

    Miller, Suzanne L; Gladstone, James N

    2002-10-01

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

  9. Graft selection in anterior cruciate ligament reconstruction.

    PubMed

    Miller, Suzanne L; Gladstone, James N

    2002-10-01

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

  10. Digital infrared thermal imaging following anterior cruciate ligament reconstruction.

    PubMed

    Barker, Lauren E; Markowski, Alycia M; Henneman, Kimberly

    2012-03-01

    This case describes the selective use of digital infrared thermal imaging for a 48-year-old woman who was being treated by a physical therapist following left anterior cruciate ligament (ACL) reconstruction with a semitendinosus autograft. PMID:22383168

  11. 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

  12. Latissimus dorsi reconstruction: a good option for patients with failed breast conservation therapy.

    PubMed

    Freeman, Mark E; Perdikis, Galen; Sternberg, Erez G; TerKonda, Sarvam P; Waldorf, James C

    2006-08-01

    The majority of patients with breast carcinoma are being treated with breast conservation therapy (BCT): lumpectomy and postoperative radiation. Local recurrence reported at 8% to 11% is often treated with salvage mastectomy. This has led to a growing group of patients requiring breast reconstruction after failed BCT. Reluctance to use the latissimus dorsi flap (LDF) has resulted from reports of high implant capsular contracture rates. We present a series of 12 patients who underwent LDF reconstruction after the development of recurrent breast cancer after BCT. All 12 patients had a satisfactory esthetic result. Despite previous radiation, the capsular contracture rate was 12.5% (median follow up, 50 months; range, 20-93 months). The most common complication was donor site seroma in 25% (3 of 12) of cases. The LDF yielded satisfactory esthetic results with a low capsular contracture rate. Despite prior radiation, LDF remains a good option for breast reconstruction after failure of BCT.

  13. "Custom-fit" versus "off-the-shelf" ACL functional braces.

    PubMed

    Wojtys, E M; Huston, L J

    2001-01-01

    Many sports medicine practitioners believe "custom-fit" functional braces are superior in performance to "off-the-shelf" braces for anterior cruciate ligament (ACL)-deficient knees. However, this is not well substantiated. This study compares a Donjoy custom-fit ACL brace (CE 2000), Donjoy off-the-shelf brace (Goldpoint), and an athletic taping technique to determine their role in our clinical practice. Five patients (3 men and 2 women) with isolated, unilateral, chronic ACL tears with an average age of 27 years (range: 19-35 years) were used to evaluate these three restraint systems. Anterior tibial laxity, quadriceps and hamstrings strength, endurance, standing long jump, brace migration with exercise, and pattern of muscle response to forced anterior tibial displacement were studied. Each patient was tested without a brace and then in each of the three test conditions (custom brace, off-the-shelf brace, and tape), with the order of testing randomized. The Donjoy custom-fit ACL functional brace did not reduce anterior laxity or improve standing long jump, muscle strength, endurance, or muscle response times significantly more than the off-the-shelf ACL brace. Both braces improved anterior stability over knee taping when the knee muscles were contracted under the low forces used in this study. After 1 hour of exercise, brace migration was significantly greater (P=.03) for the CE-2000 custom brace (18.6 mm) than for the Goldpoint off-the-shelf brace (4.5 mm). There appears to be no advantage to the more expensive custom-fit knee brace over the off-the-shelf brace.

  14. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction.

    PubMed

    Al-Ghazal, S K; Fallowfield, L; Blamey, R W

    2000-10-01

    The aim of this study was to assess and compare the psychological outcome and satisfaction of patients whom underwent wide local excision, mastectomy alone and mastectomy with breast reconstruction. A total of 577 patients had different types of operations for primary breast cancer (254 (44%) had wide local excision, 202 (35%) had simple mastectomy and 121 (21%) had breast reconstruction). Psychosocial morbidity and satisfaction were studied retrospectively using self-evaluation questionnaires. The three different surgical groups were cross-matched into four different age group. Significant statistical differences existed between the three procedures regarding satisfaction and psychosocial morbidity (anxiety, depression, body image, sexuality and self-esteem) in favour of wide local excision followed by breast reconstruction. Greatest morbidity was seen in the mastectomy group. Patient satisfaction of cosmetic outcome and psychosocial aspects was greater with wide local excision than with breast reconstruction or mastectomy. However, since wide local excision is indicated in only a group of patients, breast reconstruction should be an option available to patients requiring mastectomy.

  15. 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

  16. 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

  17. ACL repair might induce further abnormality of gamma loop in the intact side of the quadriceps femoris.

    PubMed

    Konishi, Y U

    2011-04-01

    The purpose of this study was to investigate the effect of surgery on the gamma-loop in the quadriceps of patients with ACL injuries. We compared the response to vibration stimulation in subjects with ACL repair, subjects with ACL rupture, and normal subjects, by measuring the maximal strength and integrated electromyography (I-EMG) of the quadriceps. Pre-vibration data were obtained from each subject by measuring the MVC of the knee extension and the I-EMG from the vastus medialis, vastus lateralis, and rectus femoris. Vibration stimulation was applied to the infrapatellar tendon, followed immediately by repeating maximal strength and I-EMG recording. The results of this study indicated that alpha motor neuron activity of the intact side of the vastus lateralis in response to prolonged vibration stimulation was altered by surgery, but no effect was detected in the injured side. The results could suggest that abnormality of the gamma-loop existed even in the quadriceps of patients with ACL rupture since the vibration stimulus failed to elicit changes in ACL-rupture group as compared with those of normal subjects. In comparison, abnormality of the gamma-loop in the intact side of the QF was probably induced by the rupture, and further abnormality of gamma-loop was induced by surgery.

  18. Mandibular reconstruction in the radiated patient: the role of osteocutaneous free tissue transfers

    SciTech Connect

    Duncan, M.J.; Manktelow, R.T.; Zuker, R.M.; Rosen, I.B.

    1985-12-01

    This paper discusses our experience with the second metatarsal and iliac crest osteocutaneous transfers for mandibular reconstruction. The prime indication for this type of reconstruction was for anterior mandibular defects when the patient had been previously resected. Midbody to midbody defects were reconstructed with the metatarsal and larger defects with the iliac crest. In most cases, an osteotomy was done to create a mental angle. The evaluation of speech, oral continence, and swallowing revealed good results in all patients unless lip or tongue resection compromised function. Facial contour was excellent in metatarsal reconstructions. The iliac crest cutaneous flap provided a generous supply of skin for both intraoral reconstruction and external skin coverage but tended to be bulky, particularly when used in the submental area. Thirty three of 36 flaps survived completely. Flap losses were due to anastomosis thrombosis (1), pedicle compression (1), and pedicle destruction during exploration for suspected carotid blowout (1). Ninety three percent of bone junctions developed a solid bony union despite the mandible having had a full therapeutic dose of preoperative radiation. Despite wound infections in 8 patients, and intraoral dehiscence with bone exposure in 12 patients, all but one of these transfers went on to good bony union without infection in the bone graft.

  19. Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction.

    PubMed

    Baer, Geoffrey S; Harner, Christopher D

    2007-10-01

    Anterior cruciate ligament (ACL) injuries are the most common complete ligamentous injury to the knee. The optimal graft should be able to reproduce the anatomy and biomechanics of the ACL, be incorporated rapidly with strong initial fixation, and cause low graft-site morbidity. This article reviews the literature comparing the clinical outcomes following allograft and autograft ACL reconstruction and examines current issues regarding graft choice.

  20. Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction.

    PubMed

    Baer, Geoffrey S; Harner, Christopher D

    2007-10-01

    Anterior cruciate ligament (ACL) injuries are the most common complete ligamentous injury to the knee. The optimal graft should be able to reproduce the anatomy and biomechanics of the ACL, be incorporated rapidly with strong initial fixation, and cause low graft-site morbidity. This article reviews the literature comparing the clinical outcomes following allograft and autograft ACL reconstruction and examines current issues regarding graft choice. PMID:17920959

  1. New Deep Dermal ADM Incorporates Well in Case Series of Complex Breast Reconstruction Patients.

    PubMed

    Wilson, Henry Benjamin

    2015-05-01

    Breast cancer patients with significant comorbidities present reconstructive challenges due to a predictably high complication rate. During expander-based breast reconstruction, human acellular dermal matrix (ADM) is often used to prevent pectoralis muscle retraction, facilitate early expansion, and improve cosmetic outcome. Device infection and chronic seroma have been correlated to the addition of the graft by some large database reports but not others. This study describes the first reported experience with a new deep dermal ADM, FlexHD® Pliable™ (MTF, Edison, NJ). Sixteen breasts in 10 consecutive patients identified retrospectively and followed prospectively had immediate expander-based breast reconstruction utilizing the new ADM. Patient comorbidities were catalogued, complications were recorded, and overall reconstructive success was assessed. At implant exchange, the ADM was examined for tissue ingrowth and biopsied for histologic examination. All 16 breasts had successful reconstructions. Two breasts (12.5%) developed device infection, requiring removal and later replacement of the expander. One breast (6.7%) developed chronic seroma, also requiring expander removal and later replacement. All the complicated patients had significant comorbidities, including obesity in all 3. At expander removal, the FlexHD Pliable showed near-complete visual tissue incorporation in 14 of 16 breasts (88%). This case series demonstrates significant reconstructive success in challenging patients utilizing a novel ADM. Visual and histologic assessment of tissue ingrowth into the graft suggests the high rate of complication may be due to patient comorbidities rather than addition of ADM. Additional experience is needed to confirm and the study is ongoing. PMID:26020380

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

    PubMed Central

    Papandreou, Maria G; Billis, Evdokia V; Antonogiannakis, Emmanouel M; Papaioannou, Nikos A

    2009-01-01

    Background Anterior cruciate ligament (ACL) injury or reconstruction can cause knee impairments and disability. Knee impairments are related to quadriceps performance – accelerated reaction time (ART) – and disability to performance of daily living activities which is assessed by questionnaires such as the Lysholm knee score. The purposes of this study were to investigate the effect of cross exercise, as supplementary rehabilitation to the early phase of ACL reconstruction: a) on quadriceps ART at the angles 45°, 60° and 90° of knee flexion and, b) on the subjective scores of disability in ACL reconstructed patients. Methods 42 patients who underwent ACL reconstruction were randomly divided into 3 groups, two experimental and one control. All groups followed the same rehabilitation program. The experimental groups followed 8 weeks of cross eccentric exercise (CEE) on the uninjured knee; 3 d/w, and 5 d/w respectively. Quadriceps ART was measured at 45°, 60° and 90° of knee flexion pre and nine weeks post-operatively using an isokinetic dynamometer. Patients also completed pre and post operatively the Lysholm questionnaire whereby subjective scores were recorded. Results Two factor ANOVA showed significant differences in ART at 90° among the groups (F = 4.29, p = 0.02, p < 0.05). Post hoc Tukey HSD analysis determined that the significant results arose from the first experimental group in comparison to the control (D = -0.83, p = 0.01). No significant differences were revealed at 45° and 60°. Significant differences were also found in the Lysholm score among the groups (F = 4.75, p = 0.01, p < 0.05). Post hoc analysis determined that the above significant results arose from the first experimental group in comparison with the control (D = 7.5, p < 0.01) and from the second experimental in comparison with the control (D = 3.78, p = 0.03). Conclusion CEE showed improvements on quadriceps ART at 90° at a sequence of 3 d/w and in the Lysholm score at a

  3. Hamstring pain and muscle strains following anterior cruciate ligament reconstruction: a prospective, randomized trial comparing hamstring graft harvest techniques.

    PubMed

    D'Alessandro, Peter; Wake, Giulia; Annear, Peter

    2013-04-01

    There is limited information in the literature regarding hamstring pain and muscle strains in patients following anterior cruciate ligament (ACL) reconstruction using hamstring autograft. We sought to investigate whether dividing hamstring tendons distal to the musculotendinous junction rather than forcefully stripping tendons away from the muscle belly during graft harvest resulted in a lower incidence of hamstring pain, muscle strains, and leg flexion strength deficit following commencement of sport-specific training postoperatively. Patients were randomized to either the "Cut" or "Push" groups of hamstring tendon harvesting. All other operative techniques were uniform. A total of 34 (cut = 20, push = 14) patients had a mean follow-up of 30 months, and assessments were conducted by a blinded single practitioner. A customized hamstring strain questionnaire and visual analogue pain score provided information for the study's primary focus: evaluation of postoperative hamstring pain and muscle strains. Leg flexion strength was also measured and a full knee assessment was conducted. The Cincinnati sports activity rating scale (SARS) was used to account for varying degrees of sporting participation and intensity since reconstruction. The "Cut" group's mean visual analogue score was 10.05 mm, significantly lower than the "Push" group (24.66 mm, p = 0.0398). The Cut group also recorded a significant reduction in the incidence of hamstring strains following ACL reconstruction (5/20 patients 25%) compared with the Push group (7/14 patients 50%, p = 0.045). There was no difference in leg flexion strength between the groups. Of the patients who reported hamstring strains, there was no significant difference in the mean Cincinnati SARS between the groups, nor any difference in overall knee function. The incidence of hamstring pain and muscle strains was significantly reduced in patients receiving the "cut" technique of harvesting hamstring tendons in ACL reconstruction

  4. The Correlation of Tunnel Position, Orientation and Tunnel Enlargement in Outside-in Single-Bundle Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Ko, Young Won; Rhee, Seung Jun; Kim, In Woo

    2015-01-01

    Purpose Tunnel widening after anterior cruciate ligament (ACL) reconstruction is a frequently described phenomenon. The possible etiology is multi-factorial with some mechanical and biological factors. Among those, we intended to determine the relation between the location and orientation of the femoral tunnel and the femoral tunnel enlargement after outside-in single-bundle ACL reconstruction. Materials and Methods A retrospective study including 42 patients who received single-bundle ACL reconstruction with the outside-in technique was conducted. Femoral and tibial tunnel locations were evaluated with the quadrant method and bird's-eye view using volume-rendering computed tomography. The angle and diameter of bone tunnel and the degree of tunnel enlargement were evaluated using standard radiographs. Results The degree of femoral tunnel enlargements were 42% and 36% on the anteroposterior (AP) and lateral radiographs, respectively, and the degree of tibial tunnel enlargements were 22% and 23%, respectively. Shallower location of the femoral tunnel was significantly correlated with greater femoral tunnel enlargement on the AP radiograph (r=0.998, p=0.004) and the lateral radiograph (r=0.72, p=0.005) as was the higher location of the femoral tunnel on the AP radiograph (r=-0.47, p=0.01) and the lateral radiograph (r=-0.36, p=0.009) at 12 months after surgery. Conclusions This study revealed that more anterior and higher location and more horizontal orientation of the femoral tunnel in coronal plane could result in widening of the femoral tunnel in outside-in single-bundle ACL reconstruction. PMID:26672479

  5. FUNCTIONAL PERFORMANCE AND KNEE LAXITY IN NORMAL INDIVIDUALS AND IN INDIVIDUALS SUBMITTED TO ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    PubMed Central

    de Vasconcelos, Rodrigo Antunes; Bevilaqua-Grossi, Débora; Shimano, Antonio Carlos; Jansen Paccola, Cleber Antonio; Salvini, Tânia Fátima; Prado, Christiane Lanatovits; Mello Junior, Wilson A.

    2015-01-01

    The aim of this study was to analyze the correlation between deficits in the isokinetic peak torque of the knee extensors and flexors with hop tests, postoperative knee laxity and functional scores in normal and ACL- reconstructed subjects with patellar tendon and hamstring tendon autografts. Methods: Sixty male subjects were enrolled and subdivided into three groups: Twenty subjects without knee injuries (GC group) and two groups of 20 subjects submitted to ACL reconstruction with patellar tendon (GTP group) and hamstrings autograft (GTF group). Results: The results showed significant correlation between knee extensors peak torque and performance in the hop tests for GTF and GC groups. There are no significantly correlations between post op knee laxity and Lysholm score compared with the hop tests and peak torque deficits. Concerning the differences between groups, the GTP group showed greater peak torque deficits in knee extensors, worst Lysholm scores and higher percentage of individuals with lower limb symmetry index (ISM) < 90% in both hop tests when compared to the other two groups. Conclusion: It is not recommendable to use only one measurement instrument for the functional evaluation of ACL-reconstructed patients, because significant correlation between peak torque, subject's functional score, knee laxity and hop tests were not observed in all groups. PMID:26998464

  6. Clinical Outcomes of Osseointegrated Prosthetic Auricular Reconstruction in Patients With a Compromised Ipsilateral Temporoparietal Fascial Flap.

    PubMed

    Zuo, Kevin J; Wilkes, Gordon H

    2016-01-01

    Patients with major ear deformities and associated compromise of the superficial temporal artery are poor candidates for autogenous ear reconstruction because of a tenuous ipsilateral temporoparietal fascial flap (TPFF). Osseointegrated prosthetic auricular reconstruction (OPAR) is an alternative to contralateral free TPFF microsurgical and autogenous reconstruction, but data on clinical outcomes are limited. The records of patients with ear loss or major deformity and a compromised ipsilateral TPFF who underwent OPAR from 1989 to 2013 were reviewed. Satisfaction was assessed using a questionnaire based on a 5 point Likert scale. Thirty-two patients (8 women, 24 men) with mean age 43.0 years (range, 10-70 years) underwent OPAR. The ipsilateral TPFF was compromised due to major trauma (13 patients), cancer extirpation (9), burn injury (4), previous harvest (4), arteriovenous malformation (1), or infection (1). All but 2 patients had an associated craniofacial defect, such as soft tissue deformity (87.5%), hearing loss (46.9%), or bony deformity (31.3%). The overall implant success rate was 88.6% at mean follow-up time of 7.6 years post-OPAR. Prosthesis wear averaged 12.2 hours/day and 6.6 days/week (80.5 hours/week). All 5 patients who experienced implant failures had received prior head and neck irradiation. With their prosthesis, 76.2% (16 patients) stated that their self-consciousness and self-esteem were "better" or "much better," whereas 85.7% (18 patients) stated that their self-image was "better" or "much better." All patients declared that they would undergo the treatment again. Osseointegrated prosthetic auricular reconstruction is a reliable option in this challenging population with high patient satisfaction. Patients with prior radiotherapy may have a higher chance of implant failure and would benefit from extended annual follow-up.

  7. Delayed cricoid reconstruction by use of a free graft of autogenous "patient banked" cartilage.

    PubMed

    Bumsted, R M

    1985-02-01

    Avulsed cartilage may be "banked" or preserved by subcutaneous implantation in the traumatized patient for delayed reconstruction of the defect when immediate reconstruction is contraindicated. The perichondrium of the avulsed cartilage should be preserved if possible. In the reconstructive procedure the cartilage graft must be surrounded by vascularized flaps developed from adjacent neck tissue. These vascularized flaps increase the local vascular supply for revascularization of the free graft. In addition, they allow complete separation of the free graft from the airway to minimize the possibility of secondary infection arising from the airway. Mucosal coverage of the defect does not appear to be necessary as long as well-vascularized soft tissue is available for complete coverage of the defect. The use of this technique may be considered for patients with avulsion of portions of the laryngeal cartilages when immediate reconstruction is contraindicated or when the viability of adjacent soft tissue necessary for reconstruction is uncertain. The success of this procedure may be related to the adequacy of the closure or separation of the airway from the free cartilage graft, and the ability to provide coverage of the graft with vascular tissue to allow graft revascularization. This new technique follows the traditional principles vital for successful management of laryngotracheal injuries. This procedure provides an additional method of therapy for those patients with an avulsion injury of the laryngeal cartilage. Additional surgical procedures must be performed utilizing the indications and principles presented here before this method is universally accepted for the management of severe laryngotracheal injury.

  8. Infrahyoid flap in oropharyngeal reconstruction following carcinoma resection: A study of 6 patients and literature review

    PubMed Central

    INFANTE-COSSIO, PEDRO; GONZALEZ-CARDERO, EDUARDO; LOPEZ-MARTOS, RICARDO; NUÑEZ-VERA, VICTORIA; OLMOS-JUAREZ, ERIKA; RUIZ-MOYA, ALEJANDRO; HARO-LUNA, JUAN-JOSE; TORRES-CARRRANZA, EUSEBIO

    2016-01-01

    The present study aimed to describe the techniques used and the results obtained with the infrahyoid flap for the reconstruction of medium-sized oropharyngeal defects following resection for advanced squamous cell cancer. During a period of 1 year, six patients with oropharyngeal defects were reconstructed using the infrahyoid flap. The tumor characteristics, location and size of the defect, resective and reconstructive techniques employed and the complications and outcomes of the speech and swallowing functions, as identified in the follow-up visits every 3 months, were evaluated. All flaps were performed simultaneously in association with tumoral excision and ipsilateral supraomohyoid neck dissection. The mean size of the skin paddle was 7.0×3.5 cm. The donor site was primarily sutured. The postoperative course was uneventful and all flaps were viable. One case of marginal skin paddle loss occurred without affecting the survival of the flap. Five patients received postoperative radiotherapy and one patient received concurrent postoperative chemotherapy. During the follow-up period (mean, 63 months), all patients showed excellent oral swallowing. Speech was excellent in five patients and in one patient speech was classified as good. The aesthetic results of the cervical donor site were good. Based on the present case report and the literature review, the infrahyoid flap is a simple and safe procedure for the reconstruction of the oropharynx, with a high success rate, minimal donor site morbidity and good aesthetic and functional results. The infrahyoid flap is a valid surgical option that may be considered in selected oncological patients undergoing reconstruction of medium-size oropharyngeal defects. PMID:27123141

  9. The Results of All-Inside Meniscus Repair Using the Viper Repair System Simultaneously with Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kang, Hong Je; Kim, Kwang Mee; Cho, Hang Hwan; Espinosa, Johnsel C.

    2015-01-01

    Background Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction. Methods Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning's classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing. Results The clinical success rate was 95.4% and the HSS scores were 93.9 ± 5.4 at the final follow-up. According to Henning's classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present. Conclusions The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair

  10. Donor site morbidity after reconstruction of alveolar bone defects with mandibular symphyseal bone grafts in cleft patients--111 consecutive patients.

    PubMed

    Andersen, K; Nørholt, S E; Knudsen, J; Küseler, A; Jensen, J

    2014-04-01

    The aim of this study was to assess the objective and subjective morbidity after reconstruction of alveolar bone defects with mandibular symphyseal bone grafts in patients with cleft lip and palate. One hundred and eleven patients born between 1995 and 1999, who had undergone chin bone harvesting for alveolar cleft reconstruction in the period from 2000 through 2011, were included. A survey of medical records was conducted. Subjective morbidity after reconstruction was assessed using a questionnaire. Medical records revealed few postoperative incidents; 5.6% reported persistent sensory disturbances in the donor area. Postoperative pain averaged 3.6 ± 2.1 (scale 0-10). The overall satisfaction with the surgical result was 8.7 ± 1.7 (scale 0-10). This study revealed that chin bone harvesting for reconstruction of alveolar defects in patients with cleft lip and palate is a safe and predictable procedure, highly appreciated by the patients, and characterized by only minor postoperative incidents. Patients must be informed of the risk of sensory disturbances in the donor area.

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

    PubMed Central

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

    2013-01-01

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

  12. Post-operative use of knee brace in bone-tendon-bone patellar tendon anterior cruciate ligament reconstruction: 5-year follow-up results of a randomized prospective study.

    PubMed

    Harilainen, A; Sandelin, J

    2006-02-01

    Sixty patients were prospectively randomized to brace and no-brace groups after bone-tendon-bone patellar tendon anterior cruciate ligament (ACL) reconstruction. The brace group wore a rehabilitation knee brace for 12 weeks post-operatively, while the no-brace group was mobilized immediately, and crutches were discarded 2 weeks post-operatively. The groups were comparable with respect to age, gender, time from injury to surgery and concomitant injuries. There were no differences either pre-operatively or 5 years post-operatively (80% of patients reviewed) between the groups in terms of the knee score (Lysholm), activity level (Tegner), degree of laxity or isokinetic peak muscle torque. Thus it appears that knee braces are not needed in the post-operative rehabilitation after ACL reconstruction with the patellar tendon graft.

  13. Patient Registration Using Photogrammetric Surface Reconstruction from Smartphone Imagery

    NASA Astrophysics Data System (ADS)

    Hellwich, O.; Rose, A.; Bien, T.; Malolepszy, C.; Mucha, D.; Krüger, T.

    2016-06-01

    In navigated surgery the patient's body has to be co-registered with presurgically acquired 3D data in order to enable navigation of the surgical instrument. For this purpose the body surface of the patient can be acquired by means of photogrammetry and co-registered to corresponding surfaces in the presurgical data. In this paper this task is exemplarily solved for 3D data of human heads using the face surface to establish correspondence. We focus on investigation of achieved geometric accuracies reporting positioning errors in the range of 1 mm.

  14. A prospective randomised study of anatomical single-bundle versus double-bundle anterior cruciate ligament reconstruction: quantitative evaluation using an electromagnetic measurement system.

    PubMed

    Araki, Daisuke; Kuroda, Ryosuke; Kubo, Seiji; Fujita, Norifumi; Tei, Katsumasa; Nishimoto, Koji; Hoshino, Yuichi; Matsushita, Takehiko; Matsumoto, Tomoyuki; Nagamune, Koki; Kurosaka, Masahiro

    2011-03-01

    We conducted a prospective randomised study of anatomical single-bundle (A-SB group) versus double-bundle (A-DB group) anterior cruciate ligament (ACL) reconstruction using the hamstrings tendons. Twenty patients with unilateral ACL deficiency were randomised into two groups. We created the bone tunnels at the position of the original insertion of the anteromedial bundle footprint and posterolateral bundle footprint in the A-DB group and at the central position between these two bundles in the A-SB group. All of the patients were tested before ACL reconstruction and one year after surgery. The KT-1000 measurements, isokinetic muscle peak torque and heel-height difference were evaluated and the general knee condition was assessed by Lysholm score. For pre- and postoperative stability assessment, we used the six-degrees-of-freedom of knee kinematic measurement system using an electromagnetic device (the EMS) for quantitative assessment during the Lachman test and the pivot shift test. There were no significant differences in the KT-1000 measurements, isokinetic muscle peak torque, heel-height difference, and Lysholm score at one-year follow-up between these two groups. The EMS data showed there were significant differences in the acceleration of the pivot shift test between the operated knee and the contralateral normal knees in the A-SB group. In conclusion, clinical outcomes were equally good in both groups. However, the EMS data showed the anatomical double-bundle ACL reconstruction tended to be biomechanically superior to the single-bundle reconstruction.

  15. Quality of Life in Patients with Breast Cancer-Related Lymphedema and Reconstructive Breast Surgery.

    PubMed

    Penha, Tiara R Lopez; Botter, Bente; Heuts, Esther M; Voogd, Adri C; von Meyenfeldt, Maarten F; van der Hulst, René R

    2016-07-01

    Background To evaluate the quality of life (QOL) of breast cancer survivors who have undergone breast reconstruction and have breast cancer-related lymphedema (BCRL). Methods Patients with a unilateral mastectomy with or without breast reconstruction were evaluated for BCRL and their QOL. Patients were divided into a non-BCRL and a BCRL group. Patients with subjective complaints of arm swelling and/or an interlimb volume difference of >200 mL, or undergoing treatment for arm lymphedema were defined as having BCRL. QOL was assessed using cancer-specific (EORTC QLQ-C30 and EORTC QLQ-B23) and disease specific (Lymph-ICF) questionnaires. Results In total, 253 patients with a mean follow-up time of 51.7 (standard deviation = 18.5) months since mastectomy completed the QOL questionnaires. Of these patients, 116 (46%) underwent mastectomy alone and 137 (54%) had additional breast reconstruction. A comparison of the QOL scores of 180 patients in the non-BCRL group showed a significantly better physical function (p = 0.004) for patients with reconstructive surgery compared with mastectomy patients. In the 73 patients with BCRL, a comparison of the QOL scores showed no significant differences between patients with mastectomy and reconstructive surgery. After adjusting for potential confounders, multivariate analysis showed a significant impact of BCRL on physical function (β =  - 7.46; p = 0.009), role function (β =  - 15.75; p = 0.003), cognitive function (β =  - 11.56; p = 0.005), body vision (β =  - 11.62; p = 0.007), arm symptoms (β = 20.78; p = 0.000), and all domains of the Lymph-ICF questionnaire. Conclusions This study implies that BCRL has a negative effect on the QOL of breast cancer survivors, potentially negating the positive effects on QOL reconstructive breast surgery has. PMID:26919383

  16. Voice estimation in patients after reconstructive subtotal laryngectomy

    PubMed Central

    2011-01-01

    Background Treatment of laryngeal cancers, may include surgery, radiotherapy, chemotherapy, or a combination. Total laryngectomy (TL) has been the standard surgical treatment. Partial laryngectomy procedures were performed, their advantage over TL is preservation of laryngeal functions. Methods The investigation was carried out on a group of 20 patients (3 female and 17 male), who underwent surgery according the techniques mentioned above. The methods of investigation were based on perceptual voice estimation (GRBAS), videolaryngostroboscopy, acoustic voice analysis, aerodynamic measure maximum phonation time, voice self-assessment (VHI). Results and Conclusions The perceptual voice estimation revealed a good phonation result in only 3 cases after using surgery with the Calearo method as well as the best results of MPT. The VHI reflected severe voice handicap in 2 patients (26 to 40 points). No statistically significant differences were observed between the values of the acoustic parameters in MDVP analysis after following operation -CHEP, Calearo, Sedlacek. PMID:22029703

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

    PubMed

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

    2013-08-01

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

  18. A modified arthroscopic anterior cruciate ligament double-bundle reconstruction technique with autogenous quadriceps tendon graft: remnant-preserving technique.

    PubMed

    Kim, Sung-Jae; Jo, Seung-Bae; Kim, Tai-Won; Chang, Ji-Hoon; Choi, Heon-Sik; Oh, Kyung-Soo

    2009-03-01

    Several techniques of anterior cruciate ligament (ACL) double-bundle reconstruction have been introduced to improve the functional outcome and restore normal kinematics of the knee. Meanwhile, a remnant-preserving technique was developed to preserve the proprioception and to enhance the revascularization of the reconstructed ACL. We developed double-bundle ACL reconstruction technique using autogenous quadriceps tendon graft while preserving the remnant. With this technique, two femoral sockets and one tibial tunnel are made. To preserve the remnant of the ACL, the rotational direction of the reamer was set to counterclockwise just before perforation of the tibial tunnel. To pass the graft more easily without disturbance of the remnant, the graft passage was achieved through the tibial tunnel. We suggest that the remnant-preserving technique could be an effective alternative considering its mechanical stability as well as the proprioception and vascularization recovery in arthroscopic double-bundle ACL reconstruction.

  19. Emergency Soft Tissue Reconstruction Algorithm in Patients With Open Tibia Fractures

    PubMed Central

    Ivanov, P.A.; Shibaev, E.U.; Nevedrov, A.V.; Vlasov, A.P.; Lasarev, M.P.

    2016-01-01

    Introduction: Tactic of emergency closing of soft tissue defect allows to significantly improve the treatment results concerning patients with severe open fractures. However, a number of certain factors make the implementation of this tactic rather difficult. Injured people’s unstable conditions are mong these crucial factors which include, polytrauma in lots of cases, absence of exact recommendations for recovery terms, choice of definite tissue flaps and a type of circulation. The Aim of Study: is to develop exact, usable and in practice algorithm of emergency reconstruction of leg soft tissues in patients with severe open tibia fractures, based on the usage of the most foolproof and simple methods. Data (Patients) and Methods: 85 patients with open tibia fractures complicated by soft tissue defects were included in our study. Patients were divided into two groups. The control group consisted of 56 patients. Soft tissue reconstruction in this group was provided without an exact algorithm, after continuous attempts on local healing. After analyzing the treatment process and the treatment results we have developed the algorithm of emergency soft tissue reconstruction. It was used in 29 patients (the study group). This algorithm allows choosing optimal timing for tissue reconstruction and appropriate method to be applied, depending on the patient’s condition, the mechanism of soft tissue defect formation, and its square and localization. Results: We observed a statistical decrease in deep wound infection frequency, partial tibia necrosis frequency, chronic osteomyelitis frequency, duration of hospitalization in patients with severe open tibia fractures because of using our algorithm. PMID:27583057

  20. 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…

  1. An inversion identified in acl1-1 mutant functions as an enhancer of the acl1-1 phenotype.

    PubMed

    Kamata, Naoko; Komeda, Yoshibumi

    2008-08-01

    The Arabidopsis acaulis1-1 (acl1-1) mutant exhibits severe growth defects when grown at 22 degrees C. The leaves are tiny and curled and the inflorescence stems are short. We identified an inversion mutation in the original acl1-1 plants. The acl1-1 plants were crossed with Columbia wild-type, and the acl1-1 phenotype and the inversion were segregated in the F2 generation. Compared to the original acl1-1 plants with the inversion, the genuine acl1-1 plants without the inversion grew larger and their inflorescence stems grew longer at 22 degrees C. When the plants were grown at 24 degrees C, the differences in growth became more apparent. We investigated the expression of genes located in the inversion. Two genes that were located at each end of the inversion were disrupted, and full-length transcripts were not expressed. Expressions of some genes within and adjacent to the inversion were also altered. Our results indicate that the expression of multiple genes may be involved in the enhancement of the acl1-1 phenotype.

  2. 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 reoperati