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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. ACL reconstruction

    MedlinePlus

    ... This increases the chance you may have a meniscus tear. ACL reconstruction may be used for these ... When other ligaments are also injured When your meniscus is torn Before surgery, talk to your health ...

  3. ACL reconstruction - discharge

    MedlinePlus

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

  4. ACL Reconstruction

    MedlinePlus

    ... of the major ligaments in your knee. ACL injuries most commonly occur during sports that involve sudden stops and changes in direction — such as basketball, soccer, football, tennis, downhill skiing, volleyball and gymnastics. In ...

  5. 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

  6. Mycotic Infection post ACL Reconstruction

    PubMed Central

    Costa-Paz, Matias; Ayerza, Miguel; Carbo, Lisandro; Sanchez, Marisa; Yacuzzi, Carlos; Muscolo, Luis

    2017-01-01

    Objectives: There are several studies in literature of septic arthritis after the ACL arthroscopic reconstruction related to bacterial germs. However, fungi infection is likely infrequent generating a massive bone loss with a catastrophic result. The purpose of this study was to describe preventive measures to decrease the mycotic infection after ACL reconstruction. Methods: Since 2005, we have diagnosed and treated 22 immunocompetent patients who underwent a surgery of an ACL lesion in other institutions in the country. Form these cases, we analyzed 19 which developed mycotic infection and an oncologic debridement was performed to control the pathology. In this series, we considered the initial surgery, the number of toilettes performed until their referral, magnitude of bone loss and final outcome. There were 5 other patients who consulted for mucormycosis, who finally were treated in other hospitals. Results: Epidemiology of mucormycosis is not clear. The exact cause is unknown due to heterogeneous data, different places and surgeons, facilities and type of surgical instruments in this series. In spite of not knowing the cause of the infection, several alternatives were evaluated in a non systematic way. Most of them related to the surgery room, sterilization place of the surgical tools, use of sterilizing liquids, cleanliness of lumen and cannulated bits. Instruments used during surgery were also evaluated: fields, shaver blades, drill types, ACL reconstruction fixation method. It is doubtful if the type of graft to reconstruct the ACL had any relation with infections. Among ideal preventive measures, the following are described: Surgery room with temperature and humidity control. Not using sterilizing liquids. Optimal preparation of surgical tools with adequate cleanliness of lumen and cannulated bits performed by adequate personnel. Sterilize in the same place where the surgery will be performed. Use of adequate instruments. The use of the central third of

  7. 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

  8. Deficits in Quadriceps Strength and Patient-Oriented Outcomes at Return to Activity After ACL Reconstruction

    PubMed Central

    Lepley, Lindsey K.

    2015-01-01

    Context: Side-to-side quadriceps strength deficits are linked to hazardous lower extremity mechanics and reduced function at a time when individuals are returned to activity after anterior cruciate ligament (ACL) reconstruction. As a result, generalized criteria have emerged in the literature, wherein researchers are recommending that patients be cleared for participation once side-to-side differences in strength are ≤10% of the noninjured limb. Similar recommendations exist for patient-oriented outcomes (ie, self-reported function and hop tests), where deficits of ≤10% are considered ideal at return to activity. It is unclear how many studies actually achieve these clinically recommended results. Evidence Acquisition: Articles that reported quadriceps strength deficits as compared to the contralateral limb were collected from peer-reviewed sources available on Medline and Web of Science databases (1990 through August 2014). Search terms included the following: anterior cruciate ligament OR ACL AND muscle weakness, anterior cruciate ligament OR ACL AND strength; return-to-activity AND strength; anterior cruciate ligament OR ACL AND quadriceps. Study Design: Clinical review. Level of Evidence: Level 4. Results: Average side-to-side strength deficits at 6 months postreconstruction were 23% ± 8% (range, 3%-40%), while the average at 12 months postsurgery was found to be 14% ± 6% (range, 3%-28%). The average deficits in self-reported function at 6 months (mean, 14% ± 5%) and 12 months postsurgery (mean, 13% ± 6%) were also found to be >10%. Performance on hop tests was found to be less than optimal at 6 months postsurgery (mean, 11% ± 7%), but improved at 12 months postsurgery (mean, 1.3% ± 2%). Conclusion: This review provides an up-to-date account of the typical deficits in strength and patient-oriented outcomes that exist when formalized physical therapy concludes after ACL reconstruction. Based on the studies included, it seems pertinent that researchers

  9. Rehabilitation of Patients Following Autogenic Bone-Patellar Tendon-Bone ACL Reconstruction: A 20-Year Perspective

    PubMed Central

    De Carlo, Mark S.; McDivitt, Ryan

    2006-01-01

    Rehabilitation of patients following anterior cruciate ligament (ACL) reconstruction has undergone remarkable improvements over the past two decades. During this time, ACL research has been at the forefront of many orthopaedic and sports physical therapy clinics. With over 20 years of ACL rehabilitation experience (senior author) and prior collaboration with accelerated ACL rehabilitation pioneer K. Donald Shelbourne, the authors wish to present a unique perspective on the evolution of ACL rehabilitation. Prior to the classic article by Paulos et al in 1981,1 literature on ACL rehabilitation was quite sparse. The basis for ACL rehabilitation at this time was founded in basic science studies conducted with animal models. In an effort to protect the graft, emphasis was placed on immobilization, extension limitation, restricted weight bearing, and delayed return to activity. Despite achieving good ligamentous stability, patients often experienced a spectrum of complications. In 1990, Shelbourne and Nitz2 proposed an accelerated rehabilitation protocol following ACL reconstruction based on clinical experience. Their program emphasized delayed surgery, earlier range of motion and weight bearing, and full extension. As a result, patients experienced better clinical outcomes while maintaining knee stability. The rehabilitation program presented in this paper is still largely based on the principles of the accelerated protocol. As evidence-based practice and the call for prospective, randomized clinical research continues, the continued progress in treating patients with this injury will be enhanced. Furthermore, clinicians are urged not to lose sight of the clinical reasoning that helped evolve the ACL rehabilitation process where it is today. PMID:21522223

  10. The anatomy of the proximal tibia in pediatric and adolescent patients: implications for ACL reconstruction and prevention of physeal arrest.

    PubMed

    Shea, Kevin G; Apel, Peter J; Pfeiffer, Ronald P; Traughber, Paul D

    2007-04-01

    Although the treatment of anterior cruciate ligament (ACL) tears in skeletally immature patients is still controversial, several studies have advocated ACL reconstruction in selected patients to prevent secondary injury. The proximal tibial physis is a structure at risk during ACL reconstruction in young patients, and physeal growth complications have been reported after surgery in this area. The relationship between the ACL and the proximal tibial physeal/apophyseal regions is poorly understood. This study examined the MRI anatomy of the ACL and the proximal tibia apophysis and epiphysis. MRIs of 59 skeletally immature knees were reviewed (Average age = 12.75 years, range 6-15) to define the anatomy of the epiphyseal and apophyseal regions. Measurements were recorded in three parasagittal planes: (1) at the lateral border of the patellar tendon, (2) the lateral edge of the ACL insertion, and (3) the medial edge of the ACL insertion. A single three-dimensional (3D) computed tomography (CT) scan was used to evaluate the position of standard drill holes used in ACL reconstruction to assess for potential degree of injury to the epiphyseal and apophyseal growth plates. In the parasagittal planes, the average height of the epiphysis was 19.6, 20.7, and 21.5 mm at the lateral border of the patellar tendon, the lateral border of the ACL, and the medial border of the ACL, respectively. At the level of the same landmarks, the apophysis extended below the physis at an average of 20.2, 16.8, and 7.0 mm, respectively. Expressed as a percentage of epiphysis height this was an average of 104, 82, and 33%, respectively. Examination of 3D CT images revealed that variations in drill hole placement had effects on the volume of injury to the proximal tibial physis and apophysis. Drill holes that started more medial, distal, and with a steeper angle of inclination reduced the amount of physis and apophysis violated when compared with holes placed more lateral, proximal, and with a

  11. 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.

  12. ACL reconstruction in a teenage athlete with fibular hemimelia.

    PubMed

    Mascarenhas, Randy; Simon, David; Forsythe, Brian; Harner, Christopher D

    2014-03-01

    Fibular hemimelia exists as a rare cause of ACL insufficiency. This case report concerns the diagnosis and treatment of anterior cruciate ligament insufficiency in a teenage football player with fibular hemimelia. While ACL reconstruction has been described to allow activities of daily living in this patient population, this is the first report in the literature of anterior cruciate ligament reconstruction in an athlete with fibular hemimelia. We believe that ACL reconstruction is a viable and beneficial treatment option in the care of a symptomatic patient with congenital absence of the ACL and can allow athletes with this condition to return not only to their previous functional level, but also to their previous level of play.

  13. 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.

  14. Partial ACL tears: anatomic reconstruction versus nonanatomic augmentation surgery.

    PubMed

    Buda, Roberto; Ruffilli, Alberto; Parma, Alessandro; Pagliazzi, Gherardo; Luciani, Deianira; Ramponi, Laura; Castagnini, Francesco; Giannini, Sandro

    2013-09-01

    Treatment of partial anterior cruciate ligament (ACL) tears requires ACL remnant preservation. The goal of this study was to compare the outcome of anatomic reconstruction of the torn bundle with nonanatomic augmentation using the over-the-top femoral route. Fifty-two athletes (mean age, 23.3 years) with partial ACL lesions underwent anatomic reconstruction (n=26) or nonanatomic augmentation (n=26). Intraoperative damage of the healthy bundle that required a standard ACL reconstruction occurred in 2 patients in the anatomic reconstruction group. International Knee Documentation Committee (IKDC) score, Tegner score, and arthrometer evaluation were used pre-operatively and at follow-up for up to 5 years postoperatively. One failure occurred in the anatomic reconstruction group. Mean IKDC subjective score at follow-up was 88.2 ± 5.7 in the anatomic reconstruction group and 90.2 ± 4.7 in the nonanatomic augmentation group. According to the IKDC objective score at final follow-up, 96% of knees in the nonanatomic augmentation group were normal vs 87.5% in the anatomic reconstruction group. No significative differences were observed between the 2 groups at final follow-up. Anteromedial bundle reconstruction showed significantly lower IKDC subjective and objective scores and higher residual instability values as evaluated with the arthrometer compared with posterolateral bundle reconstruction (P=.017). The surgical treatment of ACL partial tears is demanding. Adapted portals, perfect control of the tunnel drilling process, and intercondylar space management are required in anatomic reconstruction. The nonanatomic augmentation technique is simpler, providing excellent durable results over time with a lower complication rate. Anteromedial bundle reconstruction is associated with a poorer outcome, especially when performed with anatomic reconstruction.

  15. Isokinetic Testing in Evaluation Rehabilitation Outcome After ACL Reconstruction

    PubMed Central

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

    2015-01-01

    Introduction: Numerous rehab protocols have been used in rehabilitation after ACL reconstruction. Isokinetic testing is an objective way to evaluate dynamic stability of the knee joint that estimates the quality of rehabilitation outcome after ACL reconstruction. Our investigation goal was to show importance of isokinetic testing in evaluation thigh muscle strength in patients which underwent ACL reconstruction and rehabilitation protocol. Subjects and methods: In prospective study, we evaluated 40 subjects which were divided into two groups. Experimental group consisted of 20 recreational males which underwent ACL reconstruction with hamstring tendon and rehabilitation protocol 6 months before isokinetic testing. Control group (20 subjects) consisted of healthy recreational males. In all subjects knee muscle testing was performed on a Biodex System 4 Pro isokinetic dynamo-meter et velocities of 60°/s and 180°/s. We followed average peak torque to body weight (PT/BW) and classic H/Q ratio. In statistical analysis Student’s T test was used. Results: There were statistically significant differences between groups in all evaluated parameters except of the mean value of PT/BW of the quadriceps et velocity of 60°/s (p>0.05). Conclusion: Isokinetic testing of dynamic stabilizers of the knee is need in diagnostic and treatment thigh muscle imbalance. We believe that isokinetic testing is an objective parameter for return to sport activities after ACL reconstruction. PMID:25870471

  16. The effect of platelet concentrates on graft maturation and graft-bone interface healing in ACL reconstruction in human patients

    PubMed Central

    Vavken, Patrick; Sadoghi, Patrick; Murray, Martha M

    2011-01-01

    Purpose To systematically review the current evidence for effects of platelet concentrates on (1) graft maturation and (2) graft-bone interface healing in ACL reconstruction in human, controlled trials, and for ensuing differences in clinical outcomes. Methods A systematic search of PubMed, CINAHL, EMBASE, CCTR and CDSR was performed for controlled trials of human ACL reconstruction with and without platelet concentrates. Data validity was assessed and data were collected on graft maturation, graft-bone interface healing and clinical outcome. Results Eight studies met the inclusion criteria. Seven studies reported on graft maturation with significantly better outcomes in the platelet groups in four, and large differences in means in two (underpowered) studies. Five studies report on tunnel healing, but four found no difference between groups. Three studies assessed clinical outcome but found no differences, regardless whether they had shown a benefical (1/3) or no effect (2/3) of platelets on graft and tunnel healing. Conclusion The current best evidence suggests that the addition of platelet concentrates to ACL reconstruction may have a beneficial effect on graft maturation and could improve it by 20–30% on average, but with substantial variability. The most likely mode of action is that treatment with platelets accelerates graft repopulation and remodeling, and this interpretation is supported by the existing data and biologically plausible. However, the current evidence also shows only a very limited influence of platelet concentrates on graft-bone interface healing and no significant difference in clinical outcomes. Clinical Relevance This systematic review collected evidence that the use of platelet concentrates may be a safe and inexpensive way to optimize graft maturation after ACL reconstruction, but there is no evidence for improved graft-bone interface healing or a significant difference in clinical outcomes. Level of Evidence Level IV, systematic

  17. 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.

  18. 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

  19. Growth disturbances without growth arrest after ACL reconstruction in children.

    PubMed

    Chotel, Franck; Henry, Julien; Seil, Romain; Chouteau, Julien; Moyen, Bernard; Bérard, Jérôme

    2010-11-01

    Growth arrest is a major concern after ACL reconstruction in children. It usually occurs in patients near to closure of the growth plates. Growth disturbances without growth arrest are also possible and more vicious; the authors analyse the mechanism of two patients with growth disturbance due to overgrowth following ACL reconstruction. One was a symmetrical overgrowth process with 15 mm limb length discrepancy treated with percutaneous epiphysiodesis. Full correction at the time of skeletal maturity was achieved. The second patient developed an asymmetrical overgrowth with progressive tibial valgus deformity. This mechanism was similar to a posttraumatic tibial valgus deformity. After nonoperative treatment, a spontaneous correction of the deformity was noticed. Both children were young (7 and 10 years old) at the time of ACL reconstruction with an autologous iliotibial band graft. The clinical relevance of overgrowth disturbance is usually limited when compared to growth arrest but could require a second surgical procedure as reported in this study. Parents must be informed that even in experienced hands, and despite the use of a physeal sparing technique, this specific risk of growth disturbance is still present.

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

    PubMed

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

    2010-09-01

    The aim of this study was to determine whether there is a difference in the presence of the lateral intercondylar ridge and the lateral bifurcate ridge between patients with sub-acute and chronic ACL injuries. We hypothesized that the ridges would be present less often with chronic ACL deficiency. Twenty-five patients with a chronic ACL injury were matched for age and gender to 25 patients with a sub-acute ACL injury. The lateral intercondylar ridge and lateral bifurcate ridge were scored as either present, absent, or indeterminate due to insufficient visualization by three blinded observers. The kappa for the three observers was .61 for the lateral intercondylar ridge and .58 for the lateral bifurcate ridge. The lateral intercondylar ridge was present in 88% of the sub-acute patients and 88% of the chronic patients. The lateral bifurcate ridge was present in 48% of the sub-acute and 48% of the chronic patients. This matched-pairs case-control study was unable to show a difference in the presence of the femoral bony ridges between patients with acute and chronic ACL injuries. The authors would suggest looking for the ridges as a landmark of the native ACL insertion site during ACL reconstruction in both acute and chronic ACL injuries.

  1. ACL reconstruction with BPTB autograft and irradiated fresh frozen allograft*

    PubMed Central

    Sun, Kang; Tian, Shao-qi; Zhang, Ji-hua; Xia, Chang-suo; Zhang, Cai-long; Yu, Teng-bo

    2009-01-01

    Objective: To analyze the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction with irradiated bone-patellar tendon-bone (BPTB) allograft compared with non-irradiated allograft and autograft. Methods: 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 68 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into one of the two groups (autograft and irradiated allograft 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 of follow-up (ranging from 24 to 47 months), patients were evaluated by the same observer according to objective and subjective clinical evaluations. Results: Of these patients, 65 (autograft 33, irradiated allograft 32) were available for full evaluation. When the irradiated allograft group was compared to the autograft group at the 31-month follow-up by the Lachman test, the anterior drawer test (ADT), the pivot shift test, and KT-2000 arthrometer test, statistically significant differences were found. Most importantly, 87.8% of patients in the autograft group and just only 31.3% in the irradiated allograft 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%). The anterior and rotational stabilities decreased significantly in the irradiated allograft group. According to the overall International Knee Documentation Committee (IKDC), functional and subjective evaluations, and activity level testing, no statistically significant differences were found between the two groups. Besides, patients in the irradiated allograft group had a shorter operation time and a longer duration of postoperative fever. When the patients had a fever, the

  2. Outcome of ACL Reconstruction for Chronic ACL Injury in Knees without the Posterior Horn of the Medial Meniscus: Comparison with ACL Reconstructed Knees with An Intact Medial Meniscus

    PubMed Central

    Syam, Kevin; Chouhan, Devendra K.; Dhillon, Mandeep Singh

    2017-01-01

    Purpose Cadaveric studies have shown that deficiency of the posterior horn of the medial meniscus (PHMM) increases strain on the anterior cruciate ligament (ACL) graft. However, its influence on the clinical and radiological outcome after ACL reconstruction is less discussed and hence evaluated in this study. Materials and Methods This study included 77 cases of ACL reconstruction with a minimum 18-month follow-up. Of the 77 cases, 41 patients with intact menisci were compared clinically and radiologically with 36 patients with an injury to the PHMM that required various grades of meniscectomy. The knees were evaluated using subjective International Knee Documentation Committee (IKDC) score and Orthopadische Arbeitsgruppe Knie (OAK) score. Results Cases with intact menisci showed better stability (p=0.004) at an average of 44.51 months after surgery. No significant differences were noted in the overall OAK score, subjective IKDC score, and functional OAK score (p=0.082, p=0.526, and p=0.363, respectively). The incidence of radiological osteoarthrosis was significantly higher in the posterior horn deficient knees (p=0.022). Conclusions The tendency toward relatively higher objective instability and increased incidence of osteoarthrosis in the group with absent posterior horn reinforces its importance as a secondary stabiliser of the knee. PMID:28231647

  3. Patients With Ligament Hiperlaxity With Rupture Of Previous Plastic For ACL. Reconstruction With Intra-articular And Extra-articular Combined Technics

    PubMed Central

    Astore, Ignacio; Agotegaray, Juan Ignacio; Comba, Ignacio; Bisiach, Luciana

    2017-01-01

    Introduction: In cases of patients with ligament hiperlaxity with rupture of ACL, the use of a BTB graft is recommended for its reconstruction. Our job consists of the clinical and functional assessment of a group of 10 patients with ligament laxaty according to Beighton scale, who, after surgery for ACL rupture with BTB technique, suffered a rupture of the plastic. For its reconstruction a combination of intra-articular and extra-articular techniques was used with a BTB graft in the contralateral knee, associated with a modified Lemaire technique. Methods: The series consists of 10 patients, male, average age of 24.2 years, amateur athletes, operated for a second time in March, 2011 and November, 2013, with a minimum follow-up of 24 months. They were evaluated before surgery and 24 months after surgery based on Lysholm scale, IKDC evaluation form and a physical exam (Lachman - Pivot Shift). Results: After surgery, the average in Lysholm scale was of 87.6 and 86.3 for the IKDC subjetive form. In the physical exam, 8 patients showed Lachman 1+, while none of the patients showed Pivot Shift positive. 7 patients were able to return to their usual sport activities. As a postoperative disadvantage, 6 patients reported pain in the external face of the knee in the first 6 months. And 4 patients reported a subjetive loss of full extension that did not interfere with their sport activities. Conclusion: Based on our experience and literature, we believe that the combination of both techniques, intra-articular (BTB) and extra-articular (Lemaire), is a good alternative for patients with ligament laxaty, providing positive clinical and functional results.

  4. 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

  5. Asymmetrical lower extremity loading after ACL reconstruction: more than meets the eye.

    PubMed

    Chmielewski, Terese L

    2011-06-01

    Sports fans know that movement patterns are important for athletic performance. Similarly, clinicians know that addressing abnormal movement patterns after an anterior cruciate ligament (ACL) reconstruction is important for a successful return to sport. The kinematic (motion) component of movement patterns is more easily observed than the kinetic (forces) component, thus more commonly addressed in ACL reconstruction rehabilitation. Ignoring the kinetic component, though, could impede a successful return to sport. Asymmetrical lower extremity loading has been reported in a variety of activities following ACL reconstruction, and may contribute to both short- and long-term consequences. It is important that clinicians become aware of the potential for asymmetrical lower extremity loading to affect patient outcomes and for researchers to enlarge the body of knowledge.

  6. 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

  7. 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

  8. 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

  9. From open to arthroscopic anatomical ACL-reconstructions: the long way round. A statement paper.

    PubMed

    Arnold, Markus P; Friederich, Niklaus F; Müller, Werner; Hirschmann, Michael T

    2013-07-01

    The single-incision anterior cruciate ligament (ACL) reconstruction evidently has its shortcomings. In an attempt to improve the biomechanical but also the biological state of the knees after an ACL-reconstruction, double, even triple-bundle reconstructions have been popularised recently. As a positive side effect, details concerning ACL-insertion anatomy were brought back into the focus. In our opinion it would be more straight forward and logical to replace the non-anatomical single-incision technique with a more anatomic single-bundle ACL-reconstruction technique.

  10. Anterior cruciate ligament- and hamstring tendon-derived cells: in vitro differential properties of cells involved in ACL reconstruction.

    PubMed

    Ghebes, Corina Adriana; Kelder, Cindy; Schot, Thomas; Renard, Auke J; Pakvis, Dean F M; Fernandes, Hugo; Saris, Daniel B

    2015-03-11

    Anterior cruciate ligament (ACL) reconstruction involves the replacement of the torn ligament with a new graft, often a hamstring tendon (HT). Described as similar, the ACL and HT have intrinsic differences related to their distinct anatomical locations. From a cellular perspective, identifying these differences represents a step forward in the search for new cues that enhance recovery after the reconstruction. The purpose of this study was to characterize the phenotype and multilineage potential of ACL- and HT-derived cells. ACL- and HT-derived cells were isolated from tissue harvest from patients undergoing total knee arthroplasty (TKA) or ACL reconstruction. In total, three ACL and three HT donors were investigated. Cell morphology, self-renewal potential (CFU-F), surface marker profiling, expression of tendon/ligament-related markers (PCR) and multilineage potential were analysed for both cell types; both had fibroblast-like morphology and low self-renewal potential. No differences in the expression of tendon/ligament-related genes or a selected set of surface markers were observed between the two cell types. However, differences in their multilineage potential were observed: while ACL-derived cells showed a high potential to differentiate into chondrocytes and adipocytes, but not osteoblasts, HT-derived cells showed poor potential to form adipocytes, chondrocytes and osteoblasts. Our results demonstrated that HT-derived cells have low multilineage potential compared to ACL-derived cells, further highlighting the need for extrinsic signals to fully restore the function of the ACL upon reconstruction. Copyright © 2015 John Wiley & Sons, Ltd.

  11. Correlation between fixation systems elasticity and bone tunnel widening after ACL reconstruction

    PubMed Central

    Giorgio, Nicola; Moretti, Lorenzo; Pignataro, Paolo; Carrozzo, Massimiliano; Vicenti, Giovanni; Moretti, Biagio

    2016-01-01

    Summary Background Femoral and tibial tunnel widening (TW) after ACL reconstruction is a phenomenon increasing talk in the literature. It is underlying biological and mechanical causes. Objective The aim of this study was to evaluate the relationship between bone tunnel enlargement and two different ACL fixation systems. Patients and Methods 40 patient underwent ACL reconstruction with hamstring; randomly divided into group A with 20 patients treated with stiff systems (femoral Rigidfix and tibial interference screw), and into group B, with 20 patients treated with morel elastic system (femoral and tibial Tight-rope). Evaluated postoperatively with knee MRI at 40 days, 3 months, 6 months to measure bone tunnel diameters widening. Results At 40 days tunnel widening between two groups shows no statistically difference. At 3 months postoperatively, femoral bone tunnel widening amounted on average to 1.84 mm in middle of tunnel and 1 mm at the mouth in joint in group A, and respectively 3.2 mm and 2.5 mm in group B (p<0.05). Tibial tunnel widening was 1.24 mm at the mouth in joint and 1.3 mm in middle in group A and respectively 2.26 mm and 2.43 mm in group B (p<0.05). At 6 months femoral tunnel widening amounted on average to 2.45 mm in middle and 1.35 mm at the mouth in joint in group A and respectively 3.5 mm and 2.7 mm in group B (p<0.01). Tibial tunnel widening amounted on average to 1.27 at mouth in joint and 1 mm in middle of tunnel in group A and respectively 2.6 mm and 2.3 mm in group B (p<0.01). Conclusions This study results suggest elastic fixation system increases bone tunnel enlargement after ACL reconstruction with hamstring without correlation with worse clinical performance. Level of evidence IV. PMID:28217568

  12. 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

  13. 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

  14. Pretibial Cyst Formation after ACL Reconstruction. A series of 14 cases with different etiologies

    PubMed Central

    Zicaro, Juan Pablo; Ranalletta, Maximiliano; Avila, Christian Garcia; Yacuzzi, Carlos; Costa-Paz, Matias

    2017-01-01

    Objectives: Among complications following an ACL reconstruction, the formation of a pre-tibial cyst in the site of the tibial tunnel is rare and might happen even years after surgery. The purpose of this study was to analyze 14 patients with pretibial cyst after ACL reconstruction. Methods: We retrospectively evaluated patients between 2008 and 2016. The inclusion criteria were patients who underwent an ACL reconstruction, and developed an extra-articular cyst at the tibial tunnel level. For recurrence evaluation, patients with less than one-year follow-up were excluded. A pre and postoperative clinical and radiological evaluation was performed. We analyzed the graft selection and surgical technique for ACL reconstruction, the time between primary surgery and onset of symptoms, and the clinical presentation. A pre and postoperative radiological evaluation was performed for every patient. Surgical technique for cyst excision, histological analysis and culture results were also analyzed. The recurrence rate was evaluated at final follow-up. Results: Nine patients were male, with an average age of 38 years. The average follow-up was of 35 months. All ACL reconstructions were performed using hamstrings graft and a trans-tibial technique. Tibial fixation was performed with a biodegradable screw in 9 patients, three of them associated with the use of a staple. In four patients hamstrings tibial insertion was left in situ with an open stripper and fixed in the tibia using non-absorbable Ethibond 2 sutures. The average time between primary ACL surgery and onset of the cyst was 29 months. All patients presented a palpable tumor at proximal tibia and a stable knee. The cyst size varied between 1 and 3 cm. In all cases, Rx and MRI showed a widening of the tibial tunnel, though no articular communication could be confirmed. The arthroscopic evaluation revealed no graft loosening. All cysts were approached through the previous tibial incision and staples or screws where removed

  15. Correlation between body mass index and quadrupled hamstring tendon autograft size in ACL reconstruction

    PubMed Central

    ATBAŞI, ZAFER; ERÇIN, ERSIN; ERDEM, YUSUF; EMRE, TULUHAN YUNUS; ATILLA, HALIS ATIL; PARLAK, ADEM

    2016-01-01

    Purpose the aim of this study was to assess the relationship of patient weight, height and body mass index (BMI) with the size of the quadrupled hamstring tendon used in anterior cruciate ligament (ACL) reconstruction. Methods from patient records, we retrospectively assessed the weight, height, BMI and graft sizes of 126 patients who underwent ACL reconstruction using a quadrupled hamstring tendon autograft between January 2010 and January 2013 at our institution. The data obtained from perioperative measurements were studied using correlation analysis. Results statistically significant relationships were found between patient height and graft diameter (p = 0.033, r = 0.19) and between patient weight and graft diameter (p < 0.0001, r = 0.33). No statistically significant relationships were found between graft diameter and BMI or between graft length and patient height, weight and BMI (p > 0.05). Conclusions patient height and weight were found to be related to quadrupled hamstring graft diameter in our patient population. BMI was not related to the quadrupled hamstring graft size. The exact size of the graft cannot be predicted preoperatively on the basis of these variables. Level of evidence Level IV, retrospective case series. PMID:28217655

  16. ACL reconstruction: in vivo measurement of patellar tendon graft elongation.

    PubMed

    Berruto, M; Howe, J G; Beynnon, B D; Johnson, R J; Nichols, C E; Pope, M H

    1991-06-01

    The implantation of a free autogenous patellar tendon graft is the surgical technique that currently offers the best results in anterior cruciate ligament reconstruction. However, numerous aspects regarding both technique and postoperative rehabilitation can still be improved. The aim of this study was to measure the elongation of the patellar tendon in vivo in the operating room after reconstructive surgery, subjecting the knee to normal strain such as passive mobilization or anterior displacement of the tibia. Three volunteers were studied. Our results were different from those reported in a previous study conducted in vivo on a normal anterior cruciate ligament (ACL). In spite of the isometric position of the tendon, passive mobilization provoked a progressive increase in the elongation of the graft within each cycle of flexion-extension and between one cycle and the next. This also occurred during the Lachman test. These findings suggest that the graft undergoes a process of tensile adjustment when it is first put under strain. Continued elongation once this process appears stabilized raises doubts as to the reliability of isometric measuring devices.

  17. Hop tests correlate with IKDC and KOOS at minimum of 2 years after primary ACL reconstruction

    PubMed Central

    Reinke, Emily K.; Lorring, Dawn; Jones, Morgan H.; Schmitz, Leah; Flanigan, David C.; An, Angel Qi; Quiram, Amanda R.; Preston, Emily; Martin, Michael; Schroeder, Bettina; Parker, Richard D.; Kaeding, Christopher C.; Borzi, Lynn; Pedroza, Angela; Huston, Laura J.; Harrell, Frank E.; Dunn, Warren R.

    2012-01-01

    Purpose The hypothesis of this study was that single-legged horizontal hop test ratios would correlate with IKDC, KOOS, and Marx activity level scores in patients 2 years after primary ACL reconstruction. Methods Individual patient-reported outcome tools and hop test ratios on 69 ACL reconstructed patients were compared using correlations and multivariable modeling. Correlations between specific questions on the IKDC and KOOS concerning the ability to jump and hop ratios were also performed. Results The triple-hop ratio was moderately but significantly correlated with the IKDC, KOOS Sports and Recreation subscale, and the KOOS Knee Related Quality of Life subscale, as well as with the specific questions related to jumping. Similar but weaker relationship patterns were found for the single-hop ratio and timed hop. No significant correlations were found for the Marx activity level or crossover-hop ratio. Multivariable modeling showed almost no significant additional contribution to predictability of the IKDC or KOOS subscores by gender, BMI, or the number of faults on either leg. Conclusions The triple-hop test is most significantly correlated with patient-reported outcome scores. Multivariable modeling indicates that less than a quarter of the variability in outcome scores can be explained by hop test results. This indicates that neither test can serve as a direct proxy for the other; however, assessment of patient physical function by either direct report using validated outcome tools or by the hop test will provide relatively comparable data. Level of evidence II. PMID:21445595

  18. Comparison of grafts for anatomical reconstruction of the ACL: patellar versus semitendinosus/gracilis☆

    PubMed Central

    Bitun, Patrícia Barros; Miranda, Carlos Roberto; Escudero, Ricardo Boso; Araf, Marcelo; de Souza, Daphnis Gonçalves

    2015-01-01

    Objective To compare the functional results from surgical treatment for anatomical reconstruction of the anterior cruciate ligament (ACL) with a single band, using two types of autologous grafts. Methods Twenty-seven patients who underwent anatomical reconstruction of the ACL by means of the Chambat technique were evaluated prospectively. They were divided into two groups: A, with 14 patients, using grafts from flexor tendons; and B, with 13 patients, using grafts from the patellar tendon. In both groups, fixation was performed using an absorbable interference screw. Results Based on the Lysholm score, group A presented a mean score of 71.6 in the first month, while B presented 75. At the end of the sixth month, both groups presented 96.6. Evaluation of the total IKDC showed that in the first month, the majority of the patients, both in group A (85.7%) and in group B (76.9%), presented a knee assessment that was close to normal. In the sixth month, 92.9% of group A had normal presentations, and 100% of group B. Conclusion According to the Lysholm functional evaluation and the IKDC subjective assessment, there was no statistically significant difference in the results between the groups, and the results were better in the sixth month. PMID:26229896

  19. 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.

  20. Frontal plane knee mechanics and medial cartilage MR relaxation times in individuals with ACL reconstruction : A pilot study

    PubMed Central

    Kumar, Deepak; Kothari, Abbas; Souza, Richard B.; Wu, Samuel; Ma, C. Benjamin; Li, Xiaojuan

    2014-01-01

    Background The objective of this pilot study was to evaluate cartilage T1ρ and T2 relaxation times and knee mechanics during walking and drop-landing for individuals with anterior cruciate ligament reconstruction (ACL-R). Methods Nine patients (6 men and 3 women, Age 35.8±5.4 years, BMI 23.5±2.5 kg/m2) participated 1.5±0.8 years after single-bundle two-tunnel ACL reconstruction. Peak knee adduction moment (KAM), flexion moment (KFM), extension moment (KEM), and peak varus were calculated from kinematic and kinetic data obtained during walking and drop-landing tasks. T1ρ and T2 times were calculated for medial femur (MF), and medial tibia (MT) cartilage and compared between subjects with low KAM and high KAM. Biomechanical variables were compared between limbs. Results The high KAM group had higher T1ρ for MT (p = 0.01), central MT (p = 0.05), posterior MF (p = 0.04), posterior MT (p = 0.01); and higher T2 for MT (p = 0.02), MF (p = 0.05) posterior MF (p = 0.002) and posterior MT (p = 0.01). During walking, ACL-R knees had greater flexion at initial contact (p =0.04), and lower KEM (p = 0.02). During drop-landing, the ACL-R knees had lower KAM (p = 0.03) and KFM (p = 0.002). Conclusion Patients with ACL-R who have higher KAM during walking had elevated MR relaxation times in the medial knee compartments. These data suggest that those individuals who have undergone ACL-R and have higher frontal plane loading, may be at a greater risk of knee osteoarthritis. PMID:24993277

  1. Relationship of ACL Injury and Posterior Tibial Slope With Patient Age, Sex, and Race

    PubMed Central

    Waiwaiole, Alana; Gurbani, Ajay; Motamedi, Kambiz; Seeger, Leanne; Sim, Myung Shin; Nwajuaku, Patricia; Hame, Sharon L.

    2016-01-01

    Background: Posterior tibial slope (PTS) has been proposed as a potential risk factor for anterior cruciate ligament (ACL) injury; however, studies that have examined this relationship have provided inconclusive and sometimes contradictory results. Further characterization of this relationship may enable the medical community to identify individuals at greater risk for ACL injury and possibly characterize an anatomic target during surgical reconstruction. Purpose: The primary goal was to investigate the relationship between PTS and ACL injury. The secondary goal was to determine whether there are any patient factors, such as age, race, or sex, that correlate with ACL injury and PTS. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Medical records of 221 patients who underwent magnetic resonance imaging (MRI) of the knee between January 2003 and December 2009 were reviewed. Patients were separated into 2 groups: a study group of those subjects who had undergone surgery for ACL injury (n = 107) and a control group of patients diagnosed with patellofemoral syndrome (n = 114). Demographic data were collected, and MRI images from both groups were analyzed using imaging software to obtain medial and lateral tibial slope measurements. Data were then analyzed using analysis of variance (ANOVA) comparison and a multivariable regression model to determine which, if any, patient factors were related to probability of having an ACL injury. Results: ANOVA comparison demonstrated that the study group had significantly greater values for lateral PTS (6° ± 4°; P < .001) and medial PTS (7° ± 4°; P = .002) compared with controls (5° ± 3° and 5° ± 4°, respectively). After stepwise elimination of nonsignificant variables, the final multivariable logistic regression model determined that age (odds ratio [OR], 0.94; P < .001) and lateral PTS (OR, 1.12; P = .002) had statistically significant relationships with ACL injury. Medial PTS, race, and sex were not

  2. Gait Patterns Differ Between ACL-Reconstructed Athletes Who Pass Return-to-Sport Criteria and Those Who Fail

    PubMed Central

    Di Stasi, Stephanie L.; Logerstedt, David; Gardinier, Emily S.; Snyder-Mackler, Lynn

    2013-01-01

    Background The current standard of practice for an athlete to return to sport after anterior cruciate ligament (ACL) reconstruction is varied. Attempt to return to activity is typically advised 6 months after surgery, but functional performance deficits and gait abnormalities are often still evident and may have important implications on future function. Hypothesis When comparing the involved and uninvolved limbs, patients who failed return-to-sport (RTS) criteria would demonstrate (1) smaller peak knee angles, extensor moments, and peak power absorption at the knee of the involved limb and (2) larger peak hip angles, extensor moments, and peak power generation of the involved limb. Study Design Controlled laboratory study. Methods A total of 42 patients completed functional and biomechanical gait assessment 6 months after ACL reconstruction. Functional testing involved an isometric quadriceps strength test, 4 single-legged hop tests, and 2 self-report questionnaires. Three-dimensional motion analysis was used to measure sagittal plane kinematics and kinetics of the hip and knee. A mixed-model analysis of variance and post hoc t tests were used to compare the limb symmetry of those who passed and those who did not pass RTS criteria. Minimal clinically important differences were calculated from healthy gait data and used to further define meaningful limb asymmetries. Results Twenty of the 42 (48%) patients passed RTS criteria 6 months after ACL reconstruction. Patients who did not pass the criteria demonstrated statistically significant differences between limbs on all kinematic and kinetic variables at the knee (P ≤ .027). Clinically meaningful asymmetries at the hip were also identified in this group. Only kinetic asymmetries at the knee were identified in the patients who passed RTS criteria. Conclusion Athletes who demonstrate superior functional performance 6 months after ACL reconstruction may have fewer abnormal and asymmetrical gait behaviors than their

  3. Modified Transtibial versus Anteromedial Portal Technique in Single Bundle ACL Reconstruction

    PubMed Central

    Salinas, Emiliano Alvarez; Etcheto, Horacio Rivarola; Blanchod, Cristian Collazo; Escobar, Gonzalo; Zordan, Jesuan; Autorino, Carlos María

    2017-01-01

    Objectives: The aim of this study is to determine whether it is possible to achieves a similar anatomical placement of the femoral tunnel with a modified transtibial ACL single bundle reconstruction tecnique compared to anteromedial transportal technique. Results were evaluated by tomographic comparisons between patients from both groups. Methods: 36 patients (36 knees) who were candidates for an ACL single bundle reconstruction with patellar bone graft were included in the study. Patients were randomly allocated using a computerized sequence into two groups. 18 patients were assigned each group (modified transtibial vs AM transportal technique). Surgery was performed by the same surgical team in both groups. Femoral tunnel quadrant placement, oblicuity in the coronal and sagittal planes and diameter of the femoral tunnel were assesed tomographically blinded by two observers and statistical comparison between groups was realized. Results: Average distance measured from posterior edge of the condyle to the femoral tunnel ( measured as a proportion respect to the T line) was similar in both groups ( Group I : 32.7 % +- 5.1% ; Group 2: 32.4 % +-4.4% , p = 0.85). Average distance measured from the Blumensaat line to the femoral tunnel (measured as a proportion respect to the H line) was similar in both groups ( Group I: 28.5% 4.49 % Group II , 31.5% of 4.83% p = 0.06). Average angulation values of the femoral tunnel in the coronal plane were lower in Group I than in Group II (Group I = 34.8 ° range 32.7 ° - 38.6 ° and 41.2 ° range Group II 36.7 ° - 43.1 ° P = 0.0016 ). Average angulation values of the femoral tunnel in the sagittal plane were similar in both groups (Group I 40.2 ° range 38.4 ° - 43.4 ° ; Group II 38 1 ° range 36.6 ° - 40.2 ° p = 0.17).. The average diameter of the femoral tunnel was significantly higher in group I than in Group II (Group I 11 mm 0.84 mm and 10.2 mm Group II 0.65mm p = 0.007) . Conclusion: The modified transtibial technique

  4. Anterior cruciate ligament reconstruction using cryopreserved irradiated bone-ACL-bone-allograft transplants.

    PubMed

    Goertzen, M J; Clahsen, H; Schulitz, K P

    1994-01-01

    Bone-ACL-bone allograft transplantation has been investigated as a potential solution to reconstruction of the anterior cruciate ligament (ACL). To minimize disease transmission (e.g. the acquired immuno deficiency syndrome), bony and collagenous tissues should be sterilized. Recent animal studies indicate that gamma irradiation and ethylene oxide sterilization result in diminished histological and biomechanical properties. The purpose of the present study was biomechanical and histological determination of the fate of deep-frozen gamma-irradiated (2.5 Mrad) canine bone-ACL-bone allografts with argon gas protection. Particular attention was paid to collagenous and neuroanatomical morphology 3, 6 and 12 months after implantation, by comparison to a non-irradiated control group. Sixty skeletally mature foxhounds were operated on in this study, divided up in two groups of 30 dogs each. In group A animals the ACL was replaced by a deep-frozen (-80 degrees C) bone-ACL-bone LAD-augmented allograft subjected to 2.5 Mrad gamma irradiation with argon gas protection. The animals in group B received an LAD-augmented ACL-allograft transplant without gamma irradiation. All knees from both groups were evaluated 3, 6 and 12 months after implantation in regard to biomechanical properties, collagen morphology and routine histology (haematoxylin and eosin stain, polarization microscopy), neuroanatomical morphology (silver and gold chloride stain) and microvasculature (modified Spalteholz technique). The irradiated ACL allografts withstood a maximum load that was 63.8% (718.3 N) of the maximum load of normal ACLs after 12 months. By contrast, the non-irradiated allografts failed at 69.1% (780.1 N) of the maximum load of normal control ACLs.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. The use of platelets to affect functional healing of an anterior cruciate ligament (ACL) autograft in a caprine ACL reconstruction model.

    PubMed

    Spindler, Kurt P; Murray, Martha M; Carey, James L; Zurakowski, David; Fleming, Braden C

    2009-05-01

    Many anterior cruciate ligament (ACL) reconstructions have increased laxity postoperatively. We hypothesized that enhancing an ACL graft with a collagen-platelet composite (CPC) would improve knee laxity and graft structural properties. We also hypothesized the platelet concentration in the CPC would affect these parameters. Twelve goats underwent ACL reconstruction with autologous patellar tendon graft. In six goats, a collagen-platelet composite was placed around the graft (CPC group). In the remaining six goats, the collagen scaffold only was used (COLL group). Three goats were excluded due to complications. After 6 weeks in vivo, anterior-posterior (AP) laxity and tensile properties of the ACL reconstructed knees were measured and normalized against the contralateral intact knee. At a knee flexion angle of 30 degrees, the average increase in AP laxity was 40% less in the CPC group than the COLL group (p = 0.045). At 60 degrees, the AP laxity was 30% less in the CPC group, a difference that was close to statistical significance (p = 0.080). No differences were found between treatment groups with respect to the structural properties (p > 0.30). However, there were significant correlations between serum platelet concentration and AP laxity (R2 = 0.643; p = 0.009), maximum load (R2 = 0.691; p = 0.006), and graft stiffness (R2 = 0.840; p < 0.001). In conclusion, use of a CPC to enhance healing of an allograft ACL reconstruction inversely correlated with early sagittal plane laxity and the systemic platelet count was highly predictive of ACL reconstruction graft strength and stiffness at 6 weeks. These findings emphasize the importance of further research on delineating the effect of platelets in treating of ACL injuries.

  6. Bioresorbable scaffolds for anterior cruciate ligament reconstruction: do we need an off-the-shelf ACL substitute?

    PubMed

    Richmond, John C; Weitzel, Paul P

    2010-03-01

    Currently available anterior cruciate ligament (ACL) graft sources, autograft and allograft, present potential problems that a natural biomaterial ACL graft might be able to solve. Earlier efforts in the development of synthetic ACL grafts were less than optimal, and those devices have largely been abandoned. We can learn from these past failures, and potentially develop a bioresorbable scaffold for ACL reconstruction, which will provide immediate stability, promote and direct tissue in growth, and degrade at an appropriate rate, without harmful wear debris. We have developed a modified silk scaffold, which is currently being evaluated in humans in a pilot study.

  7. 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

  8. Do Newer-Generation Bioabsorbable Screws Become Incorporated into Bone at Two Years After ACL Reconstruction with Patellar Tendon Graft?

    PubMed Central

    Cox, Charles L.; Spindler, Kurt P.; Leonard, James P.; Morris, Brent J.; Dunn, Warren R.; Reinke, Emily K.

    2014-01-01

    Background: Bioabsorbable interference screws are used frequently for graft fixation in ACL (anterior cruciate ligament) reconstruction. The resorption properties of many available screws that are marketed as bioabsorbable are not well defined. The CALAXO (Smith & Nephew Endoscopy) and MILAGRO (DePuy Synthes) bioabsorbable screws contain polymers of poly(lactic-co-glycolic acid) (PLGA) plus additives to encourage osseointegration over time. The purpose of this study was to evaluate radiographic and magnetic resonance imaging (MRI) properties and compare patient-reported outcomes at a minimum of two years of follow-up after ACL reconstruction using CALAXO or MILAGRO bioabsorbable interference screws. Methods: A cohort of patients who underwent ACL reconstruction in which the fixation used was either CALAXO or MILAGRO screws returned for repeat radiographs for evaluation of tunnel widening, repeat MRI for evaluation of graft integrity and screw breakdown, and completion of the pain and symptom items of the KOOS (Knee injury and Osteoarthritis Outcome Score) questionnaire. Results: At a mean of three years (range, 2.5 to 4.0 years) after surgery, thirty-one patients with sixty-two CALAXO screws and thirty-six patients with seventy-two MILAGRO screws returned for repeat evaluation. Two blinded, independent reviewers found no significant differences between the two screw types when comparing radiographs for tibial or femoral tunnel widening or MRIs for graft integrity, tibial and femoral foreign body reactions, or femoral screw degradation. Both reviewers found a significant difference between the two screw types when comparing tibial screw degradation properties (p < 0.01). All analyzed CALAXO screws were rated as partially intact or degraded; the MILAGRO screws were more likely to be rated as intact. No significant differences were noted between the two screw types when comparing the two KOOS subscales. Conclusions: CALAXO screws in the tibial tunnel were more likely

  9. Return to sports after ACL reconstruction: a new functional test protocol

    PubMed Central

    Bisciotti, Gian Nicola; Quaglia, Alessandro; Belli, Andrea; Carimati, Giulia; Volpi, Piero

    2016-01-01

    Summary Background In literature, there are lack of studies proposing clear and rationally designed test battery to be performed after an ACL reconstruction. Methods From 2006 to 2015, 80 football players were subjected, after ACL reconstruction, to a newly conceived test battery analyzing: Isometric and isokinetic force production The different phases during the jump The correct control of the landing phase after jump The control of valgus during landing after jump and cutting movements. Results The isokinetic and isometric test do not show any significant relationship with the another test. The laboratory test as well the field test showed them a significant correlation. Conclusions The results showed that a normal force production during the laboratory does not guarantee an equally satisfactory production of force during the field test. Study design Case series (Level III). PMID:28217573

  10. THE CLINICAL UTILITY OF FUNCTIONAL PERFORMANCE TESTS WITHIN ONE-YEAR POST-ACL RECONSTRUCTION: A SYSTEMATIC REVIEW

    PubMed Central

    Narducci, Elizabeth; Waltz, Amanda; Gorski, Katheryn; Leppla, Lucas

    2011-01-01

    Introduction: A tear of the anterior cruciate ligament (ACL) represents a significant injury for an athlete that requires substantial time away from sport, and significant rehabilitation after reconstruction. The physical therapist is responsible to determine when a patient is capable of tolerating the physical demands of daily activities and to attempt to prevent re-injury. Physical or functional performance tests (FPTs) are one mechanism used to evaluate the athlete's physical skills and capabilities prior to returning to sports participation. The purpose of this systematic review is to critically examine the clinical utility of functional performance tests used with patients less than or equal to one year post ACL reconstruction. Methods: A systematic review of the relevant literature was performed using PRISMA guidelines. A total of twelve studies were included for analysis. Results: Two independent blinded reviewers then analyzed and rated the final included articles (n=12) utilizing the Newcastle-Ottawa Scale (NOS). Percent overall agreement between raters for the NOS was 88% with a fixed-marginal kappa (κ) of 0.80. Of the 12 included articles, the FPTs were utilized as an outcome measure within the study design (41.7%) or studied as a measure of function (58.3%). Among those studies that used FPTs as a “measure of function” 71.4% studied a battery of FPTs, while 28.6% studied a single test. None of the studies utilized FPTs as a measure to determine readiness to return to sport. Discussion: FPTs are being utilized with patients, less than or equal to one year post ACL reconstruction, either as an assessment of functional performance or as an outcome measure. No studies identified a FPT or test battery that has construct or predictive validity for “return to sport” in athletic population one-year post-ACL reconstruction. The identification of the critical elements within the return to sport construct may allow lower extremity performance tests to be

  11. 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.

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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.

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

    PubMed Central

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

    2016-01-01

    Background/aim Consequences of an anterior cruciate ligament (ACL) injury include worse patient-reported outcomes (PROs) and a decrease in activity level. Muscle function can be improved by targeted exercise. Our aims were to investigate cross-sectional and longitudinal associations among lower extremity muscle function and PROs after ACL injury. Methods Fifty-four participants (15 women, mean 30 years) with ACL injury or reconstruction, from the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) trial (ISRCTN84752559), were assessed with hop performance, muscle power and postural orientation 3 years (SD 0.85) after ACL injury. PROs at 3 and 5 years after injury included Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales Function in sport and recreation (KOOS Sport/rec) and Knee-related Quality of life (KOOS QoL), KOOS item Q3 (KOOS Q3), Tegner Activity Scale and Activity Rating Scale (ARS). Partial Spearman's rank-order correlation was used to analyse correlations between muscle function and PROs, controlling for gender and treatment. Results Numerous cross-sectional correlations were observed between muscle function and PROs (rsp≈0.3–0.5, p≤0.045). Worse hop performance and worse postural orientation were associated with worse KOOS scores 2 years later (rsp≥0.280, p≤0.045). Worse muscle power was associated with lower future ARS scores (rsp=0.281, p=0.044). Conclusions The moderate associations suggest that improving muscle function during rehabilitation could improve present and future PROs. PMID:27900196

  18. 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

  19. FUNCTIONAL TESTING TO DETERMINE READINESS TO DISCONTINUE BRACE USE, ONE YEAR AFTER ACL RECONSTRUCTION

    PubMed Central

    Hunter‐Giordano, Airelle; Axe, Michael J.; Snyder‐Mackler, Lynn

    2013-01-01

    Background: While the use of functional knee braces for return to sports or high level physical activity after ACL reconstruction (ACLR) is controversial, brace use is still prevalent.1,2,3,4,5 All active patients in the practice are braced after ACLR and must pass a battery of sports tests before they return to play in their brace. Criteria include a 90% score on 4 one‐legged hop tests9 burst superimposition strength test,10 Knee Outcome Survey Activities of Daily Living Scale,8 and a global rating of knee function. Purpose: The purpose of this study was to describe the use of criterion‐based guidelines to determine if athletes who had undergone an ACLR function better with or without their functional brace, one year after surgery. Study Design: Cross‐Sectional Study Methods: Sixty‐four patients post ACLR performed 4 one‐legged hop tests,9 burst superimposition strength test,10 and completed the Knee Outcome Survey Activities of Daily Living Scale,8 and a global rating of knee function one year after surgery with and without their brace. Results: Participants included 35 men and 29 women with a mean age of 25 years. The Mean Knee Outcome Survey Activities of Daily Living score was 98%, and the global rating was 97%. Of the subjects, one patient failed hop testing by at least one criterion with and without the brace. Three additional patients failed the test while braced but passed un‐braced, and one patient passed with the brace, but failed without the brace. Subjects performed significantly better un‐braced than braced in all hop tests: single leg hop braced = 101%; un‐braced = 107% (p<0.001); cross‐over hop braced = 100%; un‐braced = 105% (p<0.001); triple hop braced = 99%; un‐braced = 101% (p=0.003); timed hop braced = 98%; un‐braced = 103% (p = 0.004). Conclusions: Sixty‐two of 64 patients continued to score above return to play criteria one year after ACLR. All but two subjects in the cohort performed better un‐braced than braced

  20. In vivo bone tunnel evaluation of nanoparticle-grafts using an ACL reconstruction rabbit model.

    PubMed

    Grant, Sheila A; Smith, Sarah E; Schmidt, Hilary; Pfeiffer, Ferris; Kuroki, Kei; Sherman, Seth; White, Richard; Grant, David A

    2017-04-01

    Acellular human gracilis tendons conjugated with gold nanoparticles (AuNP) and hydroxyapatite nanoparticles (nano-HAp) were used as a graft in an anterior cruciate ligament (ACL) reconstruction rabbit model. The ACLs of 11 New Zealand rabbits were reconstructed using grafts conjugated without nanoparticles, with AuNP only, and with both AuNP and nano-HAp. Semi-quantitative histological scoring of bone tunnel portion of grafts was performed after 14 weeks. Bone tunnels were scored for graft degeneration, graft remodeling, percentage of new host fibrous connective, collateral connection, head-to-head connection, graft collagen fiber organization, new host fibrous connective tissue organization, and graft and interface vascularity. All grafts were intact at 14 weeks. Results of bone tunnel scoring indicate remodeling in all graft types with new organized host fibrous connective tissue, head-to-head connection to bone and mild inflammation associated with remodeling. Components of the 20 nm AuNP grafts have significantly more graft degeneration, more new host fibrous connective tissue, and more vascularity compared to crosslinked grafts. Comparison between femoral and tibial tunnel scores indicate more degeneration in femoral tunnels compared to tibial tunnels. Overall results indicated potentially enhanced remodeling from the use of 20 nm AuNP grafts. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1071-1082, 2017.

  1. Degeneration in ACL Injured Knees with and without Reconstruction in Relation to Muscle Size and Fat Content—Data from the Osteoarthritis Initiative

    PubMed Central

    Baum, Thomas; Nevitt, Michael C.; Nardo, Lorenzo; Gersing, Alexandra S.; Lane, Nancy E.; McCulloch, Charles E.; Rummeny, Ernst J.; Link, Thomas M.

    2016-01-01

    Background Anterior cruciate ligaments (ACL) injuries represent a major risk factor for early osteoarthritis (OA). Purpose To evaluate the prevalence and 4-year progression of knee OA measured with 3T MR-imaging in individuals with ruptured, reconstructed or normal ACL and to assess the impact of thigh muscle characteristics. Methods A total of 54 knees (23/54 male, 31/54 female) were recruited from the Osteoarthritis Initiative (OAI). At baseline, 15/54 subjects had prevalent ACL ruptures and 15/54 subjects had prevalent ACL reconstruction (24/54 normal ACL). Western Ontario and McMasters Universities Arthritis Index (WOMAC) scores, Physical Activity Scores of the Elderly (PASE) and thigh muscle characteristics including strength, fat infiltration (Goutallier score) and thigh muscle cross-sectional area (CSA) MR measurements were obtained at baseline. Whole-organ MR-imaging Scores (WORMS) were obtained at baseline and at a 4-year follow-up time-point. Multivariate regression models, adjusting for covariates (age, gender, body mass index), were used for statistical analysis. Results At baseline, subjects with prevalent ACL ruptures had worse WORMS total scores (mean±SEM, 44.1±3.5) than subjects with ACL reconstruction (30.8±4.0; P = 0.015) and worse than subjects with normal ACL (21.3±3.0; P<0.001). Cartilage scores were worse in both femorotibial compartments in ACL injured knees than in knees with normal ACL (P<0.05). Knees with ACL reconstruction showed an increased degeneration of the medial meniscus (P = 0.036), cartilage degeneration at the medial femoral condyle (P = 0.011). In a multivariate regression model, including both ACL groups and total muscle characteristics as influence parameters, high thigh muscle CSA, high muscle/ fat ratio and low Goutallier scores were associated with less degenerative changes at the knee, independent of ACL status. Knees with ACL reconstruction showed an increased progression of cartilage degeneration at the medial tibia

  2. Sex-specific gait adaptations prior to and up to six months after ACL reconstruction

    PubMed Central

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

    2015-01-01

    STUDY DESIGN Controlled longitudinal laboratory study. OBJECTIVES Compare sagittal plane gait mechanics of men and women before and up to 6 months after anterior cruciate ligament reconstruction (ACLR). BACKGROUND Aberrant gait patterns are ubiquitous after anterior cruciate ligament (ACL) rupture and persist after ACLR despite skilled physical therapy. Sex influences post-operative function and second ACL injury risk, but its influence on gait adaptations after injury have not been investigated. METHODS Sagittal plane knee and hip joint excursions during midstance and internal knee and hip extension moments at peak knee flexion were collected on 12 women and 27 men using 3-dimensional gait analysis before (Screen) and after pre-operative physical therapy (Pre-sx), and 6 months after ACLR (6mo). Repeated measures analysis of variance models were used to determine whether limb asymmetries changed differently over time in men and women. RESULTS Significant time x limb x sex interactions were identified for hip and knee excursions and internal knee extension moments (P≤.007). Both sexes demonstrated smaller knee excursions on the involved compared to the uninvolved knee at each time point (P≤.007), but only women demonstrated a decrease in the involved knee excursion from pre-sx to 6mo (P=.03). Women also demonstrated smaller hip excursions (P<.001) and internal knee extension moments (P=.005) on the involved limb compared to the uninvolved limb at 6mo. Men demonstrated smaller hip excursions and knee moments on the involved limb compared to the uninvolved limb (main effects, P<.001). CONCLUSION The persistence of limb asymmetries in men and women 6 months after ACLR indicates that current rehabilitation efforts are inadequate for some individuals following ACLR. PMID:25627155

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

    PubMed

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

    2012-11-01

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

  4. Evaluation of an intact, an ACL-deficient, and a reconstructed human knee joint finite element model.

    PubMed

    Vairis, Achilles; Stefanoudakis, George; Petousis, Markos; Vidakis, Nectarios; Tsainis, Andreas-Marios; Kandyla, Betina

    2016-02-01

    The human knee joint has a three-dimensional geometry with multiple body articulations that produce complex mechanical responses under loads that occur in everyday life and sports activities. Understanding the complex mechanical interactions of these load-bearing structures is of use when the treatment of relevant diseases is evaluated and assisting devices are designed. The anterior cruciate ligament (ACL) in the knee is one of four main ligaments that connects the femur to the tibia and is often torn during sudden twisting motions, resulting in knee instability. The objective of this work is to study the mechanical behavior of the human knee joint and evaluate the differences in its response for three different states, i.e., intact, ACL-deficient, and surgically treated (reconstructed) knee. The finite element models corresponding to these states were developed. For the reconstructed model, a novel repair device was developed and patented by the author in previous work. Static load cases were applied, as have already been presented in a previous work, in order to compare the calculated results produced by the two models the ACL-deficient and the surgically reconstructed knee joint, under the exact same loading conditions. Displacements were calculated in different directions for the load cases studied and were found to be very close to those from previous modeling work and were in good agreement with experimental data presented in literature. The developed finite element model for both the intact and the ACL-deficient human knee joint is a reliable tool to study the kinematics of the human knee, as results of this study show. In addition, the reconstructed human knee joint model had kinematic behavior similar to the intact knee joint, showing that such reconstruction devices can restore human knee stability to an adequate extent.

  5. 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

  6. Preoperative Predictors for Noncopers to Pass Return to Sports Criteria After ACL Reconstruction

    PubMed Central

    Zeni, Joseph; Di Stasi, Stephanie; Axe, Michael J.; Snyder-Mackler, Lynn

    2013-01-01

    Less than 50% of athletes pass criteria to return to sports (RTS) 6 months after ACL reconstruction (ACLR). Using data on 38 noncopers, we hypothesized that preoperative age, quadriceps strength index (QI), and knee flexion moments (KFM) during gait would predict the ability to pass/fail RTS criteria and that preoperative quadriceps strength gains would be predictive of passing RTS criteria. Gait analysis and strength data were collected before and after a preoperative intervention and 6 months after ACLR. Age, QI, and KFM each contributed to the predictability to pass or fail RTS criteria 6 months after ACLR. Collectively, the variables predict 69% who would pass and 82% who would fail RTS criteria 6 months after ACLR. Younger athletes who have symmetrical quadriceps strength and greater KFM were more likely to pass RTS criteria. Further, 63% of those who increased preoperative quadriceps strength passed RTS criteria, whereas 73% who did not failed. Increasing quadriceps strength in noncopers before ACLR seems warranted. PMID:22983930

  7. 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.

  8. 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

  9. Evaluation of strength muscle recovery with isokinetic, squat jump and stiffness tests in athletes with ACL reconstruction: a case control study.

    PubMed

    Jacopetti, Marco; Pasquini, Andrea; Costantino, Cosimo

    2016-05-06

    BackgroundThe anterior cruciate ligament (ACL) rupture accounting for about 50% of all knee ligament injuries. The rehabilitation program requires a long time to rebuild muscle strength and to reestablish joint mobility and neuromuscular control. The purpose of the study is to evaluate the muscle strength recovery in athletes with ACL reconstruction. MethodsWe enrolled soccer atlethes, with isolated anterior cruciate ligament rupture treated with bone-patellar tendon-bone autograft artroscopic reconstruction. Each patients were evaluated comparing operated and controlateral limb by isokinetic test and triaxial accelerometer test. Isokinetic movements tested were knee flexion-extension with concentric-concentric contraction. Accelerometer test were Squat Jump Test (SJT)  and Stiffness Test (ST). Results17 subjects were selected, there was no significant difference in isokinetic quadriceps and hamstrings results in strength and endurance values. Parameters of ST were comparable between the operated and unoperated side. In SJT a significant statistical difference was in height of jump (p=0,02) no statistical difference was evidenced in the other measures.ConclusionCurrently complete recovery of symmetric explosive strength seems to be an important parameter for evaluating the performance after ACL reconstruction and the symmetry in test results jump could be associated with an adequate return to sports. In our study the explosive strenght is lower in the limb operated than the healthy one. Explosive strength recovery with pliometric training should be included in the post-surgical rehabilitation protocol and its measurement should be performed to assess the full recovery before the restart of sport activities.

  10. 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.

  11. Anterior cruciate ligament reconstruction and knee osteoarthritis

    PubMed Central

    Paschos, Nikolaos K

    2017-01-01

    Anterior cruciate ligament (ACL) injury is a traumatic event that can lead to significant functional impairment and inability to participate in high-level sports-related activities. ACL reconstruction is considered the treatment of choice for symptomatic ACL-deficient patients and can assist in full functional recovery. Furthermore, ACL reconstruction restores ligamentous stability to normal, and, therefore, can potentially fully reinstate kinematics of the knee joint. As a consequence, the natural history of ACL injury could be potentially reversed via ACL reconstruction. Evidence from the literature is controversial regarding the effectiveness of ACL reconstruction in preventing the development of knee cartilage degeneration. This editorial aims to present recent high-level evidence in an attempt to answer whether ACL injury inevitably leads to osteoarthritis and whether ACL reconstruction can prevent this development or not. PMID:28361013

  12. ACL Revision in Synthetic ACL graft failure

    PubMed Central

    Etcheto, H. Rivarola; Zordán, J.; Escobar, G.; Collazo, C.; Palanconi, M.; Autorino, C.; Salinas, E. Alvarez

    2017-01-01

    The development of synthetic grafts as an alternative to biological grafts for reconstruction of the anterior cruciate ligament dates from 1980. The interest is awakened due to the potential advantages of: The absence of morbidity associated with donor site, and early return to sport. However, this surgical technique has had multiple complications associated with graft: mechanical failures (synthetic graft failure, loss of fixation), synovial foreign body reaction, recurrent stroke, recurrent instability and ultimately, early osteoarthritis. Objectives: We describe the synthetic graft failure LCA, intraoperative findings and details of surgical technique. Methods: Patient 35 years old, with a history of ACL reconstruction four years of evolution in another health center, consultation with the Service knee arthroscopy for acute knee pain left knee during secondary sporting event to a rotation mechanism with fixed foot. On physical examination, presents and positive Lachman maneuver Pivot. Radiografia in a widening of the tibial tunnel is observed. NMR shows a discontinuity of fibers of synthetic graft. Results: First time arthroscopic revision where synthetic plastic LCA identifies with Disruption fiber pattern. Intraoperatively, hypertrophic chronic synovitis localized predominantly in intercóndilo is observed. debridement thereof is performed, and proceeds to the extraction of the synthetic ligament. Then he was made prior cruentado and revival of the edges of the tunnel, filling them with non-irradiated structural bone allograft. At four months as planned and after confirmation by studies incorporating bone graft was performed the second time with the new plastic ACL. It was planned like a primary graft surgery with autologous hamstring prepared in fourfold form, and fixation with modified transtibial technique Biotransfix system proximal and distal screw Biocomposite (arthrex®). A quadruple graft 9 mm was obtained, making good positioning of tunnels and stable

  13. 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

  14. 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

  15. ACL Revision

    PubMed Central

    Costa-Paz, Matias; Dubois, Julieta Puig; Zicaro, Juan Pablo; Rasumoff, Alejandro; Yacuzzi, Carlos

    2017-01-01

    Objectives: The purpose of this study was to evaluate a series of patients one year after an ACL revision with clinical evaluation and MRI, to consider their condition before returning to sports activities. Methods: A descriptive, prospective and longitudinal study was performed. A series of patients who underwent an ACL revision between March 2014 and March 2015 were evaluated after one year post surgery. They were evaluated using the Lysholm score, IKDC, Tegner, artrometry and MRI (3.0 t). A signal pattern and osteointegration was determined in the MRI. Graft signal intensity of the ACL graft using the signal/noise quotient value (SNQ) was also determined to evaluate the ligamentatization process state. Results: A total of 18 male patients were evaluated with a mean age of 31 years old.Average scores were: Lysholm 88 points, IKDC 80 points, Pre-surgical Tegner 9 points and postoperative 4 points. Artrhometry (KT1000) at 20 newtons showed a side to side difference of less than 3 mm in 88%. Only 44% of patients returned to their previous sport activity one year after revision.The MRI showed a heterogeneous signal in neoligaments in 34% of patients. SNQ showed graft integration in only 28%. Synovial fluid was found in bone-graft interphase in 44% of tunnels, inferring partial osteointegration. The heterogeneous signal was present in 50% of patients who did not return to the previous sport level activity. (Fisher statistics: p = 0.043) There were no meaningful differences in patients with auto or allografts. Conclusion: Although the clinical evaluation was satisfactory, only 44% of patients returned to the previous level of sport activity one year after the ACL surgery. The ligamentatization process was found in 28% of knees evaluated with MRI one year later. Partial osteointegration is inferred in 44%. Results showed a meaningful relation between the signal of neoligaments in the MRI and the return to sport activity in said series of patients. MRI is a useful tool

  16. 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

  17. 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.

  18. Anatomic Anterolateral Ligament Reconstruction Improves Postoperative Clinical Outcomes Combined with Anatomic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Qiu, Man; Zhou, Aiguo; Zhang, Jian; Jiang, Dianming

    2016-01-01

    A significant cohort of patients is plagued by postoperative rotational instability after the anatomic anterior cruciate ligament (ACL) reconstruction surgery. Anatomic anterolateral ligament (ALL) reconstruction was performed in this study with the aim to assess the clinical role of ALL in knee’s stability and joint functions. Sixty patients were recruited and divided into three groups to perform the operations of anatomic single-bundle ACL reconstruction, anatomic double-bundle ACL reconstruction, and anatomic single-bundle ACL reconstruction + anterolateral ligament reconstruction, respectively. And then postoperative knee’s stability and joint functions were evaluated to compare the clinical outcomes among the three different kind of operations. The postoperative knee’s stability and joint functions of the anatomic double-bundle ACL reconstruction group and the anatomic single-bundle ACL reconstruction + ALL reconstruction group were better than the anatomic single-bundle ACL reconstruction group. No significant difference was observed between the anatomic double-bundle ACL reconstruction group and the anatomic single-bundle ACL reconstruction + ALL reconstruction group. The anatomic anterolateral ligament reconstruction could improve the clinical outcomes after patients performed the anatomic single-bundle anterior cruciate ligament reconstruction. This indicates that the anterolateral ligament plays a crucial role in knee’s stability and joint function, especially the rotational stability. Key points Anatomic anterolateral ligament reconstruction combined with anatomic anterior cruciate ligament reconstruction was performed to treat the patients with ACL rupture. Compared to the anatomic single-bundle ACL reconstruction group, the anatomic single-bundle ACL reconstruction + ALL reconstruction group achieve a better clinical outcomes. The results suggest that the anterolateral ligament plays a crucial role in knee’s stability and joint function

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

    PubMed Central

    Andersen, Christoffer H.; Bencke, Jesper; Ørntoft, Christina; Linnebjerg, Connie; Hölmich, Per

    2017-01-01

    The aim of the present single-case study was to investigate the effect of 6 weeks' kettlebell training on the neuromuscular risk profile for ACL injury in a high-risk athlete returning to sport after ACL reconstruction. A female elite soccer player (age 21 years) with no previous history of ACL injury went through neuromuscular screening as measured by EMG preactivity of vastus lateralis and semitendinosus during a standardized sidecutting maneuver. Subsequently, the player experienced a noncontact ACL injury. The player was screened again following postreconstruction rehabilitation, then underwent 6-week kettlebell training, and was subsequently screened again at 6-week follow-up. Prior to and after postreconstruction rehabilitation the player demonstrated a neuromuscular profile during sidecutting known to increase the risk for noncontact ACL injury, that is, reduced EMG preactivity for semitendinosus and elevated EMG preactivity for vastus lateralis. Subsequently, the 6-week kettlebell training increased semitendinosus muscle preactivity during sidecutting by 38 percentage points to a level equivalent to a neuromuscular low-risk profile. An ACL rehabilitated female athlete with a high-risk neuromuscular profile changed to low-risk in response to 6 weeks of kettlebell training. Thus, short-term kettlebell exercise with documented high levels of medial hamstring activation was found to transfer into high medial hamstring preactivation during a sidecutting maneuver. PMID:28197354

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

    PubMed

    Zebis, Mette K; Andersen, Christoffer H; Bencke, Jesper; Ørntoft, Christina; Linnebjerg, Connie; Hölmich, Per; Thorborg, Kristian; Aagaard, Per; Andersen, Lars L

    2017-01-01

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

  1. 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

  2. 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

  3. Relationship Between Posterior-Inferior Tibial Slope and Bilateral Noncontact ACL Injury.

    PubMed

    Hendrix, Steven T; Barrett, Austin M; Chrea, Bopha; Replogle, William H; Hydrick, Josie M; Barrett, Gene R

    2016-10-18

    Is there a correlation between increased posterior-inferior tibial slope angle and noncontact anterior cruciate ligament (ACL) injury? Does increasing the posterior-inferior tibial slope angle increase the risk of bilateral ACL injury? A computerized relational database (Access 2007; Microsoft Inc, Redmond, Washington) was used to conduct a retrospective review of patients undergoing bilateral or unilateral ACL reconstruction surgery or treatment by a single surgeon between 1995 and 2013. Included in the study were patients with bilateral and unilateral ACL injuries and patellofemoral pain syndrome with no associated ACL deficiency. Exclusion criteria included concomitant ligament injury, previous ACL reconstruction, and previous knee surgery. Also excluded were patients who did not have plain lateral radiographs. Fifty patients were randomly selected from each group. After controlling for age and Tegner activity level, the authors found that the posterior-inferior tibial slope angle was a significant predictor (P=.002) of noncontact ACL injury. Mean posterior-inferior tibial slope angle for the bilateral, unilateral, and control groups was 11.8°±2.3°, 9.3°±2.4°, and 7.5°±2.3°, respectively. In the group with unilateral ACL injury vs the group without ACL deficiency, a 1° increase in posterior-inferior tibial slope angle (P=.03) was associated with a 20% increase in unilateral ACL injury. In those with bilateral ACL injury vs those without ACL deficiency, a 1° increase in posterior-inferior tibial slope angle (P=.001) increased bilateral knee injury by 34%. The difference between the mean angles of the control group without ACL deficiency and both the bilateral injury and unilateral injury cohorts was statistically significant (P=.003). Increased posterior-inferior tibial slope angle is associated with an increased risk of noncontact bilateral and unilateral ACL injury. [Orthopedics. 201x; xx(x):xx-xx.].

  4. 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

  5. The potential for primary repair of the ACL

    PubMed Central

    Vavken, Patrick; Murray, Martha M

    2011-01-01

    The objective of this work is to assess the feasibility of successfully repairing the torn ACL. Two major motivators for developing a new treatment for ACL injuries are the recently reported high rates of osteoarthritis after conventional ACL reconstruction as well as the problem of how to safely treat skeletally immature patients. A key factor in developing such a technique was the identification of the main inhibitor of intrinsic ACL healing – the lack of clot formation between the two torn ends of the ligament. A bioactive and biocompatible scaffold which could be placed in the wound site to enhance cellular proliferation and biosynthesis was developed. This biomaterial has shown promising functional outcomes in several large animal models of primary repair of partial and complete ACL transection over 4 to 14 weeks, suggesting potential for a successful, future clinical application. PMID:21293237

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

    PubMed Central

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

    2014-01-01

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

  7. Hamstring Contracture After ACL Reconstruction Is Associated With an Increased Risk of Cyclops Syndrome

    PubMed Central

    Pinto, Francisco Guerra; Thaunat, Mathieu; Daggett, Matt; Kajetanek, Charles; Marques, Tiago; Guimares, Tales; Quelard, Bénédicte; Sonnery-Cottet, Bertrand

    2017-01-01

    Background: Cyclops syndrome is characterized by loss of terminal knee extension due to proliferative fibrous nodule formation in the intercondylar notch. This complication occurs in the early postoperative period after anterior cruciate ligament reconstruction (ACLR). The pathogenesis of Cyclops syndrome is not well understood. Hypothesis: Persistent hamstring contracture after ACLR is associated with an increased risk of subsequent Cyclops syndrome. Study Design: Case-control study; Level of evidence, 3. Methods: The files of 45 patients who underwent arthroscopic debridement of a Cyclops lesion after ACLR were analyzed. Recorded data included demographic information and technical details of surgery. Preoperative magnetic resonance images were also analyzed, and patients with femoral bone bruising were identified. Passive and active range of motion were recorded in all patients preoperatively and at 3 and 6 weeks after surgery to address the Cyclops lesion. Passive extension deficit was evaluated in comparison with the contralateral limb and classified as secondary to hamstring contracture when contracture was observed and palpated in the prone position and when the extension deficit was reversed after exercises performed to fatigue the hamstrings. A control group was selected using a random numbers table among our entire ACLR cohort. Statistical analysis was performed to analyze differences between the 2 groups. Results: There was no significant difference between the groups with regard to age at ACLR, sex distribution, time from injury to surgery (P > .05), proportion of professional athletes, presence of femoral bone bruise, or technical aspects of surgery. The overall extension deficit incidence was significantly higher in the Cyclops group at 3 weeks (Cyclops, 71%; control, 22%) (P < .001) and at 6 weeks (Cyclops, 60%; control, 7%) (P < .001). The extension deficit related to hamstring contracture was significantly higher in the Cyclops group at 3 weeks

  8. A Novel Mass-Spring-Damper Model Analysis to Identify Landing Deficits in Athletes Returning to Sport after ACL Reconstruction.

    PubMed

    Schneider, Daniel K; Gokeler, Alli; Otten, Bert; Ford, Kevin R; Hewett, Timothy E; Divine, Jon; Colosimo, Angelo J; Heidt, Robert S; Myer, Gregory D

    2016-07-19

    A mass-spring-damper model may serve as an extension of biomechanical data from three-dimensional motion analysis and epidemiological data which help to delineate populations at-risk for anterior cruciate ligament (ACL) injuries. The purpose of this study was to evaluate such a model.\\Thirty-six ACL reconstruction (ACLR) group subjects and 67 controls (CTRL) completed single-leg drop landing and single-leg broad jump tasks. Landing ground reaction force data were collected and analyzed with a mass-spring damper model. Medians, interquartile ranges, and limb symmetry indices were calculated and comparisons were made within and between groups.During a single-leg drop landing, the ACLR group had a lower spring LSI than the CTRL group (P = 0.015) and landed with decreased stiffness in the involved limb relative to the uninvolved limb (P = 0.021). The ACLR group also had an increased damping LSI relative to the CTRL group (P = 0.045). The ACLR subjects landed with increased stiffness (P = 0.006) and decreased damping (P = 0.003) in their involved limbs compared to CTRL subjects non-dominant limbs. During a single-leg forward broad jump, the ACLR group had a greater spring LSI value than the CTRL group (P = 0.045). The CTRL group also recorded decreased damping values on their non-dominant limbs compared to the involved limbs of the ACLR group (P = 0.046).Athletes who have undergone ACLR display different lower limb dynamics than healthy controls according to a mass-spring damper model. Quadriceps dominance and leg dominance are components of ACLR athletes' landing strategies and may be identified with a mass-spring-damper model and addressed during rehabilitation.

  9. How Are We Measuring Patient Satisfaction After Anterior Cruciate Ligament Reconstruction?

    PubMed Central

    Kahlenberg, Cynthia A.; Nwachukwu, Benedict U.; Ferraro, Richard A.; Schairer, William W.; Steinhaus, Michael E.; Allen, Answorth A.

    2016-01-01

    Background: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common orthopaedic operations in the United States. The long-term impact of ACL reconstruction is controversial, however, as longer term data have failed to demonstrate that ACL reconstruction helps alter the natural history of early onset osteoarthritis that occurs after ACL injury. There is significant interest in evaluating the value of ACL reconstruction surgeries. Purpose: To examine the quality of patient satisfaction reporting after ACL reconstruction surgery. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the MEDLINE database was performed using the PubMed interface. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as well as the PRISMA checklist were employed. The initial search yielded 267 studies. The inclusion criteria were: English language, US patient population, clinical outcome study of ACL reconstruction surgery, and reporting of patient satisfaction included in the study. Study quality was assessed using the Newcastle-Ottawa scale. Results: A total of 22 studies met the inclusion criteria. These studies comprised a total of 1984 patients with a mean age of 31.9 years at the time of surgery and a mean follow-up period of 59.3 months. The majority of studies were evidence level 4 (n = 18; 81.8%), had a mean Newcastle-Ottawa scale score of 5.5, and were published before 2006 (n = 17; 77.3%); 5 studies (22.7%) failed to clearly describe their method for determining patient satisfaction. The most commonly used method for assessing satisfaction was a 0 to 10 satisfaction scale (n = 11; 50.0%). Among studies using a 0 to 10 scale, mean satisfaction ranged from 7.4 to 10.0. Patient-reported outcome and objective functional measures for ACL stability and knee function were positively correlated with patient satisfaction. Degenerative knee change was negatively correlated with satisfaction

  10. 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

  11. Anterolateral Ligament Reconstruction

    PubMed Central

    Zordan, J.; Etcheto, H. Rivarola; Blanchod, C. Collazo; Palanconi, M.; Salinas, E. Álvarez; Autorino, CM; Escobar, G.

    2017-01-01

    Anterior cruciate ligament (ACL) reconstruction is a common procedure in daily practice with 75 to 97% excellent long-term results. But in certain cases, some patients perceive rotational instability, for this reason the revision rate can be 10 to 15%. Objectives: evaluate functional outcome in revisions of ACL reconstruction associated with ALL. Methods: Between July 2015 and February 2016 (11 knees) Eleven Revision ACL reconstruction were performed with ALL with double incision technique performed by the same surgical team. Inclusion criteria were: ACL reconstruction failures with a grade 2 or 3 Lachman test, a grade 3 pivot-shift without other ligamentary injury lesions associated and complete range of motion. Results: The concept of rotational instability associated with ACL injury has been described more than a decade ago. However, there is no consensus on how to quantify rotational instability in ACL injuries; so when associating an extracapsular technique. Currently there is a lack of high-level evidence comparing isolated ACL repair and associated with the modified reconstruction of ALL that allows us to define therapeutic approaches. The ALL reconstruction associate an ACL reconstruction remains a matter of study. Conclusion: We obtain excellent results in antero – posterior and rotational stability after performing the procedure.

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

    PubMed Central

    Reischl, Nikolaus; Rönn, Karolin; Magnusson, Robert A.; Gautier, Emanuel; Jakob, Roland P.

    2016-01-01

    Background. The injured anterior cruciate ligament (ACL) has a limited healing capacity leading to persisting instability. Hypothesis/Purpose. To study if the application of a brace, producing a dynamic posterior drawer force, after acute ACL injury reduces initial instability. Study Design. Cohort study. Methods. Patients treated with the ACL-Jack brace were compared to controls treated with primary ACL reconstruction und controls treated nonsurgically with functional rehabilitation. Measurements included anterior laxity (Rolimeter), clinical scores (Lysholm, Tegner, and IKDC), and MRI evaluation. Patients were followed up to 24 months. Results. Patients treated with the ACL-Jack brace showed a significant improvement of anterior knee laxity comparable to patients treated with ACL reconstruction, whereas laxity persisted after nonsurgical functional rehabilitation. The failure risk (secondary reconstruction necessary) of the ACL-Jack group was however 21% (18 of 86) within 24 months. Clinical scores were similar in all treatment groups. Conclusion. Treatment of acute ACL tears with the ACL-Jack brace leads to improved anterior knee laxity compared to nonsurgical treatment with functional rehabilitation. PMID:28053787

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

    PubMed

    Jacobi, Matthias; Reischl, Nikolaus; Rönn, Karolin; Magnusson, Robert A; Gautier, Emanuel; Jakob, Roland P

    2016-01-01

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

  14. Changes of early post-traumatic osteoarthritis in an ovine model of simulated ACL reconstruction are associated with transient acute post-injury synovial inflammation and tissue catabolism.

    PubMed

    Heard, B J; Solbak, N M; Achari, Y; Chung, M; Hart, D A; Shrive, N G; Frank, C B

    2013-12-01

    The study described here tested the hypothesis that early intra-articular inflammation is associated with the development of post-traumatic osteoarthritis (PTOA) in a sheep model. We extended previously published work in which we investigated joint gross morphology and synovial mRNA expression of inflammatory and catabolic molecules 2 weeks after anatomic Anterior cruciate ligament (ACL) autograft reconstructive surgery (ACL-R). The same variables have been analyzed at 20 weeks post surgery together with new experimental variables at both time points. Animals were sacrificed at 20 weeks post ACL-R surgery and their joints graded for signs of PTOA. Synovial samples were harvested for histological grading plus mRNA and protein analysis for a panel of inflammatory and catabolic molecules. The mRNA expression levels for this panel plus connective tissue matrix turnover molecules were also investigated in cartilage samples. Results of gross morphological assessments at 20 weeks post surgery showed some changes consistent with early OA, but indicated little progression of damage from the 2 week time point. While significant alterations in mRNA levels for synovial inflammatory and catabolic molecules were detected at 2 weeks, values had normalized by 20 weeks. Similarly, all mRNA expression levels for inflammatory and catabolic molecules in articular cartilage had returned to normal levels by 20 weeks post ACL-R surgery. We conclude that synovial inflammatory processes are initiated very early after ACL-R surgery and may instigate events that lead to the gross cartilage and joint abnormalities observed as early as 2 weeks. However, the absence of sustained inflammation and joint instability may prevent OA progression.

  15. 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.

  16. Functional Outcome of Transphyseal Reconstruction of the Anterior Cruciate Ligament in Skeletally Immature Patients

    PubMed Central

    Kim, Sung-Jae; Shim, Dong-Woo

    2012-01-01

    Purpose In anterior cruciate ligament (ACL) injury, conventional adult reconstruction techniques have to face the potential risk of growth disturbance or angular deformities in skeletally immature patients. The aim of this study was to evaluate the clinical outcomes of ACL reconstruction by conventional transphyseal tunnel technique. Materials and Methods On a retrospective basis, we reviewed 25 skeletally immature patients; all the patients showed skeletal maturity at last follow-up, and the mean age was 16.4 years. The average injury to surgery interval was 12.6 months. Clinical outcomes were assessed at a mean of 74.4 months postoperatively using the Lysholm Knee Scoring Scale, the Tegner activity level, the International Knee Documentation Committee (IKDC), and plain radiographs. Results All the patients had undergone transphyseal reconstruction of ACL. The mean Lysholm score was 48.36 points preoperatively and 93.32 points postoperatively; the mean Tegner activity level was changed from 3.0 points to 5.6 points. The mean IKDC level was categorized as C preoperatively and changed to A postoperatively. Conclusions Our midterm outcome at an average 6 years after surgery was satisfactory without significant leg length discrepancies or abnormal alignment of the knee joint. Transphyseal reconstruction of ACL is a good treatment modality in the skeletally immature patient. PMID:22977795

  17. 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

  18. 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

  19. 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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

    We compared muscle activity of the quadriceps, hamstring, and gastrocnemius muscles when ACL-intact (ACLINT) and ACL-reconstructed (ACLREC) 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 ms and 78 ms earlier in ACLINT than in ACLREC subjects, respectively. Biceps femoris (BF) peak timing was 90 ms earlier in ACLINT than in ACLREC subjects and 75 ms earlier in females than in males. Medial gastrocnemius (MG) muscle peak timing was 77 ms earlier in ACLINT than in ACLREC 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 ACLREC than in ACLINT subjects. There was evidence suggesting that the loading phase quadriceps:hamstring (quad:ham) muscle activity ratio was greater in ACLREC than in ACLINT subjects. Finally, the injury risk phase quad:ham muscle activity ratio was found to be 4.8 times greater in females than in males. In conclusion, there are differences in muscle activity related to ACL status and sex that could potentially help explain graft failure risk and the sex bias. PMID:23966333

  2. Bone marrow edema-like lesions (BMELs) are associated with higher T1ρ and T2 values of cartilage in anterior cruciate ligament (ACL)-reconstructed knees: a longitudinal study

    PubMed Central

    Gong, Jingshan; Pedoia, Valentina; Facchetti, Luca; Link, Thomas M.; Ma, C. Benjamin

    2016-01-01

    Background To evaluate the longitudinal changes of bone marrow edema-like lesions (BMELs) in patients after anterior cruciate ligament (ACL) reconstruction and to investigate the effect of BMELs on cartilage matrix composition changes measured using MR T1ρ and T2 mapping. Methods Patients with acute ACL tear were enrolled in a prospective study. MR imaging was performed at baseline (before surgeries) and at 6-month, 1-year and 2-year after ACL reconstruction. MR imaging included sagittal high-resolution, 3D fast spin-echo (CUBE) sequences for BMEL evaluation, and 3D T1ρ mapping and T2 mapping for cartilage assessment. BMELs were assessed using whole-organ magnetic resonance imaging score (WORMS), and the volume of BMELs was measured by a semi-automatic method. Generalized estimating equation (GEE) was used to explore association between BMELs at baseline and cartilage changes during follow-up. Results Fifty four patients were included in the present study and 39 patients had completed 2-year follow-up. BMELs were noted in 42 injured knees (77.8%) with 105 lesions and in 7 contralateral knees (13.0%) with 9 lesions (χ2=45.763, P<0.001) at the baseline. The WORMS and volume of BMELs of the injured knees were 2.36±0.65 and 386.98±382.54 mm3 (r=0.681, P<0.001), respectively. 87 BMELs were found at baseline in 34 patients (87.2%) of the 39 patients who had completed 2 years follow-up. During the follow-up, 18 (20.7%), 12 (13.8%), and 5 (5.7%) baseline lesions were still seen at 6-month, 1-year and 2-year, respectively. The changes of BMELs prevalence regarding bone compartments over time points were statistically significant (χ2=163.660, P<0.001). Except T2 value at 6 months, T1ρ and T2 values of cartilage overlying baseline BMELs in the injured knees were higher than that of anatomically matched cartilage in the contralateral knees at baseline and each follow-up time-point. In the injured knees, GEE analysis showed that baseline BMELs were significantly

  3. 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.

  4. All-Epiphyseal, All-Inside Anterior Cruciate Ligament Reconstruction Technique for Skeletally Immature Patients

    PubMed Central

    McCarthy, Moira M.; Graziano, Jessica; Green, Daniel W.; Cordasco, Frank A.

    2012-01-01

    Anterior cruciate ligament (ACL) injuries are an increasingly recognized problem in the juvenile population. Unfortunately, outcomes with conservative treatment are extremely poor. Adult reconstruction techniques are inappropriate to treat skeletally immature patients because of the risk of physeal complications, including limb-length discrepancy and angular deformities. “Physeal-sparing” reconstruction techniques exist, but their ability to restore knee stability is not well understood. We describe an all-epiphyseal ACL reconstruction for use in skeletally immature patients. This is an all-inside technique with the femoral tunnel drilled retrograde and the tibial tunnel drilled retrograde; both tunnels are entirely within the epiphysis. Fixation of the hamstring autograft is achieved with soft-tissue buttons on both the femur and tibia. We present case examples for 2 patients who underwent the all-inside, all-epiphyseal reconstruction and our postoperative rehabilitation protocol. We present a novel surgical technique for an all-inside, all-epiphyseal ACL reconstruction in skeletally immature patients. PMID:23767001

  5. 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

  6. 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.

  7. All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Surgical Technique Using a Split Tibial Tunnel

    PubMed Central

    Lykissas, Marios G.; Nathan, Senthil T.; Wall, Eric J.

    2012-01-01

    Many techniques have been described for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients, including extra-articular, complete or partial transphyseal, and physeal-sparing techniques. An all-epiphyseal technique places the tendon and its tunnels and fixation all within the child's epiphysis, leaving the growth plates untouched. We describe an all-epiphyseal quadruple-hamstring ACL reconstruction using a split tibial tunnel. The split tibial tunnels drop the tunnel size down to 4.5 to 5.5 mm from 7 to 8 mm because only half the total graft diameter passes through each of the split tunnels. This increases the safety margin for keeping the tunnel within the tibial epiphysis, in addition to avoiding damage into the growth plate. The bone bridge between the 2 tunnels serves as a solid low-profile fixation post. Femoral graft fixation is achieved with an interference screw, which allows precise tensioning and low-profile fixation entirely within the femoral tunnel. By placing the graft at the native ACL's anatomic attachment points without spanning or violating the growth plates at any step of the procedure, an all-epiphyseal ACL reconstruction with a split tibial tunnel theoretically minimizes the risk of growth disturbance in an ACL-deficient child. PMID:23766968

  8. Anterior Cruciate Ligament (ACL) Injuries

    MedlinePlus

    ... Week of Healthy Breakfasts Shyness Anterior Cruciate Ligament (ACL) Injuries KidsHealth > For Teens > Anterior Cruciate Ligament (ACL) ... and Recovery Coping With an ACL Injury About ACL Injuries A torn anterior cruciate ligament (ACL) is ...

  9. Effect of ACL graft material on joint forces during a simulated in vivo motion in the porcine knee: examining force during the initial cycles.

    PubMed

    Boguszewski, Daniel V; Wagner, Christopher T; Butler, David L; Shearn, Jason T

    2014-11-01

    This study compared three-dimensional forces in knees containing anterior cruciate ligament (ACL) graft materials versus the native porcine ACL. A six-degree-of-freedom (DOF) robot simulated gait while recording the joint forces and moments. Knees were subjected to 10 cycles of simulated gait in intact, ACL-deficient, and ACL-reconstructed knee states to examine time zero biomechanical performance. Reconstruction was performed using bone-patellar tendon-bone allograft (BPTB), reconstructive porcine tissue matrix (RTM), and an RTM-polymer hybrid (Hybrid). Forces and moments were examined about anatomic DOFs throughout the gait cycle and at three key points during gait: heel strike (HS), mid stance (MS), toe off (TO). Compared to native ACL, each graft restored antero-posterior (A-P) forces throughout gait. However, all failed to mimic normal joint forces in other DOFs. For example, each reconstructed knee showed greater compressive forces at HS and TO compared to the native ACL knee. Overall, the Hybrid graft restored more of the native ACL forces following reconstruction than did BPTB, while RTM grafts were the least successful. If early onset osteoarthritis is in part caused by altered knee kinematics, then understanding how reconstruction materials restore critical force generation during gait is an essential step in improving a patient's long-term prognosis.

  10. Incidence and Characterization of Injury to the Infrapatellar Branch of the Saphenous Nerve after ACL Reconstruction: A Prospective Study

    PubMed Central

    Cohen, Steven B.; Ciccotti, Michael C.; Dodson, Christopher C.; Tjoumakaris, Fotios P.; Salvo, John P.; Marchetto, Paul A.; Watson, Ryan A.; Salminen, Matthew Robert; Flato, Russell R.; O'Brien, Daniel Francis

    2014-01-01

    Objectives: The infrapatellar branch of the saphenous nerve is commonly injured in anterior cruciate ligament reconstruction (ACLR) causing sensory deficits around the knee. The primary purpose of this prospective study was to determine the incidence of patient reported sensory deficits around the knee following ACLR. The secondary purpose was to determine if sensory deficits caused by intraoperative injury present at 6 weeks changed in severity and total area after 6 months and 1 year postoperatively. Methods: Two-hundred and fifty patients that underwent ACLR with or without meniscal repair were prospectively enrolled. Variables for each patient included: type of graft, direction of tibial incision, number of portals, and length of surgical incision. The grafts used were categorized into three types: Allograft (allo), hamstring autograft (HS), or patella tendon autograft (BTB). At 6 weeks, patients completed a questionnaire to ascertain any sensory deficits over their knee. Patients rated their sensory deficit on a scale from 0-10 (“0” = (no deficit) to “10” (complete lack of sensation) and shaded areas on a picture of a knee split into nine rectangular segments (3 by 3 grid) to determine the location of any numbness. Patients completed the same questionnaire at 6 months and 1 year. Any patient that was noted to have no stated numbness at 6 weeks or 6 months was noted to have completed the study. A mixed effects linear regression model was used to identify variables which were predictors for the patient-reported severity of numbness. Results: Overall, 67/221 (30.3%) patients who underwent ACLR stated that they had no numbness at 6 weeks. Of those patients who reported numbness at 6 weeks, 16.6% (25/151) considered their numbness completely resolved by six months. At 1 year, 73.2% (90/123) reported their numbness had gotten better and 14.2% (18/123) considered their numbness resolved. The most common location of numbness was along the inferolateral aspect

  11. 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

  12. 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.

  13. 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

  14. Continuous ACL graft, results

    PubMed Central

    Díaz, Jorge Luis; Vega, Marcelo; Matesevach, Ivan

    2017-01-01

    Objectives: describe our technique using hamstring graft that respects the proximal continuity of Semitendinosus and uses the superior biological potential of the distal periosteum., preserving and stressing the ST reinforce the retropulsión and dynamic control of external rotation of the knee. Here the technique, results, difficulties and foundations. Methods: The sample of this research was composed of 229 cases operated between 01/03/97 and 01/03/13 in Arthroscopy Private Center., 166 male and 63 female, the postop follow-up was 86 months. Evaluated with IKDC, Lysholm, Hamstring EMG. Comparative histology study in rabbits. Results: IKDC and Lysholm score showed 93% of very good results. Conclusion: Dynamic ACL reconstruction achieves a static-dynamic stabilization of the knee. Grafts have a plus in their biological potential (proximal continuity - osteo-periosteal insertion of the tendons in the femoral tunnel). The hamstring maintains its functionality (EMG). 93% satisfactory results (IKDC, Lysholm). It is a valid surgical option in ACL injuries.

  15. 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

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

    PubMed Central

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

    2017-01-01

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

  17. 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

  18. 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

  19. The characteristics of EEG power spectra changes after ACL rupture

    PubMed Central

    Miao, Xin; Huang, Hongshi; Hu, Xiaoqing; Li, Dai; Yu, Yuanyuan; Ao, Yingfang

    2017-01-01

    Background Reestablishing knee stability is the core of the treatment of ACL (Anterior Cruciate Ligament) injury. Some patients still have a feeling of instability of the knee after ACL injury treatment. This unstable feeling may be caused by central nervous system changes after ACL rupture. Methods To identify the central changes after ACL rupture, EEG spectra were recorded to compare ACL patients and healthy controls when they were walking, jogging, and landing. Results There was a significant increase in delta, theta, alpha and beta band power during walking, jogging and landing in ACL patients. We also found an asymmetry phenomenon of EEG only in the ACL patients, mainly in the frontal area and central-parietal area. The asymmetry of beta band power extended to the frontal and the central area during jogging and landing task. Conclusions There were significant differences in EEG power spectra between the ACL patients and healthy people. ACL patients showed high EEG band power activities and an asymmetry phenomenon. EEG power changes were affected by movements, the asymmetry extended when performing more complicated movements. PMID:28182627

  20. 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.

  1. 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.

  2. The use of autologous chondrocyte implantation following and combined with anterior cruciate ligament reconstruction

    PubMed Central

    Bartlett, W.; Gooding, C. R.; Sood, M.; Skinner, J. A.; Carrington, R. W.J.; Briggs, T. W.R.; Bentley, G.

    2005-01-01

    We report our experience of using autologous chondrocyte implantation (ACI) to treat osteochondral defects of the knee in combination with anterior cruciate ligament (ACL) reconstruction. The outcome of symptomatic osteochondral lesions treated with ACI following previous successful ACL reconstruction is also reviewed. Patients were followed for a mean of 23 months. Nine patients underwent ACL reconstruction in combination with ACI. Mean modified Cincinnati knee scores improved from 42 to 69 following surgery. Seven patients described their knee as better and two as the same. A second group of nine patients underwent ACI for symptomatic articular cartilage defects following previous ACL reconstruction. In this group, the mean modified Cincinnati knee score improved from 53 to 62 after surgery. Six patients described their knee as better and three as worse. Combined treatment using ACI with ACL reconstruction is technically feasible and resulted in sustained improvement in pain and function. The results following previous ACL reconstruction also resulted in clinical improvement, although results were not as good as following the combined procedure. PMID:16320051

  3. 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.

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

    PubMed Central

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

    2017-01-01

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

  5. 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

  6. Femoral and Tibial Tunnel Diameter and Bioabsorbable Screw Findings After Double-Bundle ACL Reconstruction in 5-Year Clinical and MRI Follow-up

    PubMed Central

    Kiekara, Tommi; Paakkala, Antti; Suomalainen, Piia; Huhtala, Heini; Järvelä, Timo

    2017-01-01

    Background: Tunnel enlargement is frequently seen in short-term follow-up after anterior cruciate ligament reconstruction (ACLR). According to new evidence, tunnel enlargement may be followed by tunnel narrowing, but the long-term evolution of the tunnels is currently unknown. Hypothesis/Purpose: The hypothesis was that tunnel enlargement is followed by tunnel narrowing caused by ossification as seen in follow-up using magnetic resonance imaging (MRI). The purpose of this study was to evaluate the ossification pattern of the tunnels, the communication of the 2 femoral and 2 tibial tunnels, and screw absorption findings in MRI. Study Design: Case series; Level of evidence, 4. Methods: Thirty-one patients underwent anatomic double-bundle ACLR with hamstring grafts and bioabsorbable interference screw fixation and were followed with MRI and clinical evaluation at 2 and 5 years postoperatively. Results: The mean tunnel enlargement at 2 years was 58% and reduced to 46% at 5 years. Tunnel ossification resulted in evenly narrowed tunnels in 44%, in conical tunnels in 48%, and fully ossified tunnels in 8%. Tunnel communication increased from 13% to 23% in the femur and from 19% to 23% in the tibia between 2 and 5 years and was not associated with knee laxity. At 5 years, 54% of the screws were not visible, with 35% of the screws replaced by a cyst and 19% fully ossified. Tunnel cysts were not associated with worse patient-reported outcomes or knee laxity. Patients with a tibial anteromedial tunnel cyst had higher Lysholm scores than patients without a cyst (93 and 84, P = .03). Conclusion: Tunnel enlargement was followed by tunnel narrowing in 5-year follow-up after double-bundle ACLR. Tunnel communication and tunnel cysts were frequent MRI findings and not associated with adverse clinical evaluation results. PMID:28203605

  7. 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

  8. Postural stability and responses to vibrations in patients after anterior cruciate ligament surgical reconstruction.

    PubMed

    Hirjaková, Z; Šingliarová, H; Bzdúšková, D; Kimijanová, J; Bučková, K; Valkovič, P; Hlavačka, F

    2016-10-24

    The aim of the study was to evaluate the effect of surgical reconstruction of anterior cruciate ligament (ACL) on postural stability and responses to lower limb (LL) muscles vibrations. Centre of pressure (CoP) was measured in 17 subjects during stance on firm/foam surface with eyes open/closed and during unilateral vibrations of LL muscles (m. triceps surae - TS, m. quadriceps femoris - Q, m. quadriceps femoris and hamstrings simultaneously - QH). The measurements were performed: 1) preoperatively, 2) six weeks and 3) three months after the reconstruction. Decreased postural stability was documented six weeks after the reconstruction compared to preoperative measurement. Three months after the reconstruction significant improvement was observed during stance on foam surface with eyes closed. Preoperatively, altered reactions of LL with ACL lesion compared to intact LL were manifested by slower response in first 3 s of TS vibration and by increased CoP shift in last 5 s of QH vibration. After the reconstruction, we observed slower CoP reaction and decreased CoP shift during TS vibration of LL with ACL lesion compared to preoperative level. Posturography during quiet stance and during TS vibration reliably detect postural changes due to ACL reconstruction and can be potentially useful in clinical practice.

  9. 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

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

    PubMed Central

    Hur, Chang-Ik; Song, Eun-Kyoo; Kim, Sung-Kyu; Lee, Seung-Hun; Seon, Jong-Keun

    2017-01-01

    Background: Early ACL reconstruction, before retuning to activity eliminates recurrent episodes of instability and thereby decreases chances of meniscal and cartilage injury. However, there are no clear and uniform guidelines regarding the timing of ACL reconstruction or clarity in the definition of early and delayed reconstruction to reduce the complications after reconstruction in the ACL injured knee. The purpose of this study was to compare the clinical outcome, stability, muscle power, and postural control after early and delayed anterior cruciate ligament (ACL) reconstruction. Materials and Methods: Patients who had ACL reconstruction with a quadruple hamstring tendon with a minimum 2-year followup were evaluated. Early (within 3 weeks) reconstruction group was 48 knees and delayed (more than 3 months) group was 43 knees. We compared the two groups with regard to Lysholm knee score, range of motion (ROM), Lachman test, Tegner activity scale, associated meniscal or chondral injuries, and anterior laxity. We also compared muscle strength with an isokinetic dynamometer and postural control with computed dynamic posturography at the final followup. Results: While 50% of early and 70% of delayed group had meniscal injuries (P = 0.06), of which were reparable in 42% of early group and 17% of delayed group (P = 0.04). However, there was no significant difference in cartilage injury (P = 0.14). At the final followup, no significant differences were found between two groups for Lysholm score (P = 0.28), Tegner activity scale (P = 0.27), and ROM. The stabilities regarding Lachman and pivot-shift tests, and anterior laxity also showed no significant differences between two groups. The mean extension and flexion muscles power, and postural control showed no significant inter-group differences (P > 0.05). Conclusions: Early ACL reconstruction had excellent clinical results and stability as good as delayed reconstruction without the problem of knee motion, muscle power

  11. Reconstructive Surgery in the Thermally Injured Patient

    DTIC Science & Technology

    2012-01-01

    lateral thoracic, lower abdom- inal, or groin areas are chosen. Since harvesting includes removal of all regenerative dermal layers down to adipose tissue...Understanding and managing burn pain : part 1. Am J Nursing 2009;109:4. 113Reconstructive Surgery in the Thermally Injured Patient

  12. Fungal osteomyelitis after arthroscopic anterior cruciate ligament reconstruction: a case report with review of the literature.

    PubMed

    Sun, Lei; Zhang, Lei; Wang, Kai; Wang, Wei; Tian, Min

    2012-10-01

    Fungal osteomyelitis is a very rare complication after anterior cruciate ligament (ACL) reconstruction associated with catastrophic consequences. Herein, we present a case of such disastrous complication after ACL reconstruction. A 23-year-old man developed fever, swelling and pain of the affected knee from 18 days after arthroscopic ACL reconstruction. Therefore, he underwent arthroscopic debridement, removal of the graft and internal fixators, irrigation and suction drainage, successively. Negative results for serial bacterial cultures and smear examinations are obtained. However, computer tomography and X-ray examination showed massive bone destruction at 48 days after ACL reconstruction. As the first open debridement was performed at 50 days after ACL reconstruction, fungal infection was diagnosed based on finding Aspergillus hyphae in pathologic examination of the debrided bone sample. After the final debridement, a 12-cm bone loss in the distal femur was treated by Ilizarov's bone transport. The patient got solid arthrodesis of the affected knee without clinical infection at a year after the initial operation. In addition, a review of the literature regarding case reports of fungal osteomyelitis after ACL reconstruction is presented.

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. Anterior cruciate ligament reconstruction tunnel size: causes of tunnel enlargement and implications for single versus two-stage revision reconstruction.

    PubMed

    Rizer, Magda; Foremny, Gregory Brian; Rush, Augustus; Singer, Adam D; Baraga, Michael; Kaplan, Lee D; Jose, Jean

    2017-02-01

    Anterior cruciate ligament (ACL) reconstructions have increased over the past 25 years. The increased incidence of ACL reconstructions has translated into a larger number of graft failures and revision ACL procedures. It is important to understand the causes of graft failure when evaluating for a revision ACL reconstruction and to appreciate changes in tunnel anatomy over time prior to planning revision surgery. In this manuscript, tunnel size for ACL reconstruction and implications for single-stage versus two-stage revision ACL reconstruction will be discussed, as well as causes of tunnel enlargement, including mechanical and biological factors.

  18. Quadriceps Strength, Muscle Activation Failure, and Patient-Reported Function at the Time of Return to Activity in Patients Following Anterior Cruciate Ligament Reconstruction: A Cross-sectional Study

    PubMed Central

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

    2016-01-01

    Study Design Cross-sectional. Objectives To determine if quadriceps activation failure (QAF) moderates the relationship between quadriceps strength and physical function in individuals post-anterior cruciate ligament (ACL) reconstruction. Background QAF may impair the recovery of physical function post ACL reconstruction, given that QAF reduces strength, and strength is related to physical function. Evidence of this relationship has been found in individuals with knee osteoarthritis, wherein patients with lower strength and greater QAF had lower levels of physical function. Methods Participants consisted of 52 individuals who were cleared for return to activity at an average ± SD of 7.4 ± 1.2 months post ACL reconstruction. QAF was assessed using the superimposed burst technique and quadriceps strength was assessed using concentric isokinetic contractions (Nm/kg). Physical function was quantified using a combined variable of physical (single leg hop for distance) and self-reported function (International Knee Documentation Committee form) calculated using a principal component analysis (PCPF). Simple correlations were then performed to determine the order in which variables were entered into the regression model to evaluate if QAF moderates the relationship between quadriceps strength and physical function. Results The combination of quadriceps strength and the interaction of strength-by-QAF predicted 30% of the variance in physical function (R2=0.30, P<.001; PCPF = -0.61strength + 0.20interaction - 1.896); however the interaction of strength-by-QAF only accounted for 7% of the capabilities of the model (P=.023). Conclusion Physical function is largely influenced by the recovery of quadriceps strength and minimally attenuated by QAF. These data suggest that QAF may affect individuals post ACL reconstruction differently, and to a lesser extent, than knee individuals with knee osteoarthritis. PMID:26471854

  19. The effects of ACL injury on quadriceps and hamstring torque, work and power.

    PubMed

    Pincivero, Danny M; Heller, Brandan M; Hou, Su-I

    2002-09-01

    The aim of this study was to assess isokinetic torque, work and power between non-injured, ACL (anterior cruciate ligament)-deficient and ACL-reconstructed individuals. Ten healthy, non-injured individuals, seven unilateral ACL-deficient individuals and six unilateral ACL-reconstructed individuals were assessed for isokinetic quadriceps and hamstring strength at 1.05 and 3.14 rad.s-1. Peak torque, total work, average power and the ratio of peak torque to body mass were computed for both velocities. Peak torque was also corrected for body mass, using allometric modelling. The non-injured individuals showed significantly greater quadriceps peak torque to body mass ratios than the ACL-deficient and ACL-reconstructed individuals at both velocities, and greater hamstring peak torque to body mass ratios than the ACL-deficient group at 3.14 rad.s-1 (P < 0.05). The ACL-deficient individuals displayed greater quadriceps and hamstring peak torque, total work and average power than the non-injured individuals at 1.05 rad.s-1 (P < 0.05). The ACL-deficient individuals also displayed significantly greater peak torque, total work and average power than the ACL-reconstructed individuals for the quadriceps at both velocities (P < 0.05). The ACL-deficient individuals demonstrated greater hamstring peak torque and total work than the non-injured individuals at both velocities (P < 0.05). The allometrically modelled peak torques at both isokinetic velocities demonstrated that the quadriceps muscle values were significantly higher in the non-involved than the involved limb. The hamstring peak torques corrected for body mass were significantly higher in the non-involved than the involved limb only at 1.05 rad.s-1. The main finding from the present study is that isokinetic measures in ratio-scaled or absolute units yield a different outcome and, hence, interpretation compared with the allometric approach.

  20. Osteoarthritis Prevalence Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Numbers-Needed-to-Treat Analysis

    PubMed Central

    Luc, Brittney; Gribble, Phillip A.; Pietrosimone, Brian G.

    2014-01-01

    Objective: To determine the prophylactic capability of anterior cruciate ligament (ACL) reconstruction in decreasing the risk of knee osteoarthritis (OA) when compared with ACL-deficient patients, as well as the effect of a concomitant meniscectomy. We also sought to examine the influence of study design, publication date, and graft type as well as the magnitude of change in physical activity from preinjury Tegner scores in both cohorts. Data Sources: We searched Web of Science and PubMed databases from 1960 through 2012 with the search terms osteoarthritis, meniscectomy, anterior cruciate ligament, anterior cruciate ligament reconstruction, and anterior cruciate ligament deficient. Study Selection: Articles that reported the prevalence of tibiofemoral or patellofemoral OA based on radiographic assessment were included. We calculated numbers needed to treat and relative risk reduction with associated 95% confidence intervals for 3 groups (1) patients with meniscal and ACL injury, (2) patients with isolated ACL injury, and (3) total patients (groups 1 and 2). Data Extraction: A total of 38 studies met the criteria. Of these, 27 assessed the presence of tibiofemoral osteoarthritis in patients treated with anterior cruciate ligament reconstruction. Data Synthesis: Overall, ACL reconstruction (ACL-R) yielded a numbers needed to treat to harm of 16 with a relative risk increase of 16%. Anterior cruciate ligament reconstruction along with meniscectomy yielded a numbers needed to treat to benefit of 15 and relative risk reduction of 11%. Isolated ACL-R showed a numbers needed to treat to harm of 8 and relative risk increase of 43%. Activity levels were decreased in both ACL-R (d = −0.90; 95% confidence interval = 0.77, 1.13) and ACL-deficient (d = −1.13; 95% confidence interval = 0.96, 1.29) patients after injury. Conclusions: The current literature does not provide substantial evidence to suggest that ACL-R is an adequate intervention to prevent knee osteoarthritis

  1. 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

  2. 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

  3. Radiation risk from fluoroscopically-assisted anterior cruciate ligament reconstruction

    PubMed Central

    Chitnavis, JP; Karthikesaligam, A; Macdonald, A; Brown, C

    2010-01-01

    INTRODUCTION Precise tunnel positioning is crucial for success in anterior cruciate ligament (ACL) reconstruction. The use of intra-operative fluoroscopy has been shown to improve the accuracy of tunnel placement. Although radiation exposure is a concern, we lack information on the radiation risk to patients undergoing fluoroscopically-assisted ACL reconstruction with a standard C-arm. The aim of our study was to determine the mean radiation doses received by our patients. PATIENTS AND METHODS Radiation doses were recorded for 18 months between 1 April 2007 and 30 September 2008 for 58 consecutive patients undergoing ACL reconstruction assisted by intra-operative fluoroscopy. Dose area product (DAP) values were used to calculate the entrance skin dose (ESD), an indicator of potential skin damage and the effective dose (ED), an indicator of long-term cancer risk, for each patient. RESULTS The median age of 58 patients included in data analysis was 28 years (range, 14–52 years), of whom 44 were male (76%). The mean ESD during intra-operative fluoroscopy was 0.0015 ± 0.0029 Gy. The mean ED was 0.001 ± 0.002 mSv. No results exceeded the threshold of 2 Gy for skin damage, and the life-time risk of developing new cancer due to intra-operative fluoroscopy is less than 0.0001%. CONCLUSIONS Radiation doses administered during fluoroscopically-assisted ACL reconstruction were safe and do not represent a contra-indication to the procedure. PMID:20501019

  4. Computer-assisted anterior cruciate ligament reconstruction. Four generations of development and usage.

    PubMed

    Klos, Tiburtius V S

    2014-12-01

    The purpose of this paper is to review the literature about the contribution of navigation in anterior cruciate ligament (ACL) reconstruction. The evolution of computer-assisted surgery (CAS) for ACL reconstruction has undergone several steps. These steps were divided into 4 subsequent developments: (1) positioning of ACL graft placement; (2) laxity measurement of ACL reconstruction (quality control); (3) kinematic evaluation during ACL reconstruction (navigated pivot shift); (4) case-specific individual ACL reconstruction with adjustments and additional reconstruction options. CAS has shown to improve femoral tunnel positioning, even if clinical outcomes do not improve results of manual techniques. CAS technology has helped researchers better understand the effects of different ACL reconstruction techniques and bundles replacements on joint laxity and to describe tunnel positioning in relation to native ACL insertion. CAS in ACL surgery can improve results at time zero and can improve knowledge in this field.

  5. Anterior Cruciate Ligament Reconstruction: Clinical Outcomes of Patella Tendon and Hamstring Tendon Grafts

    PubMed Central

    Gulick, Dawn T.; Yoder, Heather N.

    2002-01-01

    An injury to the ACL can result in significant functional impairment. It has been estimated that more than 100,000 new ACL injuries occur each year. Surgeons employ numerous techniques for reconstruction of the ACL. Of critical importance is the source of the graft to replace the damaged ACL. The graft choices include autografts (the patient's own tissue), allografts (donor tendon), and synthetic/prosthetic ligaments. Tissue harvest sites for autografting include the middle third of the patella tendon, the quadriceps tendon, semitendinosus tendon, gracilis tendon, iliotibial band, tensor fascia lata, and the Achilles tendon. Selection of the type of graft material is predicated upon the tissue's ability to tolerate high levels of stress. Likewise, the clinical presentation and functional outcome is related to the graft material selected. This manuscript specifically examined the patella tendon and hamstring tendon grafts. Numerous manuscripts that studied the outcomes of these graft materials were compiled to help the clinician appreciate the advantages and disadvantages of each of the graft materials. Outcome measures such as thigh circumference, knee range of motion, isokinetic strength, knee stability, pain, and vertical jump/1-leg hop were incorporated. The purpose of this manuscript was to compare and contrast the clinical presentation of patients who underwent an ACL reconstruction using the patella tendon versus the hamstring tendons. This information can be valuable to the clinician when considering the rehabilitation protocol after ACL reconstruction. PMID:24701126

  6. Anterior Cruciate Ligament (ACL) Injuries

    MedlinePlus

    ... what the surgeon advises. previous continue Rehab and Recovery Recovery from ACL surgery can take from 6 months ... frequent therapy, but they won't necessarily speed recovery. In the early stages of recovery, a doctor ...

  7. Anterior cruciate ligament (ACL) injury

    MedlinePlus

    ... proper techniques when playing sports or exercising. Some college sports programs teach athletes how to reduce stress placed on the ACL. The use of knee braces during vigorous athletic activity ( ...

  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. 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

  10. Single-Stage Reconstruction of Both Cruciate Ligaments

    PubMed Central

    Andreoli, Mauro; Zicaro, Juan Pablo; Yacuzzi, Carlos; Costa-Paz, Matias

    2017-01-01

    Objectives: Isolated Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL), or central pivot lesions are rare. These are frequently associated with collateral ligaments injuries. The purpose of this retrospective study was to evaluate clinical and functional outcomes of 4 patients with acute ACL and PCL injury who underwent a simultaneous single-stage arthroscopic reconstruction. Methods: The inclusion criteria were patients with isolated ACL and PCL injuries, with a minimum follow-up of 2 years. We evaluated the type of graft used, the surgical technique and postoperative complications. The scales used for clinical evaluation were the Knee Society Score (KSS), IKDC, Lysholm and Tegner. Knee stability was assessed using the KT-1000 arthrometer. Results: Three men and one woman, with an average age of 48 years (45 to 56 years) were evaluated. Three presented a sport injury and one a car accident. Mean follow-up was 8 years. In all patients allograft was used for ligament reconstruction. Average postoperative results were: KSS 74-82, Lysholm 76, IKDC 63 and Tegner 6. KT-1000 arthrometer showed an average difference of 4mm compared to the contralateral knee. One patient underwent reintervention due to meniscal injury. Conclusion: ACL and PCL simultaneous single-stage reconstruction is a really demanding surgery. We achieved good results using allograft for both ligaments reconstruction. No clinical or functional postoperative complications were recorded.

  11. 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

  12. Is bone tunnel osseointegration in hamstring tendon autograft anterior cruciate ligament reconstruction important?

    PubMed

    Logan, Martin; Williams, Andy; Myers, Peter

    2003-10-01

    A 27-year-old man underwent anterior cruciate ligament (ACL) reconstruction using 4-strand hamstring autograft with femoral and tibial interference screw fixation. Four weeks after surgery, he developed a discharging hematoma through the graft harvest-tibial tunnel incision, which persisted. The patient required further surgical intervention 7 weeks after the initial surgery. The wound was debrided, the tibial interference screw was removed, and the tibial tunnel was completely cleared of graft remnants. Arthroscopy of the knee was performed, in which the ACL graft appeared healthy and viable. No evidence of intra-articular sepsis was found. Postoperatively, the rehabilitation program was uneventful and, at 36 months, the patient has unrestricted activity and no clinical evidence of excessive ACL laxity. This case supports the importance of marginal articular surface healing of the ACL graft, suggesting that tibial intratunnel healing becomes redundant.

  13. 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.

  14. Effect of Anterior Tibiofemoral Glides on Knee Extension during Gait in Patients with Decreased Range of Motion after Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Hunt, Michael A.; Di Ciacca, Stephen R.; Jones, Ian C.; Padfield, Beverley

    2010-01-01

    ABSTRACT Purpose: The purpose of this preliminary investigation was to evaluate the effect of anterior tibiofemoral glides on maximal knee extension and selected spatiotemporal characteristics during gait in patients with knee extension deficits after anterior cruciate ligament (ACL) reconstruction. Methods: Twelve patients with knee-extension deficits after recent ACL reconstructions underwent quantitative gait analyses immediately before and after 10 minutes of repeated anterior tibiofemoral glides on the operative limb, and again after a 10-minute seated rest period. Results: Maximum knee extension during stance phase of the operative limb significantly increased immediately after the treatment (mean increase: 2.0°±4.1°, 95% CI: 0.6°–3.3°). Maximum knee extension decreased after the 10-minute rest period (mean decrease: 0.9°±1.8°, 95% CI: −0.1°–1.8°), although the decrease was not statistically significant. Small increases in operative limb step length, stride length, and gait speed were observed after the rest period compared to baseline values only. Conclusions: A single session of anterior tibiofemoral glides increases maximal knee extension during the stance phase of gait in patients with knee-extension deficits. Increases in knee extension are small and short-lived, however, suggesting that continued activity is required to maintain the observed improvements. PMID:21629602

  15. Patient satisfaction following nipple reconstruction incorporating autologous costal cartilage

    PubMed Central

    Lipa, Joan E; Addison, Patrick D; Neligan, Peter C

    2008-01-01

    BACKGROUND: Nipple-areolar reconstruction completes post-mastectomy breast reconstruction. Many techniques for nipple reconstruction have been described, and each has their advocates and critics. One of the frequent failings of most designs is loss of nipple projection with time. OBJECTIVES: To determine the effect of including autologous costal cartilage on patient satisfaction with their nipple reconstruction. METHODS: Sixty-eight patients were identified who had undergone fishtail flap nipple reconstruction following autologous free flap breast reconstruction between 1990 and 2004. Qualitative questionnaires, using Likert scales, were sent to each patient to specifically assess their satisfaction with their nipple reconstruction. RESULTS: Of 26 respondents (mean ± SEM follow-up period 3.7±3.6 years), 13 had undergone nipple reconstruction incorporating costal cartilage banked at the time of initial breast reconstruction, and the other 13 had no cartilage in their nipple reconstructions. While both groups would opt for nipple reconstruction again, patients with cartilage grafts incorporated into their reconstructions had overall satisfaction ratings 1.92 grades higher on average (not significant, P=0.12) than those without. This difference increased to 3.2 grades when the satisfaction of the patient’s partner was taken into account (P<0.05). Improved satisfaction corresponded to higher scores for volume, consistency, texture, and particularly for projection and contour of the nipple (P<0.05). Although nipple morphology changed over time, there was a trend toward improved stability in the cartilage group. CONCLUSIONS: Patient satisfaction with nipple reconstruction can be improved by incorporating costal cartilage beneath the skin flaps. Superior contour and projection are sustained over time. PMID:19554171

  16. 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

  17. ACL Injury, Return To Play And Reinjury In The Elite, Collegiate Athlete: An Analysis Of A Single, Division I NCAA Cohort

    PubMed Central

    Kamath, Ganesh V.; Murphy, Timothy; Creighton, Robert A.; Taft, Timothy N.; Spang, Jeffrey T.

    2014-01-01

    Objectives: Graft survivorship, reinjury rates, and career length are poorly understood after ACL reconstruction in the elite, NCAA Division-I athlete. The purpose of this study was to examine the outcomes of ACL reconstruction in a Division-I athlete cohort. Methods: Retrospective chart review was performed of all Division-I athletes at a single, public university from 2000 to 2009 until completion of eligibility. Athletes with a Pre-collegiate (PC) and Intra-collegiate (IC) ACL reconstruction were separated into two cohorts. Graft survivorship, reoperation rates, and career length information was collected. Results: 35 athletes were identified with a pre-collegiate (PC) ACL reconstruction; 60 with an intra-collegiate (IC) reconstruction. The PC group had a 17.1% injury rate to the original graft, with a 20.0% rate of contralateral ACL injury. For the IC group, the reinjury rates were 1.9% to the ACL graft, with a 9.2% rate of contralateral ACL injury after an IntraCollegiate ACL reconstruction. The PC group used 78% of their total eligibility (avg 3.11 yrs). Athletes in the IC group used an average of 77% of their remaining NCAA eligibility. 88.3% of the IC group played an additional non-redshirt year after their injury. Reoperation rate for the PC group was 51.4% and 20.3% for the IC group. Conclusion: Reoperation and reinjury rates are high after ACL reconstruction in the Division-I athlete. Pre-collegiate ACL reconstruction is associated with a very high rate of repeat ACL reinjury to the graft or opposite knee (37.1%). The majority of athletes are able to return to play after successful reconstruction.

  18. [Reconstruction of the ear in the burns patient].

    PubMed

    Carrillo-Córdova, Jorge Raúl; Jiménez Murat, Yusef; Apellaniz-Campo, Armando; Bracho-Olvera, Hazel; Carrillo Esper, Raúl

    2017-03-06

    Face burns are a singular pathology with great functional and psychological impact in the patients suffering them. The ears play a fundamental role in personal interactions and damage to this organ results in physical and emotional distress. The reconstructive treatment of the burned ear is a challenge. Multiple procedures have been described to achieve success in the reconstruction of the burned ear; immediate reconstruction with autologous rib cartilage, secondary reconstruction, alloplastic material reconstruction, tissue expansion, skin grafts and also microvascular flaps are some of the most common procedures used in this patients. All these techniques focus on giving a natural appearance to the patient. Burns to the ears affect 30% of the patients with facial burns, they require an excellent treatment given by a multidisciplinary team.

  19. Posteromedial Corner Reconstruction

    PubMed Central

    Ferrer, Gonzalo; Leon, Agustín; Wirth, Hans; Mena, Adolfo; Tuca, María José; Espinoza, Gonzalo

    2017-01-01

    Objective: Report the experience, after 1-year follow-up, of 30 patients who underwent anatomical knee reconstruction of posteromedial corner (PMC) injuries, using La Prade´s Technique. Methods: Retrospective cohort study of 30 consecutive patients with PMC injuries operated between November 2010 and May 2014 by the same surgical team. Inclusion criteria: patients with clinical presentation and images (stress radiographs and MRI) compatible with PMC injury, who maintained a grade III chronic instability in spite of at least 3 months of orthopedic treatment, who were reconstructed using La Prade’s anatomical technique, and completed at least 12 months of follow-up. Exclusion criteria: discordance between clinical and image studies, grade I or II medial instability, and surgery performed through a different technique. Data was collected by reviewing the electronic files and images. Functional scores (IKDC and Lysholm) were applied and registered in the preoperative evaluation, and then 6 and 12 months after surgery. Results: Thirty patients (28 men and 2 women) met the inclusion criteria. Mean age was 43 years (24-69). The vast majority (28 patients) had a high-energy mechanism of injury. Twenty patients were diagnosed in the acute setting, while 10 had a delayed diagnosis after poor results of concomitant ligament reconstructions. With the exception of 2 patients, who presented with isolated PMC injury, the majority had associated injuries as detailed: 11 cases had PMC + anterior cruciate ligament (ACL) injury, 3 patients had PMC + posterior cruciate ligament (PCL) injury, 3 patients had PMC + meniscal tears, 9 patients had PMC + ACL + PCL injuries, and there were 2 cases of PMC + ACL + PCL + lateral collateral ligament injuries. Mean time for PMC reconstruction surgery was 5 months (range 2-32). Lysholm and IKDC scores were 18,2 (2-69) and 24,3 (9,2-52,9) respectively in the preoperative setting, improving to 76,7 (44-94) and 70,7 (36,8-95,4) after 1-year follow

  20. 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

  1. Chest wall reconstruction in a pediatric patient with ectopia cordis.

    PubMed

    Mohan, Raja; Peralta, Mat; Perez, Ramiro; Rosenkranz, Eliot R; Panthaki, Zubin J

    2010-08-01

    Ectopia cordis is defined as a congenital malposition of the heart outside of the thoracic cavity. It is a rare condition, and complete ectopia cordis can be a fatal condition. Successful surgical reconstruction of this defect has been reported but is uncommon. The general approach to reconstructing the chest wall involves repositioning the heart and providing adequate coverage of the chest wall defect. We describe our experience with a patient who had complete thoracic ectopia cordis treated with staged chest wall reconstruction. The first stage involved temporary closure with synthetic material, and the second stage involved definitive reconstruction with autologous bone and cartilage grafts supported with plates. The patient has been active and without complaints since the second stage and is awaiting tracheal decannulation. There have been a few descriptions of how to approach chest wall reconstruction in patients with ectopia cordis. The 2 stage method described can be considered to repair the chest wall defect in complete thoracic ectopia cordis.

  2. 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

  3. Reconstructive surgery in immunocompromised patients: evaluation and therapy

    PubMed Central

    Dunda, Sebastian E.; Bozkurt, Ahmet; Pallua, Norbert; Krapohl, Björn Dirk

    2015-01-01

    Background: An increasing number of patients undergoing reconstructive surgery are immunocompromised due to different reasons and different medical treatments. Some of the used immunosuppressive drugs may affect the process of wound healing and thereby, impair the long-term success of surgical treatment. Therefore, this retrospective analysis aimed at the evaluation of the perioperative treatment and surgical outcome of immunocompromised patients undergoing different reconstructive procedures. Methods: A retrospective review was performed of 8 immunocompromised patients with different primary diseases who needed reconstructive surgery: 2 patients with non-Hodgkin lymphoma, 1 patient with an acute myeloid leukemia, 1 patient with colitis ulcerosa, 1 patient with liver cirrhosis, 1 patient with chronic polyarthritis, and 2 patients with malignant melanoma. Results: In 7 of our 8 presented cases, multiple operations with wound debridements have been necessary to optimize the granulation of the wound bed before reconstructive surgery. 3 out of these 7 patients required further operations due to wound dehiscence or necrosis, with 2 of them as a result of increased immunosuppressive therapy. 5 out of 8 patients needed no further surgical treatment. Conclusions: Both the perioperative drug therapy and the reconstructive surgery concept need to be determined carefully in each individual case of the immunocompromised patients. Thus, the appropriate point in time of operation to achieve the best possible wound healing as well as the complexity of the procedure will require the consideration of a ‘less is more’ strategy in selected cases. PMID:26734539

  4. 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.

  5. Anatomical reference point for harvesting a flexor graft during arthroscopic reconstruction of the anterior cruciate ligament☆

    PubMed Central

    de Lima Lopes, Clécio; Arantes, Gabriel; de Oliveira, Rodrigo Victor Lapenda; Pinto, Dilamar Moreira; Gonçalves, Marcelo Carvalho Krause; Gonçalves, Romeu Carvalho Krause

    2015-01-01

    Objectives To evaluate the prevalence of a vascular network adjacent to the insertion of the pes anserinus, so that it could be used as an anatomical reference point to facilitate harvesting flexor grafts for arthroscopic reconstruction of the anterior cruciate ligament (ACL). Methods Thirty patients with ACL tears who were going to undergo ACL reconstruction using the tendons of the semitendinosus and gracilis muscles as grafts were selected randomly. During the harvesting of these tendons, the presence or absence of this anatomical reference point was noted. Results All the patients presented a vascular network of greater or lesser diameter. Conclusion The vascular network seems to be a good reference point during harvesting of the tendons of the semitendinosus and gracilis muscles, for facilitating graft harvesting. PMID:26229911

  6. Access to Breast Reconstruction and Patient Perspectives on Decision Making

    PubMed Central

    Morrow, Monica; Li, Yun; Alderman, Amy K.; Jagsi, Reshma; Hamilton, Ann S.; Graff, John J.; Hawley, Sarah T.; Katz, Steven J.

    2016-01-01

    IMPORTANCE Most women having mastectomy for breast cancer treatment do not have breast reconstruction. OBJECTIVE To examine correlates of reconstruction and determine if there is a significant unmet need for reconstruction. DESIGN Los Angeles and Detroit SEER registries utilized rapid case ascertainment to identify a sample of women diagnosed with breast cancer. Subjects were surveyed a median of 9mos post-diagnosis initially; those remaining disease-free were surveyed again at 4yrs to determine the frequency of immediate and delayed reconstruction, and patient attitudes toward the procedure. SETTING Two metropolitan area population-based SEER registries were used to identify subjects; Latina/Black women were oversampled to ensure adequate minority representation. PARTICIPANTS Women age 20-79 with DCIS and stage 1-3 invasive carcinoma diagnosed between 6/05-2/07 were eligible if they could complete a questionnaire in English or Spanish. Initial survey was sent to 3252 women. 2290 completed it. 1536 completed the follow-up survey. The 485 undergoing initial mastectomy and remaining disease-free at follow-up are this report’s subject. MAIN OUTCOMES/MEASURES Participants were surveyed a mean of 9mos and again at 50mos post-diagnosis. Latina and Black women were oversampled. RESULTS Response rates in the initial and follow-up surveys were 73% and 68%, respectively (overall, 50%). Of 485 patients reporting mastectomy at initial survey and remaining disease-free, 41.6% had reconstruction—24.8% immediate, 16.8% delayed. Factors significantly associated with not receiving reconstruction were Black race, lower education level, older age, major co-morbidity, and receipt of chemotherapy. Only 13% of women were dissatisfied with reconstruction decision making, but dissatisfaction was higher among non-whites in the sample(p=.032). The most common patient-reported reasons for not having reconstruction were the desire to avoid additional surgery and feeling that it was not

  7. 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

    2013-03-06

    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.

  8. 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

  9. Care of patients with deep inferior epigastric perforator reconstruction.

    PubMed

    Long, Laura; Israelian, Amy

    2013-01-01

    Recent trends reflect greater numbers of women opting for mastectomy for invasive breast cancer. Breast reconstruction, either at the time of mastectomy or later, is increasingly an option patients prefer. Although many women opt for implants, reconstruction using autologous tissue offers several advantages including tissue that feels more natural and will age naturally with the patient. The deep inferior epigastric perforator flap has emerged as an alternative to the transverse rectus abdominis myocutaneous flap and allows for preservation of the underlying abdominal muscle. As greater numbers of surgeons are able to offer this microvascular alternative, nurses will care for these postoperative patients in the intensive care unit and medical/surgical settings. This article reviews the evaluation of patients for deep inferior epigastric perforator reconstruction and the unique complexities of postoperative nursing care for these patients.

  10. Allergic reaction to biodegradable interference poly-L-lactic acid screws after anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft.

    PubMed

    Mastrokalos, Dimitrios S; Paessler, Hans H

    2008-06-01

    We report a case of a systemic allergic reaction to biodegradable poly-L-lactic acid (PLLA) interference screws after anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone graft. A 30-year-old patient complained of certain symptoms, such as an inability to focus mentally, rash on the right femur, chronic fatigue, decreased sex drive, and localized alopecia, 3 months after ACL reconstruction in the right knee. Two biodegradable PLLA interference screws had been used for proximal and distal graft fixation. Allergy testing showed a value of 7 in PLLA antigen. After removal of 1 screw in August 2000, the patient reported marked improvement, but some symptoms remained. In July 2001 he underwent arthroscopic revision ACL reconstruction with hamstrings via an implant-free technique with intensive debridement of the tunnels and removal of all scar tissue and screw rests. All symptoms disappeared, and the PLLA antigen number fell from 3 to "concentrate" 2 months postoperatively.

  11. Review of NASA ACLS research

    NASA Technical Reports Server (NTRS)

    Daugherty, R. H.

    1983-01-01

    An experimental investigation was conducted to evaluate a method of maintaining stability of an air cushion vehicle and also to evaluate several concepts to brake and steer an ACLS-equipped vehicle. The investigation used a modified airboat equipped with an air cushion landing system. The pressure relief door stability concept was characterized by the ACLS pressure time histories. The pressure relief doors vented excess cavity and lobe pressures and consistently maintained vehicle heave and pitch stability. Braking concepts were characterized by the average deceleration of the vehicle. Reduced lobe flow and cavity venting braking concepts were evaluated in this program. The cavity venting concept demonstrated the best performance, producing decelerations on the test vehicle on the same order as moderate braking with conventional wheel brakes. Steering concepts were evaluated by recording the path taken while attempting to follow a prescribed maneuver. The steering concepts evaluated included using rudders only, using differential lobe flow, and using rudders combined with a lightly loaded, nonsteering center wheel. The latter concept proved to be the most accurate means of steering the vehicle on the ACLS, producing translational deviations which, while two to three times higher than those from conventional nose gear steering, were still felt to provide reasonably precise steering control for this type vehicle.

  12. 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.

  13. 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

  14. Pain Assessment After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Okoroha, Kelechi R.; Keller, Robert A.; Jung, Edward K.; Khalil, Lafi; Marshall, Nathan; Kolowich, Patricia A.; Moutzouros, Vasilios

    2016-01-01

    Background: Anterior cruciate ligament (ACL) reconstruction is a common outpatient procedure that is accompanied by significant postoperative pain. Purpose: To determine differences in acute pain levels between patients undergoing ACL reconstruction with bone–patellar tendon–bone (BTB) versus hamstring tendon (HS) autograft. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 70 patients who underwent primary ACL reconstruction using either BTB or HS autografts consented to participate. The primary outcome of the study was postoperative pain levels (visual analog scale), which were collected immediately after surgery and for 3 days postoperatively. Secondary outcome measures included opioid consumption (intravenous morphine equivalents), hours slept, patient satisfaction, reported breakthrough pain, and calls to the physician. Results: Patients treated with BTB had increased pain when compared with those treated with HS in the acute postoperative period (mean ± SD: day 0, 6.0 ± 1.7 vs 5.2 ± 2.0 [P = .066]; day 1, 5.9 ± 1.7 vs 4.9 ±1.7 [P = .024]; day 2, 5.2 ± 1.9 vs 4.1 ± 2.0 [P = .032]; day 3, 4.8 ± 2.1 vs 3.9 ± 2.3 [P = .151]). There were also significant increases in reported breakthrough pain (day 0, 76% vs 43% [P = .009]; day 1, 64% vs 35% [P = .003]) and calls to the physician due to pain (day 1, 19% vs 0% [P = .041]) in the BTB group. There were no significant differences in narcotic requirements or sleep disturbances. Overall, the BTB group reported significantly less satisfaction with pain management on days 0 and 1 (P = .024 and .027, respectively). Conclusion: A significant increase in acute postoperative pain was found when performing ACL reconstruction with BTB compared with HS. Patients treated with BTB were more likely to have breakthrough pain, decreased satisfaction with their pain management, and to contact their physician due to pain. These findings suggest a difference in early postoperative pain between the 2 most

  15. The effects of femoral graft placement on cartilage thickness after anterior cruciate ligament reconstruction.

    PubMed

    Okafor, Eziamaka C; Utturkar, Gangadhar M; Widmyer, Margaret R; Abebe, Ermias S; Collins, Amber T; Taylor, Dean C; Spritzer, Charles E; Moorman, C T; Garrett, William E; DeFrate, Louis E

    2014-01-03

    Altered joint motion has been thought to be a contributing factor in the long-term development of osteoarthritis after ACL reconstruction. While many studies have quantified knee kinematics after ACL injury and reconstruction, there is limited in vivo data characterizing the effects of altered knee motion on cartilage thickness distributions. Thus, the objective of this study was to compare cartilage thickness distributions in two groups of patients with ACL reconstruction: one group in which subjects received a non-anatomic reconstruction that resulted in abnormal joint motion and another group in which subjects received an anatomically placed graft that more closely restored normal knee motion. Ten patients with anatomic graft placement (mean follow-up: 20 months) and 12 patients with non-anatomic graft placement (mean follow-up: 18 months) were scanned using high-resolution MR imaging. These images were used to generate 3D mesh models of both knees of each patient. The operative and contralateral knee models were registered to each other and a grid sampling system was used to make site-specific comparisons of cartilage thickness. Patients in the non-anatomic graft placement group demonstrated a significant decrease in cartilage thickness along the medial intercondylar notch in the operative knee relative to the intact knee (8%). In the anatomic graft placement group, no significant changes were observed. These findings suggest that restoring normal knee motion after ACL injury may help to slow the progression of degeneration. Therefore, graft placement may have important implications on the development of osteoarthritis after ACL reconstruction.

  16. [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.

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

    PubMed

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

    2012-06-01

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

  18. Arthroscopic Control for Safe and Secure Seating of Suspensory Devices for Femoral Fixation in Anterior Cruciate Ligament Reconstruction Using Three Different Techniques

    PubMed Central

    Kang, Seo Goo; Lee, Yong Seuk

    2017-01-01

    Purpose The purpose of this study was to evaluate the efficacy of our technique that allows direct visualization of seating of suspensory devices in anterior cruciate ligament (ACL) reconstruction. Materials and Methods Three different suspensory devices (TightRope RT, RetroButton, and EndoButton) were used in ACL reconstruction using 3 different techniques (outside-in, anteromedial [AM] portal, and transtibial techniques). Positioning of a guiding material and seating pattern of the suspensory devices were evaluated according to the surgical technique and suspensory device used. Results On the transtibial technique, 21 of total 26 cases (81%) of single bundle reconstructions and 22 of total 22 cases (100%) of double bundle reconstructions required superolateral capsulotomy where buttons were found in 21 of total 21 cases (100%) and 17 of 22 cases (77%), respectively. On the AM portal technique, all patients required capsulotomy and the button was found in only 18 of total 32 cases (56%) even after capsulotomy. On the outside-in technique, all patients required capsulotomy and the button was found in 86 of total 86 cases (100%). Conclusions Our technique for direct visualization of seating of the suspensory devices was more effective in outside-in and single bundle transtibial ACL reconstruction. However, it was less effective in double bundle transtibial and AM portal ACL reconstructions. PMID:28231646

  19. 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

  20. 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.

  1. 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

  2. Depression and psychiatric disease associated with outcomes after anterior cruciate ligament reconstruction

    PubMed Central

    Wu, Hao-Hua; Liu, Max; Dines, Joshua S; Kelly, John D; Garcia, Grant H

    2016-01-01

    While most patients with an anterior cruciate ligament (ACL) injury indicate satisfaction with surgical intervention, a significant proportion still do not return to pre-injury level of function or sport. Psychiatric comorbidities, such as depression, have recently been associated with poor clinical outcomes after ACL reconstruction (ACLR). To date, no article has yet examined how depression affects ACLR outcomes and how potential screening and intervention for psychological distress may affect postoperative activity level. The purpose of this review is to delineate potential relationships between depression and ACLR outcome, discuss clinical implications and identify future directions for research. PMID:27900267

  3. 50 CFR 648.290 - Tilefish Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... detailed review of fishery performance relative to the sector ACLs at least every 5 years. (1) If the ACL... recommendations to the MAFMC for changes in measures intended to ensure ACLs are not as frequently exceeded. (2...) Performance reviews shall not substitute for annual reviews that occur to ascertain if prior year ACLs...

  4. 50 CFR 648.290 - Tilefish Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... detailed review of fishery performance relative to the sector ACLs at least every 5 years. (1) If the ACL... recommendations to the MAFMC for changes in measures intended to ensure ACLs are not as frequently exceeded. (2...) Performance reviews shall not substitute for annual reviews that occur to ascertain if prior year ACLs...

  5. 50 CFR 648.290 - Tilefish Annual Catch Limit (ACL).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... detailed review of fishery performance relative to the sector ACLs at least every 5 years. (1) If the ACL... recommendations to the MAFMC for changes in measures intended to ensure ACLs are not as frequently exceeded. (2...) Performance reviews shall not substitute for annual reviews that occur to ascertain if prior year ACLs...

  6. 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.

  7. An Athlete's Nightmare: Tearing the ACL

    MedlinePlus

    ... women's knees tends to bend inward when women land." Some researchers believe that this inward bend may ... any athlete suffers ACL damage is because they land in a flat-footed position, as opposed to ...

  8. 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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2016-05-01

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

  11. 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

  12. 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.

  13. TRITON-X is most effective among three decellularization agents for ACL tissue engineering.

    PubMed

    Vavken, Patrick; Joshi, Shilpa; Murray, Martha M

    2009-12-01

    Ruptures of the anterior cruciate ligament (ACL) are still associated with high rates of long-term complications, even in patients undergoing modern, state-of-the-art replacement. Tissue-engineering approaches have been shown to be of value in improving treatment of ACL ruptures. However, the success of tissue-engineering procedures depends on the choice of an appropriate biomaterial. Decellularized ACL tissue potentially combines the structural composition of the targeted tissue with a reduced risk of graft rejection or disease transmission. In this study, we tested the effectiveness of currently available decellularization methods based on TRITON-X, sodium dodecyl sulfate (SDS), and trypsin. After identifying the most effective decellularization method, the capacity for reseeding with ACL fibroblasts was studied. All decellularization protocols reduced DNA content, with TRITON-X treatment having the greatest effect. Concurrently, decellularization did not affect tissue collagen or total protein content, but did decrease glycosaminoglycan content. TRITON-X also resulted the least glycosaminoglycan depletion. Porcine ACL tissue after decellularization with TRITON-X could be successfully reseeded with human ACL fibroblasts as demonstrated by steady DNA content and increasing pro-collagen expression.

  14. Effects of electrical and electromagnetic stimulation after anterior cruciate ligament reconstruction.

    PubMed

    Currier, D P; Ray, J M; Nyland, J; Rooney, J G; Noteboom, J T; Kellogg, R

    1993-04-01

    A need exists to develop new methods of neuromuscular electrical stimulation (NMES) that are both effective and relatively pain-free. The purpose of this pilot study was to determine the effects of both NMES and a new method of electromagnetic (NMES/PEMF) stimulation for reducing girth loss and for reducing pain and muscle weakness of the knee extensor muscles in patients during the first 6 weeks after reconstructive surgery of the anterior cruciate ligament (ACL). Seventeen patients receiving ACL reconstructive surgery participated as a control group (N = 3), as an NMES group (N = 7), and with combined NMES and magnetic field stimulation (NMES/PEMF) (N = 7). Patients receiving NMES/PEMF rated each type of stimulation for perceived pain and were measured for their torque. Torque results revealed a mean decrease of 13.1% for NMES/PEMF patients. The mean percent of thigh girth decreased 8.3% for controls, 0.5% for NMES, and 2.3% for NMES/PEMF patients. The NMES/PEMF patients rated NMES as causing about twice the pain intensity as NMES/PEMF during treatments. As a result of this data, the authors conclude that both NMES and NMES/PEMF are effective in reducing girth loss and that NMES/PEMF is less painful than NMES alone in treating patients after ACL reconstruction.

  15. 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

  16. 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

  17. 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.

  18. Causes of Failure of Anterior Cruciate Ligament Reconstruction and Revision Surgical Strategies

    PubMed Central

    Di Benedetto, Paolo; Di Benedetto, Enrico; Fiocchi, Andrea; Beltrame, Alessandro; Causero, Araldo

    2016-01-01

    Purpose Long-term outcomes of anterior cruciate ligament (ACL) reconstruction are good or excellent; however, 0.7%–20% of patients suffer from recurrent instability due to graft failure. The purpose of this paper was to analyse failure aetiology and the possibilities of revision surgical strategies, with a description of our experience. We obtained optimal and good results in most of our patients. Materials and Methods We retrospectively reviewed 42 patients who underwent revision surgery (43 revisions) due to relapsing instability after ACL reconstruction between 2006 and 2015. We used allografts in 39 cases and autografts in 4 cases. Results The 85.7% of the patients obtained optimal results (normal knee; group A) and the 7.2% obtained good results (nearly normal knee; group B) according to the International Knee Documentation Committee score. The most frequent failure causes were traumatic events, non-anatomic tunnel placement, and lack of graft incorporation. Conclusions A correct revision surgery requires accurate patient evaluation and knee imaging. Preoperative planning starts with the identification of the cause of failure of the primary reconstruction. Then, the most suitable procedure should be determined for each case. It is also important to accurately inform the patient of all the complexity of an ACL revision surgery even if it is a procedure with high rates of excellent and good outcomes. PMID:27894180

  19. Impact of Patient Sex on Clinical Outcomes

    PubMed Central

    Teitsma, Xavier M.; van der Hoeven, Henk; Tamminga, Rob; de Bie, Rob A.

    2014-01-01

    Background: The Combined Quality Care Anterior Cruciate Ligament registry provides data for clinical research regarding primary anterior cruciate ligament (ACL) surgery. Purpose: To explore the data with regard to the clinical outcomes between sexes after ACL reconstruction in a Dutch population. Study Design: Cohort study; Level of evidence, 3. Methods: Data involving patients diagnosed with an ACL tear and eligible for surgery were recorded. Isokinetic muscle strength, functional muscle performance, and anterior-posterior translation of the knee joint were documented preoperatively and at 3, 6, 9, and 12 months postoperatively. Patients completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and Tegner rating scales during each examination using a web-based questionnaire. Results: Approximately 90% of ACL injuries occurred during sport activities. The mean (SD) age at surgery was 28 (11) years for both men and women, and the majority of patients were treated with hamstring tendon autografts (94%). Four percent received bone–patellar tendon–bone autografts, and 2% of the patients received other grafts. Preoperatively, the KOOS, Lysholm, and Tegner scores were significantly higher in males. Twelve months postoperatively, both sexes showed comparable isokinetic strength (P = .336), knee laxity (P = .680), and hop test for distance (P = .122) when comparing the injured with the uninjured side. Self-reported knee function was comparable between sexes as assessed by the KOOS (P = .202), Lysholm (P = .872), and Tegner (P = .767) questionnaires during the 12-month follow-up. Conclusion: One year after ACL surgery, all patients had improved greatly, showing only minor differences between sexes. The male group showed slightly better results when evaluating self-reported knee questionnaires. Comparable outcomes and knee function between sexes can therefore be presumed with patients who are treated with hamstring tendon autografts in a Dutch

  20. Reconstruction Following Tumor Resections in Skeletally Immature Patients.

    PubMed

    Levin, Adam S; Arkader, Alexandre; Morris, Carol D

    2017-03-01

    Reconstruction options in children after bone tumor resection are as varied as they are challenging. Advances in biologic and endoprosthetic design have led to many choices, all of which must be considered in the context of prognosis, treatment limitations, and patient/family expectations. The current experience and results of limb-sparing surgery following bone sarcoma resection in growing children are discussed, including allograft, autograft, and metallic prostheses alone and in combination, especially as they pertain to the knee. In some cases, the ablative options of amputation and rotationplasty must be seen as equal and, at times, superior choices to limb salvage.

  1. Pathophysiology of nerve regeneration and nerve reconstruction in burned patients.

    PubMed

    Coert, J Henk

    2010-08-01

    In extensive burns peripheral nerves can be involved. The injury to the nerve can be direct by thermal or electrical burns, but nerves can also be indirectly affected by the systemic reaction that follows the burn. Mediators will be released causing a neuropathy to nerves remote from the involved area. Involved mediators and possible therapeutic options will be discussed. In burned patients nerves can be reconstructed using autologous nerve grafts or nerve conduits. A key factor is an adequate wound debridement and a well-vascularized bed to optimize the outgrowth of the axons. Early free tissue transfers have shown promising results.

  2. Quantitative topographic anatomy of the femoral ACL footprint: a micro-CT analysis.

    PubMed

    Norman, Daniel G; Getgood, Alan; Thornby, John; Bird, Jonathan; Turley, Glen A; Spalding, Tim; Williams, Mark A

    2014-11-01

    The femoral footprint of the anterior cruciate ligament (ACL) is a much-studied anatomic structure, predominantly due to its importance during ACL reconstruction surgery. A new technique utilising high-resolution micro-computed tomography (micro-CT) is described, allowing detailed three-dimensional (3D) quantitative analysis of this structure. Seven cadaveric knees were scanned using micro-CT, yielding 3D data with a reconstructed voxel size of 60 μm. A novel method of 3D surface extraction was developed and validated, facilitating both qualitative observation of surface details and quantitative topographic assessment using colour-coded relief maps. Images were displayed on an immersive 3D visualisation wall, and ten experienced ACL clinicians were surveyed as to the presence and morphology of osseous landmarks, providing qualitative assessment of whether such features can be reliably identified for navigation during surgery. Both quantitative analysis and qualitative assessment of the footprints in this study showed significant variability in the presence and morphology of osseous landmarks, with the lateral intercondylar ridge being objectively present in four out of seven relief maps, although reportedly seen in six out of seven cases in the qualitative study, suggesting an element of subjectivity and interpretation. This is the first study to utilise micro-CT in the study of ACL anatomy.

  3. 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.

  4. Free Microsurgical and Pedicled Flaps for Oncological Mandibular Reconstruction: Technical Aspects and Evaluation of Patient Comorbidities

    PubMed Central

    Hassid, Victor J.; Maqusi, Suhair; Culligan, Emmett; Cohen, Mimis N.; Antony, Anuja K.

    2012-01-01

    Oncologic mandibular reconstruction has changed significantly over the years and continues to evolve with the introduction of newer technologies and techniques. Patient demographic, reconstructive, and complication data were obtained from a prospectively maintained clinical database of patients who underwent head and neck reconstruction at our institution. The free fibular flap is now considered the gold standard for mandibular reconstruction. However, in patients with multiple comorbidities, lengthy procedures may be less optimal and pedicled flaps, with specific modifications, can yield reasonable outcomes. Technical aspects and comorbidity profiles are examined in the oncological mandibular reconstruction cohort. PMID:22550602

  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. ACL injury while jumping rope in a patient with an unintended increase in the tibial slope after an opening wedge high tibial osteotomy.

    PubMed

    Jung, Kwang Am; Lee, Su Chan; Hwang, Seung Hyun; Song, Moon Bok

    2009-08-01

    High tibial osteotomy (HTO) is an accepted surgical technique for the treatment of medial compartmental arthrosis of the knee in younger patients. Compared to total knee arthroplasty, HTO may be a good choice in patients who wish to continue with heavy labor and/or impact sports. Based on the rehabilitation protocol after HTO, impact sports, such as running, jumping rope, and full sports activities, are generally permitted 6 months postoperatively. Jumping rope is an excellent form of aerobic exercise, and when done properly, jumping rope can lead to a dramatic improvement in rehabilitation and full sports activities. However, an adequate evaluation should be performed prior to initiating impact sports. We present the case of a ruptured anterior cruciate ligament that occurred in a patient with an unintended increase in the tibial slope after an opening wedge HTO who was jumping rope.

  7. ACL Tears on The Rise Among Kids, Especially Girls

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_163730.html ACL Tears on the Rise Among Kids, Especially Girls ... A common knee injury -- an anterior cruciate ligament (ACL) tear -- has steadily increased among 6- to 18- ...

  8. Return to Sports after Acute Simultaneous Reconstruction of Anterior Cruciate Ligament Injury and Grade III Medial Collateral Ligament Injury

    PubMed Central

    Bertona, Agustin; Zicaro, Juan Pablo; Viescas, Juan Manuel Gonzalez; Atala, Nicolas; Yacuzzi, Carlos; Costa-Paz, Matias

    2017-01-01

    Objectives: Combined Anterior Cruciate Ligament (ACL) injury and Medial Collateral Ligament (MCL) injury account for 20% of knee ligament lesions. Conservative treatment of MCL and surgical ACL reconstruction are generally recommended. Significant medial instability after non-surgical management of MCL can lead to ACL reconstruction failure. The optimal management for athletes with combined ACL-MCL injuries remains controversial. The purpose of this study was to analyze the functional and clinical evolution of patients who underwent combined ACL-MCL surgery and their return-to-sport level with minimum 2-years follow-up. Methods: A total of 20 athletes with acute simultaneous ACL/Grade III MCL reconstructions were treated between March 2006 and January 2014. The minimum follow-up time was 24 months. Subjective functional results (IKDC, Lysholm), range of motion, anterior-medial and rotational stability (Lachmann, Pivot Shift, valgus stress) were evaluated. The ability to return to sport (Tegner) and the level achieved was recorded. Results: All patients significantly improved functional scores and stability tests. The mean subjective IKDC score improved from 37.7 ± 12.9 (range 21-69) preoperatively to 88.21 ± 4.47 (range 80-96) postoperatively (P <0.05). The average Lysholm score was 40.44 ± 10.58 (range 27-65) preoperatively and 90.83 ± 3.38 (range 84-95) postoperatively (P <0.05). Valgus and sagittal laxity was not observed (IKDC A 92% B 8%) at final follow-up. All patients had normal/nearly normal (IKDC A or B) mobility. All patients returned to sports; 90% reached the level they had prior to the ligamentous injury. Of all competitive athletes, 66% achieved the same level of sport. Conclusion: In athletes with acute ACL-Grade III MCL lesions, an early simultaneous reconstruction can significantly improve the medial and sagittal stability of the knee. This procedure resulted in excellent functional outcomes, with return to the same level of sports in the

  9. Comparison of analgesic effects of intra-articular tenoxicam and morphine in anterior cruciate ligament reconstruction.

    PubMed

    Guler, Gulen; Karaoglu, Sinan; Velibasoglu, Hediye; Ramazanogullari, Nesrin; Boyaci, Adem

    2002-07-01

    This study compared the analgesic effect of intra-articular injection of tenoxicam with that of morphine on postoperative pain after anterior cruciate ligament (ACL) reconstruction. Forty-two patients undergoing arthroscopically ACL reconstructions using hamstring tendons underwent the same anesthetic protocol. The patients were randomized to receive 25 ml normal saline, 20 mg tenoxicam in 25 ml normal saline, or 2 mg morphine in 25 ml normal saline. Postoperative pain was assessed using a visual analogue scale and measuring analgesic requirements. We found both that both intra-articular tenoxicam and intra-articular morphine provided better analgesia than that in the control group. Although pain scores were similar between tenoxicam and morphine groups 30 min postoperative, the analgesic requirements in with tenoxicam were significantly lower than those with morphine group 3-6 h postoperatively.

  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. 50 CFR 648.120 - Scup Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... shall recommend to the MAFMC separate ACLs for the commercial and recreational scup fisheries, the sum... and recreational fishing sector ACLs will be established consistent with the allocation guidelines... recreational sector ACLs may be established on an annual basis for up to 3 years at a time, dependent...

  12. 50 CFR 648.120 - Scup Annual Catch Limit (ACL).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... shall recommend to the MAFMC separate ACLs for the commercial and recreational scup fisheries, the sum... and recreational fishing sector ACLs will be established consistent with the allocation guidelines... recreational sector ACLs may be established on an annual basis for up to 3 years at a time, dependent...

  13. 50 CFR 648.120 - Scup Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... shall recommend to the MAFMC separate ACLs for the commercial and recreational scup fisheries, the sum... and recreational fishing sector ACLs will be established consistent with the allocation guidelines... recreational sector ACLs may be established on an annual basis for up to 3 years at a time, dependent...

  14. Rehabilitation After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kruse, L.M.; Gray, B.; Wright, R.W.

    2012-01-01

    Background: Rigorous rehabilitation after anterior cruciate ligament (ACL) reconstruction is necessary for a successful surgical outcome. A large number of clinical trials continue to assess aspects of this rehabilitation process. Prior systematic reviews evaluated fifty-four Level-I and II clinical trials published through 2005. Methods: Eighty-five articles from 2006 to 2010 were identified utilizing multiple search engines. Twenty-nine Level-I or II studies met inclusion criteria and were evaluated with use of the CONSORT (Consolidated Standards of Reporting Trials) criteria. Topics included in this review are postoperative bracing, accelerated strengthening, home-based rehabilitation, proprioception and neuromuscular training, and six miscellaneous topics investigated in single trials. Results: Bracing following ACL reconstruction remains neither necessary nor beneficial and adds to the cost of the procedure. Early return to sports needs further research. Home-based rehabilitation can be successful. Although neuromuscular interventions are not likely to be harmful to patients, they are also not likely to yield large improvements in outcomes or help patients return to sports faster. Thus, they should not be performed to the exclusion of strengthening and range-of-motion exercises. Vibration training may lead to faster and more complete proprioceptive recovery but further evidence is needed. Conclusions: Several new modalities for rehabilitation after ACL reconstruction may be helpful but should not be performed to the exclusion of range-of-motion, strengthening, and functional exercises. Accelerated rehabilitation does not appear to be harmful but further investigation of rehabilitation timing is warranted. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:23032584

  15. Returning to sport after anterior cruciate ligament reconstruction in amateur sports men: a retrospective study

    PubMed Central

    Notarnicola, Angela; Maccagnano, Giuseppe; Barletta, Federico; Ascatigno, Leonardo; Astuto, Leopoldo; Panella, Antonio; Tafuri, Silvio; Moretti, Biagio

    2016-01-01

    Summary Background According to the literature, 95% of professional athletes return to their sport after anterior cruciate ligament (ACL) reconstruction surgery. The main objective of this study was to verify the return to sport after ACL reconstruction in a homogenous group of amateur sportsmen and sportswomen in a series of Italian patients. Materials and methods We designed a retrospective study in which we analyzed the amateur sports patients operated for ACL reconstruction. We verified whether they had returned to sporting activities by comparing the pre- and post-operative Tegner activity scores. We then analyzed the average time to restart the sporting activity and the Lysholm and International Knee Documenting Committee (IKDC) scores. Results We analyzed 80 subjects: 47.5% restarted a sports activity, on average after eight months, with a significant reduction of their competitive level or physical commitment, as expressed by the Tegner activity score (pre-operative: 6.9; post-operative: 3.9; p<0.01). The functional knee recovery was good, as expressed by the average score of the Lyshom Knee Scoring Scale (93.5) and the IKDC (74.7). Conclusions In the literature, a return to sport for international case studies and amateur sports is higher than our data. In our population we found the lack of information provided by the medical staff at discharge and follow-up. The assessment at a short-term follow up allowed us to verify that at the end of the post-surgical rehabilitation program the patients were uninformed about the timing and the ability to resume a sporting activity. An efficacious relationship between orthopedic doctor, physiotherapist and a doctor in motorial science may ensure proper treatment the patient after ACL reconstruction. It is important to guarantee the restarting of the sports activity to have a better quality of life in amateur sports. Level of evidence: V. PMID:28217571

  16. Effect of ACL Transection on Internal Tibial Rotation in an in Vitro Simulated Pivot Landing

    PubMed Central

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

    2011-01-01

    , under the large forces associated with a simulated pivot landing, but it leads to a significant increase in anterior tibial translation. Clinical Relevance: An ACL reconstruction that restores both ligament orientation and stiffness will provide major resistance to anterior tibial translation while providing minor resistance to axial tibial rotation. PMID:21325589

  17. Contact Stress and Kinematic Analysis of All-Epiphyseal and Over-the-Top Pediatric Reconstruction Techniques for the Anterior Cruciate Ligament

    PubMed Central

    McCarthy, Moira M.; Tucker, Scott; Nguyen, Joseph T.; Green, Daniel W.; Imhauser, Carl W.; Cordasco, Frank A.

    2014-01-01

    Background Anterior cruciate ligament (ACL) injuries are an increasingly recognized problem in the pediatric population. Unfortunately, outcomes with conservative treatment are extremely poor. Furthermore, adult reconstruction techniques may be inappropriate to treat skeletally immature patients due to the risk of physeal complications. “Physeal-sparing” reconstruction techniques exist but their ability to restore knee stability and contact mechanics is not well understood. Purpose (1) To assess the ability of the all-epiphyseal (AE) and over-the-top (OT) reconstructions to restore knee kinematics; (2) to assess whether these reconstructions decrease the high posterior contact stresses seen with ACL deficiency; (3) to determine whether the AE or OT produce abnormal tibiofemoral contact stresses. Hypothesis The AE reconstruction will restore contact mechanics and kinematics similarly to that of the ACL intact knee. Methods Ten fresh-frozen human cadaveric knees were tested using a robotic manipulator. Tibiofemoral motions were recorded with the ACL intact, after sectioning the ACL, and after both reconstructions in each of the 10 specimens. The AE utilized an all-inside technique with tunnels exclusively within the epiphysis and fixed with suspensory cortical fixation devices. The OT had a central and vertical tibial tunnel with an over-the-top femur position and was fixed with staples and posts on both ends. Anterior stability was assessed with 134N anterior force at 0, 15, 30, 60, and 90° of knee flexion. Rotational stability was assessed with combined 8 Nm and 4 Nm of abduction and internal rotation, respectively, at 5, 15, and 30° of knee flexion. Results Both reconstruction techniques offloaded the posterior aspect of the tibial plateau compared to the ACL deficient knee in response to both anterior loads and combined moments as demonstrated by reduced contact stresses in this region at all flexion angles. Compared to the ACL intact condition, both the AE

  18. 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.

  19. The addition of clonidine to bupivacaine in combined femoral-sciatic nerve block for anterior cruciate ligament reconstruction.

    PubMed

    Couture, Darren J; Cuniff, Heather M; Maye, John P; Pellegrini, Joseph

    2004-08-01

    Clonidine has been shown to prolong sensory analgesia when given as an adjunct to peripheral nerve blocks but has not been evaluated when given in conjunction with a femoral-sciatic nerve block. The purpose of this investigation was to determine whether the addition of clonidine to a femoral-sciatic nerve block would prolong the duration of sensory analgesia in groups of patients undergoing anterior cruciate ligament (ACL) reconstruction. This prospective, randomized, double-blind investigation was performed on 64 subjects undergoing ACL reconstruction. Patients were assigned randomly to receive a femoral-sciatic nerve block using 30 mL of 0.5% bupivacaine with 1:200,000 epinephrine (control group) or 30 mL of 0.5% bupivacaine with 1:200,000 epinephrine and 1 microg/kg of clonidine (experimental group). Variables measured included demographics, timed pain intensity measurements, postoperative analgesic consumption, duration of analgesia, and patient satisfaction. No significant differences were noted between groups for pain intensity scores, duration of sensory analgesia, postoperative analgesic requirements, or overall patient satisfaction. Both groups reported minimal amounts of postoperative pain and high analgesic satisfaction scores. Based on our results, we do not recommend the addition of clonidine to a femoral-sciatic nerve block when given to facilitate postoperative analgesia in patients undergoing ACL reconstruction.

  20. Biomechanical Outcomes After Bio-enhanced Anterior Cruciate Ligament Repair and Anterior Cruciate Ligament Reconstruction Are Equal in a Porcine Model

    PubMed Central

    Vavken, Patrick; Fleming, Braden C.; Mastrangelo, Ashley N.; Machan, Jason T.; Murray, Martha M.

    2011-01-01

    Purpose The objective of this study was to compare the biomechanical outcomes of a new method of anterior cruciate ligament (ACL) treatment, bio-enhanced ACL repair, with ACL reconstruction in a large animal model. Methods Twenty-four skeletally immature pigs underwent unilateral ACL transection and were randomly allocated to receive bio-enhanced ACL repair with a collagen-platelet composite, allograft (bone–patellar tendon– bone) reconstruction, or no further treatment (n = 8 for each group). The structural properties and anteroposterior laxity of the experimental and contralateral ACL-intact knees were measured 15 weeks postoperatively. All dependent variables were normalized to those of the contralateral knee and compared by use of generalized linear mixed models. Results After 15 weeks, bio-enhanced ACL repair and ACL reconstruction produced superior biomechanical outcomes to ACL transection. However, there were no significant differences between bio-enhanced ACL repair and ACL reconstruction for maximum load (P = .4745), maximum displacement (P = .4217), or linear stiffness (P = .6327). There were no significant differences between the 2 surgical techniques in anteroposterior laxity at 30° (P = .7947), 60° (P = .6270), or 90° (P = .9008). Conclusions Bio-enhanced ACL repair produced biomechanical results that were not different from ACL reconstruction in a skeletally immature, large animal model, although the variability associated with both procedures was large. Both procedures produced significantly improved results over ACL transection, showing that both were effective in this model. Clinical Relevance Bio-enhanced ACL repair may 1 day provide an alternative treatment option for ACL injury. PMID:22261137

  1. INFLUENCE OF ANTERIOR PAIN ON RESULTS FROM ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    PubMed Central

    Vasconcelos, Wilson; Santos, Claudinei; Ferracini, Antonio Marcos; Dejour, David

    2015-01-01

    Objective: To examine the impact of residual pain on functional outcomes two years after arthroscopic anterior cruciate ligament (ACL) reconstruction and compare the types of graft used during the procedure (patellar vs. flexor). Method: A retrospective epidemiological study on 129 ACL reconstructions with a mean follow-up of 28 months was conducted. The presence, intensity and location of the anterior pain were investigated. Pain provocation tests were conducted, sensitivity was analyzed and functional scores were applied (IKDC, femoropatellar and SF-36), comparing the results with the type of graft used. Results: Anterior pain was present in 28% of patients with a mean intensity of 2.9 in 10. When pain was present, the functional scores decreased significantly. Abnormalities of knee sensitivity and gait occurred frequently with use of the patellar tendon, but there was no statistical difference regarding the presence of pain. Conclusion: The presence of anterior pain in ACL reconstructions, even if minimal, has a deleterious effect on the final outcome over the medium term. Because of the influence of graft harvesting on the presence of abnormalities of knee sensitivity and gait, choosing the graft should take into account the patient's professional and sports activities. PMID:27026984

  2. 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

  3. Arthroscopically assisted meniscal allograft transplantation with and without combined anterior cruciate ligament reconstruction.

    PubMed

    Yoldas, Erol A; Sekiya, Jon K; Irrgang, James J; Fu, Freddie H; Harner, Christopher D

    2003-05-01

    The menisci provide a vital role in load transmission across the knee joint as well as contribute to knee stability, particularly in the ACL-deficient knee. Loss of the meniscus, in part or in total, significantly alters joint function and predisposes the articular cartilage to degenerative changes, which has been well documented both clinically and radiographically. This study examined clinical and patient-reported outcomes following meniscal allograft transplantation with and without combined ACL reconstruction in a select group of 31 patients with complaints of pain and/or instability (34 meniscal allografts); 11 underwent isolated meniscal transplantation and 20 meniscal transplantation combined with ACL reconstruction. Bony fixation was performed with bone plugs for medial transplants and using a bone bridge for lateral transplants. All patients completed several knee-specific and general measures of health-related quality of life and underwent a comprehensive physical examination. Flexion weightbearing PA radiographs at latest follow-up were compared to those obtained preoperatively. Mean follow-up was 2.9 years (range 2-5.5 years). The Activities of Daily Living and Sports Activities Scale scores were 86+/-11 and 78+/-16, respectively, and the average Lysholm score was 84+/-14. There were no significant differences in these scores based upon which meniscus (medial or lateral) was transplanted, concurrent ACL reconstruction, or the degree of chondrosis at arthroscopy. SF-36 scores indicated that patients were functioning at a level similar to the age- and sex-matched population. Twenty-two patients stated they were greatly improved, 8 were somewhat improved, 1 was without change. All but one patient reported that knee function and level of activity were normal or nearly normal. The average loss of motion compared to the noninvolved side was 3 degrees for extension and 9 degrees for flexion. All but one patient had a negative or 1+ Lachman's test. The

  4. 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].

  5. Kinesiophobia After Anterior Cruciate Ligament Rupture and Reconstruction: Noncopers Versus Potential Copers

    PubMed Central

    Hartigan, Erin H.; Lynch, Andrew D.; Logerstedt, David S.; Chmielewski, Terese L.; Snyder-Mackler, Lynn

    2016-01-01

    STUDY DESIGN Secondary-analysis, longitudinal cohort study. OBJECTIVES To compare kinesiophobia levels in noncopers and potential copers at time points spanning pre– and post–anterior cruciate ligament (ACL) reconstruction and to examine the association between changes in kinesiophobia levels and clinical measures. BACKGROUND After ACL injury, a screening examination may be used to classify patients as potential copers or noncopers based on dynamic knee stability. Quadriceps strength, single-leg hop performance, and self-reported knee function are worse in noncopers. High kinesiophobia levels after ACL reconstruction are associated with poorer self-reported knee function and lower return-to-sport rates. Kinesiophobia levels have not been examined before ACL reconstruction, across the transition from presurgery to postsurgery, or based on potential coper and noncoper classification. METHODS Quadriceps strength indexes, single-leg hop score indexes, self-reported knee function (Knee Outcome Survey activities of daily living subscale, global rating scale), and kinesiophobia (Tampa Scale of Kinesiophobia [TSK-11]) scores were compiled for potential copers (n = 50) and noncopers (n = 61) from 2 clinical trial databases. A repeated-measures analysis of variance was used to compare TSK-11 scores between groups and across 4 time points (before preoperative treatment, after preoperative treatment, 6 months post–ACL reconstruction, and 12 months post–ACL reconstruction). Correlations determined the association of kinesiophobia levels with other clinical measures. RESULTS Presurgery TSK-11 scores were significantly higher in noncopers than in potential copers. Postsurgery, no group differences existed. TSK-11 scores in both groups decreased across all time points; however, TSK-11 scores decreased more in noncopers in the interval between presurgery and postsurgery. In noncopers, the decreases in TSK-11 scores from presurgery to postsurgery and after surgery were

  6. ACLED Country Report: Central African Republic

    DTIC Science & Technology

    2015-01-01

    violence between January 1997 and September 2014. Almost 8,000 fatalities have occurred during this time, making it the fourteenth most fatal country in...the dataset in this regard. However, violence has escalated sharply in recent years: the majority of these events occurred since the outbreak of the...CAR) is the fifteenth most violent country in the ACLED dataset, with over 2,000 recorded events of political violence between January 1997 and

  7. Correlation between the result from arthroscopic reconstruction of the anterior cruciate ligament of the knee and the return to sports activity☆

    PubMed Central

    Almeida, Alexandre; Valin, Márcio Rangel; Ferreira, Ramon; de Almeida, Nayvaldo Couto; Agostini, Ana Paula

    2014-01-01

    Objective To evaluate the return to pre-injury sports activity in a group of patients who underwent anterior cruciate ligament (ACL) reconstruction, in relation to age, sex, body mass index (BMI) and associations with upper-limb fractures. Methods A group of 265 patients who underwent ACL reconstruction using an ipsilateral graft from the thigh flexor tendons, between July 2000 and November 2007, was analyzed. Results A total of 176 patients was evaluated after a mean period of 34.95 ± 18.8 months (median: 31 months) (interquartile range: 20–48 months). The minimum evaluation period was 12 months and the maximum was 87 months. The number of patients who returned to their sports activity prior to tearing the ACL was 121/176 (68.8%). Patients under 30 years of age more frequently returned to sports activity and this was considered significant: p = 0.016; odds ratio, OR = 0.44 (95% confidence interval, CI: 0.22–0.86). Returning to previous sports activity more frequently was not considered significant for male sex (p = 0.273), individuals with BMI < 25 (p = 0.280) or patients with an ACL injury unrelated to an initial traumatic episode with upper-limb fracturing (p = 0.353). Conclusions The rate of return to the sports activity prior to ACL injury was 68.8%. It was found that patients under the age of 30 years had a significantly greater rate of return to sports activity after the surgery. In relation to sex, BMI and association with an initial traumatic episode of upper-limb fracturing, there was no statistical difference in the return to sports activity. PMID:26229807

  8. Physeal-Sparing Technique for Femoral Tunnel Drilling in Pediatric Anterior Cruciate Ligament Reconstruction Using a Posteromedial Portal

    PubMed Central

    Lemos, Stephen E.; Keating, Patrick M.; Scott, Timothy P.; Siwiec, Ryan M.

    2013-01-01

    Pediatric anterior cruciate ligament (ACL) tears present a technical dilemma for orthopaedic surgeons. Multiple surgical techniques have been described to protect the distal femoral and proximal tibial physes. We present an ACL reconstruction technique performed on a 12-year-old girl with open physes who sustained an ACL tear after a noncontact twisting injury while playing soccer. A hamstring autograft reconstruction was performed by use of a posteromedial portal to drill the femoral tunnel in an all-epiphyseal fashion at the anatomic footprint of the native ACL. This case provides a new surgical technique to achieve anatomic fixation for ACL reconstruction in a skeletally immature individual using a posteromedial portal to drill a physeal-sparing lateral femoral tunnel for anatomic ACL reconstruction. This advancement may make drilling the femoral tunnel less technically challenging compared with other proposed methods while maintaining the lateral wall of the distal femur. PMID:24892013

  9. Mid-Term Outcomes of Anterior Cruciate Ligament Reconstruction with Far Anteromedial Portal Technique

    PubMed Central

    Jeon, Yoon Sang; Choi, Sung Wook; Park, Ju Hyun; Yoon, Jae Sik; Shin, Jung Sub; Kim, Myung Ku

    2017-01-01

    Purpose The purpose of this study was to evaluate the mid-term outcomes of anatomic anterior cruciate ligament (ACL) reconstruction using two anteromedial (AM) portals by comparing with short-term follow-up results. Materials and Methods Fifty patients who were treated by ACL reconstruction using a two AM portal technique were evaluated retrospectively. The follow-up period was at least 5 years. The mean follow-up period was 68.5±13.9 months. The mid-term clinical outcomes were compared with short-term (≥12 months) results. For the assessment of knee stability, anterior tibial translation was evaluated using the Lachman test and the KT-2000. Rotational stability was evaluated using pivot shift test. For clinical assessment, the Lysholm and International Knee Documentation Committee scores were used. Results The average anterior translation was 2.1±1.4 mm at the short-term follow-up and 2.8±1.8 mm at the mid-term follow-up. Stability and midterm clinical outcomes were not significantly improved compared to the short-term follow-up results. At the mid-term follow-up, anteroposterior (AP) instability assessed by the KT-2000 was slightly increased, but still acceptable. On the other clinical physical evaluation, there was no statistically significant difference. Conclusions The short-term and mid-term outcomes of ACL reconstruction using the two AM portal technique were not significantly different except for AP stability although the value was less than 3 mm at both follow-ups. Therefore, this operative technique could be considered a satisfactory alternative for ACL reconstruction. PMID:28231644

  10. Clinical Results of Technique for Double Bundle Anterior Cruciate Ligament Reconstruction Using Hybrid Femoral Fixation and Retroscrew

    PubMed Central

    Kim, Doo-Sup; Yi, Chang-Ho; Chung, Hoi-Jung

    2011-01-01

    Background Anatomic anterior cruciate ligament (ACL) reconstruction has been presented as a means to more accurately restore the native anatomy of this ligament. This article describes a new method that uses a double bundle to perform ACL reconstruction and to evaluate the clinical outcome. Methods Grafts are tibialis anterior tendon allograft for anteromedial bundle (AMB) and hamstring tendon autograft without detachment of the tibial insertion for posterolateral bundle (PLB). This technique creates 2 tunnels in both the femur and tibia. Femoral fixation was done by hybrid fixation using Endobutton and Rigidfix for AMB and by biointerference screw for PLB. Tibial fixations are done by Retroscrew for AMB and by native insertion of hamstring tendon for PLB. Both bundles are independently and differently tensioned. We performed ACL reconstruction in 63 patients using our new technique. Among them, 47 participated in this study. The patients were followed up with clinical examination, Lysholm scales and International Knee Documentation Committee (IKDC) scoring system and radiological examination with a minimum 12 month follow-up duration. Results Significant improvement was seen on Lachman test and pivot-shift test between preoperative and last follow-up. Only one of participants had flexion contracture about 5 degrees at last follow-up. In anterior drawer test by KT-1000, authors found improvement from average 8.3 mm (range, 4 to 18 mm) preoperatively to average 1.4 mm (range, 0 to 6 mm) at last follow-up. Average Lysholm score of all patients was 72.7 ± 8.8 (range, 54 to 79) preoperatively and significant improvement was seen, score was 92.2 ± 5.3 (range, 74 to 97; p < 0.05) at last follow-up. Also IKDC score was normal in 35 cases, near normal in 11 cases, abnormal in 1 case at last follow-up. Conclusions Our new double bundle ACL reconstruction technique used hybrid fixation and Retroscrew had favorable outcomes. PMID:22162791

  11. Evaluation of Infection after Anterior Cruciate Ligament Reconstruction during a Short Period

    PubMed Central

    Kim, Hee-June; Lee, Hyun-Joo; Lee, Jong-Chul; Min, Seung-Gi; Kyung, Hee-Soo

    2017-01-01

    Purpose We encountered 7 cases (7.1%) of infection (5 deep and 2 superficial) in 98 cases of anterior cruciate ligament (ACL) reconstruction using hamstring autografts in a 17-month period. The aim of this study was to analyze the causes of infection and to introduce our treatment strategy. Materials and Methods We investigated the shelf-life of the fixation implants, the order of surgery, previous knee surgery, infectious pathogen, treatment of infection, and results of treatment. Results There was no problem with the expiration date of the fixation implants. The order of surgery was either the last or second to the last of all those performed on the same day. One patient had undergone knee surgery 8 months previously. The treatment after infection included aggressive debridement in all cases. Revision ACL reconstruction with graft removal was performed in 1 case of persistent infection with methicillin-resistant Staphylococcus aureus. All cases had satisfactory clinical results without recurrence during a mean 24.9 months of follow-up. Conclusions We could not verify the exact cause of the high incidence of infection during the 17-month period. However, preventive measures are important to decrease the incidence of infection after ACL reconstruction. PMID:28231648

  12. 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

  13. 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

  14. Anterior cruciate ligament reconstruction using quadriceps tendon autograft for adolescents with open physes- a technical note

    PubMed Central

    2011-01-01

    Background One major concern in the treatment of ACL lesions in children and adolescents with open physes is the risk of iatrogenic damage to the physes and a possibly resulting growth disturbance. Purpose The primary purpose of this article is to describe our technique of a transphyseal ACL reconstruction using quadriceps tendon-bone autograft in children and adolescents with open growth plates. The secondary aim is to report our early results in terms of postoperative growth disturbances which are considered to be a major concern in this challenging group of patients. It was our hypothesis that with our proposed technique no significant growth disturbances would occur. Methods From January 1997 to December 2007 49 consecutive children and adolescents with open growth plates were treated for a torn ACL using the aforementioned surgical technique. The patients (28 males and 21 females) with a median age at surgery of 13 (range 8-15) years were retrospectively evaluated. Outcome measures were follow-up radiographs (weight-bearing long leg radiographs of the injured and uninjured knee, anteroposterior and lateral views, a tangential view of the patella and a tunnel view of the injured knee) and follow-up notes (6 weeks, 3, 6, 12 months and until closing of physes) for occurrence of any tibial and/or femoral growth changes. Results: All of the 49 patients had a sufficient clinical and radiological follow-up (minimum 5 years, rate 100%). 48 cases did not show any clinical and radiological growth disturbance. One case of growth disturbance in a 10.5 years old girl was observed. She developed a progressive valgus-flexion deformity which was attributed to a malplacement of the autograft bone block within the femoral posterolateral epiphyseal plate leading to an early localized growth stop. None of the patients were reoperated due to ACL graft failure. Five of the patients underwent revision ACL surgery due to another adequate sports trauma after the growth-stop. The

  15. Implementation of a Breast/Reconstruction Surgery Coordinator to Reduce Preoperative Delays for Patients Undergoing Mastectomy With Immediate Reconstruction

    PubMed Central

    Losk, Katya; Mallory, Melissa A.; Camuso, Kristen; Cutone, Linda; Caterson, Stephanie; Bunnell, Craig A.

    2016-01-01

    Purpose: Mastectomy with immediate reconstruction (MIR) requires coordination between breast and reconstructive surgical teams, leading to increased preoperative delays that may adversely impact patient outcomes and satisfaction. Our cancer center established a target of 28 days from initial consultation with the breast surgeon to MIR. We sought to determine if a centralized breast/reconstructive surgical coordinator (BRC) could reduce care delays. Methods: A 60-day pilot to evaluate the impact of a BRC on timeliness of care was initiated at our cancer center. All reconstructive surgery candidates were referred to the BRC, who had access to surgical clinic and operating room schedules. The BRC worked with both surgical services to identify the earliest surgery dates and facilitated operative bookings. The median time to MIR and the proportion of MIR cases that met the time-to-treatment goal was determined. These results were compared with a baseline cohort of patients undergoing MIR during the same time period (January to March) in 2013 and 2014. Results: A total of 99 patients were referred to the BRC (62% cancer, 21% neoadjuvant, 17% prophylactic) during the pilot period. Focusing exclusively on patients with a cancer diagnosis, an 18.5% increase in the percentage of cases meeting the target (P = .04) and a 7-day reduction to MIR (P = .02) were observed. Conclusion: A significant reduction in time to MIR was achieved through the implementation of the BRC. Further research is warranted to validate these findings and assess the impact the BRC has on operational efficiency and workflows. PMID:26883406

  16. The effect of the variation in ACL constitutive model on joint kinematics and biomechanics under different loads: a finite element study.

    PubMed

    Wan, Chao; Hao, Zhixiu; Wen, Shizhu

    2013-04-01

    The biomechanics and function of the anterior cruciate ligament (ACL) have been widely studied using both experimental and simulation methods. It is known that a constitutive model of joint tissue is a critical factor in the numerical simulation. Some different ligament constitutive models have been presented to describe the ACL material behavior. However, the effect of the variation in the ligament constitutive model on joint kinematics and biomechanics has still not been studied. In this paper, a three-dimensional finite element model of an intact tibiofemoral joint was reconstructed. Three ACL constitutive models were compared under different joint loads (such as anterior tibial force, varus tibial torque, and valgus tibial torque) to investigate the effect of the change of the ACL constitutive model. The three constitutive models corresponded to an isotropic hyperelasticity model, a transversely isotropic hyperelasticity model with neo-Hookean ground substance description, and a transversely isotropic hyperelastic model with nonlinear ground substance description. Although the material properties of these constitutive equations were fitted on the same uniaxial tension stress-strain curve, the change of the ACL material constitutive model was found to induce altered joint kinematics and biomechanics. The effect of different ACL constitutive equations on joint kinematics depended on both deformation direction and load type. The variation in the ACL constitutive models would influence the joint kinematic results greatly in both the anterior and internal directions under anterior tibial force as well as some other deformations such as the anterior and medial tibial translations under valgus tibial torque, and the medial tibial translation and internal rotation under varus torque. It was revealed that the transversely isotropic hyperelastic model with nonlinear ground substance description (FE model III) was the best representation of the realistic ACL property by a

  17. Ureteral Reconstruction With Bowel Segments: Experience With Eight Patients in a Single Institute

    PubMed Central

    Takeuchi, Motoi; Tsukamoto, Taiji

    2014-01-01

    Purpose Although replacement of the ureter with a bowel segment is indicated for large ureteral defects, it is still a challenging technique for urologists. We present our experience and outcome of ureteral reconstruction using bowel segments. Materials and Methods Ureteral reconstruction with bowel segments was performed in eight patients in our institute between 1969 and 2009. We investigated the position and length of the ureteral defect and methods of reconstruction as well as the patients' backgrounds, postoperative complications, and clinical outcomes. Results Five patients underwent ureteral replacement with isolated ileal segments alone. In one patient, the ureter was reconstructed by using the Yang-Monti procedure with the ileum. A colon segment was used in two patients who required bladder augmentation for tuberculous contracted bladder at the same time. Metabolic acidosis occurred in three patients having a solitary kidney and the ureter had to be replaced by a relatively long intestinal segment. Two patients who received preoperative radiation therapy were required to undergo additional operations. Long-term cancer-free survival was achieved in one patient who underwent ileal substitution for low-grade renal pelvic cancer. Conclusions Although ureteral replacement with a bowel segment is a challenging and useful procedure, attention must be paid to the possibility of metabolic acidosis, which is likely to occur in patients having a solitary kidney with renal insufficiency or in patients requiring a long intestinal segment for reconstruction. In addition, preoperative radiation therapy for the pelvic organs may cause postoperative complications. PMID:25405017

  18. Free gracilis flap for chest wall reconstruction in male patient with Poland syndrome after implant failure

    PubMed Central

    Cherubino, Mario; Maggiulli, Francesca; Pellegatta, Igor; Valdatta, Luigi

    2016-01-01

    Poland's syndrome (PS) is a congenital monolateral deformity that may involve breast, chest wall, and upper limb with different degrees of clinical expressions. In some cases, the problem is mainly cosmetic, and the reconstruction should be performed to achieve minimal scarring and donor site morbidity. The authors describe a case report of a male patient with PS who developed a severe capsular contraction after 25 years implant reconstruction, who was treated after explantation using free gracilis flap (FGF). In this patient, only the pectoralis major muscle was missing. An FGF was performed to reconstruct the anterior axillary fold and the soft tissue defect. There was no flap loss, the patient had a clearly improved appearance of the chest wall, and the pain syndrome was solved. In this case report, we demonstrate our experience with the use of an FGF for chest wall reconstruction in male patients with PS after prosthesis explantation. PMID:27833290

  19. Tibial plateau fracture following gracilis-semitendinosus anterior cruciate ligament reconstruction: The tibial tunnel stress-riser.

    PubMed

    Sundaram, R O; Cohen, D; Barton-Hanson, N

    2006-06-01

    Tibial plateau fractures following anterior cruciate ligament (ACL) reconstruction are extremely rare. This is the first reported case of a tibial plateau fracture following four-strand gracilis-semitendinosus autograft ACL reconstruction. The tibial tunnel alone may behave as a stress riser which can significantly reduce bone strength.

  20. What are patients' goals and concerns about breast reconstruction after mastectomy?

    PubMed

    Lee, Clara N; Hultman, Charles Scott; Sepucha, Karen

    2010-05-01

    Discussions about breast reconstruction should include factual information and consideration of the patient's personal concerns. Providers are familiar with the relevant facts but may not know which personal concerns are important to patients. Experience with breast cancer patients has found that providers frequently do not know their patients' treatment preferences. To help reconstructive surgeons discuss personal preferences with their patients, we sought to identify women's key concerns related to breast reconstruction. We employed a qualitative design and convened a sample of 65 women in 7 focus groups and 15 semi-structured interviews. Women with a recent history of early-stage breast cancer who had a mastectomy with or without reconstruction were included. A variety of backgrounds, including underserved populations, low education levels, and various ages were represented. Qualitative content analysis was performed, and key themes were identified. Five key themes emerged. (1) Magnitude of surgery and recovery. Many women reported that concerns over the number of operations, duration of recovery, and risk of complications strongly affected their decision-making. (2) Using one's own tissue. Several women felt comforted by the notion of using their own tissue for reconstruction. (3) Looking natural in clothing. Many women pointed out the difference between how they look in clothing versus how they look naked. (4) Avoiding an external prosthesis. Several women stressed practical concerns and framed the reconstruction decision in terms of not having to use prosthesis. (5) Considering others' opinions. A few women reported that their partners' opinion strongly influenced their decision. Many women stated that they ultimately followed their doctor's recommendation. Women considering reconstruction have some unmet emotional and physical needs as well as important goals and concerns that can affect their decisions about and experience with reconstruction. In particular

  1. 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

  2. The long-term functional and radiological outcome after open reconstruction of the anterior cruciate ligament.

    PubMed

    Sutherland, A G; Cooper, K; Alexander, L A; Nicol, M; Smith, F W; Scotland, T R

    2010-08-01

    We identified a series of 128 patients who had unilateral open reconstruction of the anterior cruciate ligament (ACL) by a single surgeon between 1993 and 2000. In all, 79 patients were reviewed clinically and radiologically eight to 15 years after surgery. Assessment included measurement of the Lysholm and Tegner scores, the ACL quality-of-life score and the Short Form-12 score, as well as the International Knee Documentation Committee clinical assessment, measurement of laxity by the KT-1000 arthrometer, a single-leg hop test and standardised radiography of both knees using the uninjured knee as a control. Of the injured knees, 46 (57%) had definite radiological evidence of osteoarthritis (Kellgren-Lawrence grade 2 or 3), with a mean difference between the injured and non-injured knees of 1.2 grades. The median ACL quality-of-life score was 80 (interquartile range (IQR) 60 to 90), the Lysholm score 84 (IQR 74 to 95), the Short Form-12 physical component score 54 (IQR 49 to 56) and the mean Hop Index 0.94 (0.52 to 1.52). In total 58 patients were graded as normal, 20 as nearly normal and one as abnormal on the KT-1000 assessment and pivot-shift testing. Taking the worst-case scenario of assuming all non-attenders (n = 48), two septic failures and one identified unstable knee found at review to be failures, the failure rate was 40%. Only two of the patients reviewed stated that they would not have similar surgery again. Open reconstruction of the ACL gives good, durable functional results, but with a high rate of radiologically evident osteoarthritis.

  3. Computer-Assisted Mandibular Reconstruction using a Patient-Specific Reconstruction Plate Fabricated with Computer-Aided Design and Manufacturing Techniques.

    PubMed

    Wilde, Frank; Cornelius, Carl-Peter; Schramm, Alexander

    2014-06-01

    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.

  4. Landing Mechanics During Side Hopping and Crossover Hopping Maneuvers in Noninjured Women and Women With Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Ortiz, Alexis; Olson, Sharon; Trudelle-Jackson, Elaine; Rosario, Martin; Venegas, Heidi L.

    2011-01-01

    Objective To compare, landing mechanics and electromyographic activity of the lower extremities during side hopping and crossover hopping maneuvers, in noninjured women and women with anterior cruciate ligament (ACL) reconstruction. Design A case-control study. Setting A 3-dimensional motion analysis laboratory. Participants Twenty-eight young women (range, 21–35 years) (15 control subjects and 13 subjects with ACL reconstruction). Patients and Methods All participants performed a side-to-side hopping task that consisted of hopping single-legged 10 times consecutively from side to side across 2 lines marked 30 cm apart on 2 individual force plates. The task was designated as a side hopping when the hop was to the opposite side of the stance leg and as crossover hopping when the hop was toward the side of the stance leg. Main Outcome Measurements Peak hip-/knee-joint angles; peak knee extension/abduction joint moments; electromyographic studies of the gluteus maximus, gluteus medius, rectus femoris, and hamstring muscles; and quadriceps/hamstring co-contraction ratio were compared between the groups by means of 2 × 2 multivariate analysis of variance tests (group × maneuver). Results Noninjured women and women with ACL reconstruction exhibited similar hip-and knee-joint angles during both types of hopping. Hip-joint angles were greater during the crossover hopping in both groups, and knee-joint angles did not differ between the groups or hops. Knee-joint moments demonstrated a significant group × maneuver interaction. Greater knee extension and valgus moments were noted in the control group during crossover hopping, and greater knee abduction moments were noted in the ACL group during side hopping. Electromyographic data revealed no statistically significantly differences between the groups. Conclusions Women with ACL reconstruction exhibited the restoration of functional biomechanical movements such as hip-/knee-joint angles and lower extremity neuromuscular

  5. New perspectives on ACL injury: On the role of repetitive sub-maximal knee loading in causing ACL fatigue failure.

    PubMed

    Wojtys, Edward M; Beaulieu, Mélanie L; Ashton-Miller, James A

    2016-12-01

    In this paper, we review a series of studies that we initiated to examine mechanisms of anterior cruciate ligament (ACL) injury in the hope that these injuries, and their sequelae, can be better prevented. First, using the earliest in vitro model of a simulated single-leg jump landing or pivot cut with realistic knee loading rates and trans-knee muscle forces, we identified the worst-case dynamic knee loading that causes the greatest peak ACL strain: Combined knee compression, flexion, and internal tibial rotation. We also identified morphologic factors that help explain individual susceptibility to ACL injury. Second, using the above knee loading, we introduced a possible paradigm shift in ACL research by demonstrating that the human ACL can fail by a sudden rupture in response to repeated sub-maximal knee loading. If that load is repeated often enough over a short time interval, the failure tended to occur proximally, as observed clinically. Third, we emphasize the value of a physical exam of the hip by demonstrating how limited internal axial rotation at the hip both increases the susceptibility to ACL injury in professional athletes, and also increases peak ACL strain during simulated pivot landings, thereby further increasing the risk of ACL fatigue failure. When training at-risk athletes, particularly females with their smaller ACL cross-sections, rationing the number and intensity of worst-case knee loading cycles, such that ligament degradation is within the ACL's ability to remodel, should decrease the risk for ACL rupture due to ligament fatigue failure.© 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2059-2068, 2016.

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

    PubMed

    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.

  7. 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

  8. 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.

  9. The anatomy of the anterior cruciate ligament and its relevance to the technique of reconstruction.

    PubMed

    Śmigielski, R; Zdanowicz, U; Drwięga, M; Ciszek, B; Williams, A

    2016-08-01

    Anterior cruciate ligament (ACL) reconstruction is commonly performed and has been for many years. Despite this, the technical details related to ACL anatomy, such as tunnel placement, are still a topic for debate. In this paper, we introduce the flat ribbon concept of the anatomy of the ACL, and its relevance to clinical practice. Cite this article: Bone Joint J 2016;98-B:1020-6.

  10. 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)

  11. Immediate Microsurgical Bone and Nerve Reconstruction in the Irradiated Patient: A Case Report.

    PubMed

    Tursun, Ramzey; Green, J Marshall

    2016-12-11

    Microsurgical reconstructive techniques have revolutionized the treatment of large head and neck defects. These defects were once forever life altering because of the considerable morbidity to both the form and function of the patient. As time has progressed, microsurgical technique has improved dramatically and has become institutionalized in our training programs. Free flap outcomes in head and neck reconstruction have improved dramatically, and optimization of these outcomes is now key. One overlooked area has been neurosensory reconstruction. In our practice we have focused on this detail, which has proved to be quite important to the patient. This case report details one such case in which a mandibular resection was performed to treat osteoradionecrosis. We, as the reconstructive team, elected to perform a double-barrel fibular free flap procedure with simultaneous inferior alveolar nerve reconstruction using a 70-cm processed nerve allograft. Normal neurosensory function returned in this patient. As the state of the art advances with continued successful osseous and soft tissue reconstruction in the head and neck, we propose concomitant neurosensory functional reconstruction always be considered.

  12. Anterior cruciate ligament reconstruction combined with valgus tibial osteotomy (combined procedure).

    PubMed

    Boss, A; Stutz, G; Oursin, C; Gächter, A

    1995-01-01

    We assessed the patients who were operated on in a combined procedure from 1980 to 1992 with anterior cruciate ligament (ACL) insufficiency, cartilaginous lesions of the medial compartment, lesion of medial meniscus and varus malalignment. The combined operative procedure was autologous intra-articular ACL reconstruction with the middle third of the patellar ligament--partially augmented with Kennedy-ligament augmentation device (LAD) in hot dog technique--and high tibial osteotomy. The patients were examined according to the criteria of IKDC including testing of anterior stability with the KT-1000 arthrometer. Radiographically we checked axis and arthritis according to a modified score of Kannus. Twenty-seven of 34 patients who fulfilled the inclusion criteria could be followed up in three categories (2-5 years post-operatively, 5-10 years postoperatively, over 10 years post-operatively). Total qualification was good in 37%; there were no perioperative complications. Rehabilitation was not prolonged. Eighty-nine percent practised their preoperative job, over 50% had a higher level of sports activities than preoperatively, and more than 25% regained their pretraumatic sports capacity. Two-thirds had no giving way and less than 3 mm translation difference in comparison to the contralateral knee. Seventy-five percent of patients would accept the operation again. Radiological findings had no correlation to overall qualification. The encouraging results with respect to many of the criteria suggest using the combined procedure in a young patient with ACL insufficiency, varus malalignment and medial compartment damage including medial meniscus lesion.

  13. 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

  14. Accumulation of irrigation fluid in the calf as a complication during high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament reconstruction.

    PubMed

    Marti, C B; Jakob, R P

    1999-01-01

    Extravasation of irrigation fluid during arthroscopy is a well-known complication. We report a case of accumulation of fluid into the calf during open wedge high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament (ACL) reconstruction. The main cause for fluid extravasation was the drilling of the tibial tunnel, which allowed the fluid to cross the osteotomy gap and invade the flexor compartments. Although an elevation of the intracompartmental pressure was measured, there was no clinical evidence of compartment syndrome. A subcutaneous release of the flexor compartment of the leg was performed. The patient suffered no further sequelae. High tibial osteotomy combined with simultaneous arthroscopic ACL reconstruction has to be performed carefully, and potential complications must be detected immediately to prevent compartment syndrome.

  15. Nipple Reconstruction Using the C-V Flap Technique: Long-Term Outcomes and Patient Satisfaction

    PubMed Central

    Jalini, Lona; Lund, Jonathan; Kurup, Vijay

    2017-01-01

    BACKGROUND Nipple creation using the C-V flap technique is often the final step in breast reconstruction. The aim of this study was to subjectively and objectively assess the cosmetic outcomes and satisfaction of patients undergoing C-V flap nipple reconstruction. METHODS Subjective assessments of patient satisfaction with the neo-nipple were recorded by visual analogue scoring (VAS; 0-10). Objective measurements were performed using a calliper to measure nipple projection relative to the native breast. Descriptive data analysis was performed with differences in projection assessed with the Mann-Whitney test and mean and median VAS scores (with inter-quartile ranges; IQR) calculated to describe satisfaction. RESULTS Thirty-three C-V flap nipple reconstructions were performed. 87.9% received latissimus dorsi (LD) reconstructions with implants and 12.1% had transverse rectus abdominis muscle (TRAM) reconstructions. The median projection of reconstructed nipples was 4.7 mm (range 4-10.2 mm) at 4.6 years mean follow-up, which was not significantly different from the contralateral nipple (p = 0.34). Patient satisfaction was 9 (IQR: 8-10) with shape, 9 (IQR: 7.5-10) with projection, 5 (IQR: 2-9.6) with sensation, and 8.5 (IQR: 6-9.5) with symmetry. Median overall satisfaction was 9 (IQR: 8-10). Three patients had complete nipple loss, of whom two had undergone nipple piercing post procedure and none had received radiotherapy. CONCLUSION C-V flap nipple reconstructions provide a simple and reliable method to reconstruct the nipple that enhances confidence and perception of body image. Satisfaction was high with long-term outcomes in terms of projection equivalent to the contralateral breast. PMID:28289616

  16. Primary TEP placement in patients with laryngopharyngeal free tissue reconstruction and salivary bypass tube placement.

    PubMed

    Divi, Vasu; Lin, Derrick T; Emerick, Kevin; Rocco, James; Deschler, Daniel G

    2011-03-01

    The authors examined the feasibility and advantages of primary tracheoesophageal puncture (TEP) with intraoperative placement of the voice prosthesis for patients undergoing laryngopharyngectomy requiring free tissue reconstruction and salivary bypass tube placement. Six patients were identified; 4 underwent total laryngopharyngectomy, and 2 underwent total laryngectomy with partial pharyngectomy. All 6 required free tissue reconstruction, and a salivary bypass tube was placed in all cases. All patients had a 20F Indwelling Blom-Singer prosthesis (InHealth Technologies, Carpinteria, California) placed. No complications were noted with intraoperative prosthesis placement. No prostheses were dislodged in the postoperative period. At 6 months, 4 patients available for evaluation had successful voice outcomes, and 3 were disease free. This study demonstrates the effectiveness of voice prosthesis placement at the time of primary TEP associated with free tissue reconstruction of a laryngopharyngeal defect with salivary bypass tube placement.

  17. Physiotherapy after reconstruction of anterior cruciate ligament

    PubMed Central

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

    2012-01-01

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

  18. [Damage of reconstructive operations in patients after urgent obstructive resection of colon].

    PubMed

    Gibert, B K; Matveev, I A; Khasiia, D T; Matveev, A I

    2015-01-01

    It was performed comparative analysis of results of reconstructive operations in 116 patients with terminal colostomy after urgent obstructive resection of colon. Damage of reconstructive operations which differ by only access was estimated. Midline access was used in 49 patients, parastomal - in 51 cases. Laparoscopic operation was applied in 16 patients. The most traumatic method was middle laparotomy for restoration of colonic integrity. Laparoscopic operations and parastomal access are less invasive. Laparoscopic operations are accompanied by longer duration, greater blood loss and later restoration of intestinal motility pattern in comparison with surgery through parastomal access. It is associated with duration and damage of adhesiotomy stage.

  19. 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.

  20. Tunnel widening prevention with the allo-Achilles tendon graft in anterior cruciate ligament reconstruction: Surgical tips and short term followup

    PubMed Central

    Suh, Dong Won; Han, Seung Beom; Yeo, Woo Jin; Lee, Won Hee; Kwon, Jae Ho; Kyung, Bong Soo

    2017-01-01

    Background: Tunnel widening (TW) after anterior cruciate ligament (ACL) reconstruction can be a serious complication, and there is controversy over how to prevent it. This study aimed to suggest surgical approaches to prevent TW using an allo-Achilles tendon graft, and then to evaluate TW after these surgical tips were applied. Materials and Methods: Sixty two patients underwent ACL reconstruction with an allo-Achilles tendon graft. Four surgical approaches were used: Making a tibial tunnel by bone impaction, intraarticular reamer application, bone portion application for the femoral tunnel, and an additional bone plug application for the tibial tunnel. After more than 1-year, followup radiographs including anteroposterior and lateral views were taken in 29 patients encompassing thirty knees. The diameter of the tunnels at postoperation day 1 (POD1) and at followup was measured and compared. Results: In 18 knees (60%), there were no visible femoral tunnel margins on the radiographs at POD1 or followup. In the other 12 cases, which had visible femoral tunnel margins on followup radiographs, the mean femoral tunnel diameter was 8.6 mm. In the tibial tunnel, the mean diameters did not increase on all three levels (proximal, middle, and distal), and there was no statistically significant difference between the diameters at POD1 and followup. Conclusion: The suggested tips for surgery involving an allo-Achilles tendon graft can effectively prevent TW after ACL reconstruction according to this case series. These surgical tips can prevent TW.

  1. Validation of a questionnaire assessing patient's aesthetic and functional outcome after nasal reconstruction: the patient NAFEQ-score.

    PubMed

    Moolenburgh, S E; Mureau, M A M; Duivenvoorden, H J; Hofer, S O P

    2009-05-01

    In determining patient satisfaction with functional and aesthetic outcome after reconstructive surgery, including nasal reconstruction, standardised assessment instruments are very important. These standardised tools are needed to adequately evaluate and compare outcome results. Since no such instrument existed for nasal reconstruction, a standardised evaluation questionnaire was developed to assess aesthetic and functional outcome after nasal reconstruction. Items of the Nasal Appearance and Function Evaluation Questionnaire (NAFEQ) were derived from both the literature and experiences with patients. The NAFEQ was validated on 30 nasal reconstruction patients and a reference group of 175 people. A factor analysis confirmed the arrangement of the questionnaire in two subscales: functional and aesthetic outcome. High Cronbach's alpha values (>0.70) for both subscales showed that the NAFEQ was an internally consistent instrument. This study demonstrated that the NAFEQ can be used as a standardised questionnaire for detailed evaluation of aesthetic and functional outcome after nasal reconstruction. Its widespread use would enable comparison of results achieved by different techniques, surgeons and centres in a standardised fashion.

  2. 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

  3. 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…

  4. Knee biomechanics during a jump-cut maneuver: Effects of gender & ACL surgery

    PubMed Central

    Miranda, Daniel L.; Fadale, Paul D.; Hulstyn, Michael J.; Shalvoy, Robert M.; Machan, Jason T.; Fleming, Braden C.

    2012-01-01

    Purpose The purpose of this study was to compare kinetic and knee kinematic measurements from male and female ACL-intact (ACLINT) and ACL-reconstructed (ACLREC) subjects during a jump-cut maneuver using biplanar videoradiography. Methods Twenty subjects were recruited; 10 ACLINT (5 males, 5 females) and 10 ACLREC (4 males, 6 females; five years post surgery). Each subject performed a jump-cut maneuver by landing on a single leg and performing a 45° side-step cut. Ground reaction force was measured by a force plate and expressed relative to body weight. Six-degree-of-freedom knee kinematics were determined from a biplanar videoradiography system and an optical motion capture system. Results ACLINT female subjects landed with a larger peak vertical GRF (p<0.001) compared to ACLINT male subjects. ACLINT subjects landed with a larger peak vertical GRF (p≤0.036) compared to ACLREC subjects. Regardless of ACL reconstruction status, female subjects underwent less knee flexion angle excursion (p=0.002) and had an increased average rate of anterior tibial translation (0.05±0.01%/millisecond; p=0.037) after contact compared to male subjects. Furthermore, ACLREC subjects had a lower rate of anterior tibial translation compared to ACLINT subjects (0.05±0.01%/millisecond; p=0.035). Finally, no striking differences were observed in other knee motion parameters. Conclusion Women permit a smaller amount of knee flexion angle excursion during a jump-cut maneuver, resulting in a larger peak vertical GRF and increased rate of anterior tibial translation. Notably, ACLREC subjects also perform the jump cut maneuver with lower GRF than ACLINT subjects five years post surgery. This study proposes a causal sequence whereby increased landing stiffness (larger peak vertical GRF combined with less knee flexion angle excursion) leads to an increased rate of anterior tibial translation while performing a jump-cut maneuver. PMID:23190595

  5. Lateral tarsal artery flap: an option for hypopharyngeal reconstruction in patients with hypopharyngeal carcinomas after surgery

    PubMed Central

    Wang, Chengyuan; Wang, Qiang; Wang, Zengtao; Li, Guojun; Yang, Dazhang

    2015-01-01

    Background: Hypopharyngeal reconstruction following resection of hypopharyngeal carcinoma has utilized local, regional and free tissue transfer flap options. No single surgical technique is currently in use for hypopharyngeal reconstruction that is applicable to all patients. In this article, we introduce the application of the lateral tarsal artery flap (LTA flap) as a reconstructive option following hypopharyngeal oncologic ablation. Methods: From June 2010 to January 2012, four patients of hypopharyngeal carcinomas underwent total laryngectomy and partial pharyngectomy followed by single-stage reconstruction with LTA flaps. After operation, patients were treated with radical radiotherapy within four weeks. All the patients were followed up. Results: All flaps survived, with an average size of 7.5 cm × 5.8 cm (range of 8.0-7.0 cm × 6.0-5.0 cm). There were no complications or contractures during the follow-up. Normal diets were adopted two weeks after operation. The follow-up ranged from 12-20 months (mean: 15 months). There were no distal stenosis or pharyngocutaneous fistula nor were there any donor-site complications. Conclusion: The LTA flap could be a viable option for hypopharyngeal reconstruction following head and neck oncologic resection. It seems that LTA flap would be a promising flap deserving extensively research. PMID:26131060

  6. Successful penile reconstruction after multimodal therapy in patients with primitive neuroectodermal tumor originating from the penis.

    PubMed

    Akino, Tomoshige; Shinohara, Nobuo; Hatanaka, Kanako; Kobayashi, Nozomi; Yamamoto, Yuhei; Nonomura, Katsuya

    2014-06-01

    We herein present an extremely rare case of primitive neuroectodermal tumor originating in the penis. A 16-year-old male adolescent presented with painful penile swelling. Pathological, immunohistochemical and cytogenetical examinations of the specimens obtained from total penectomy confirmed the diagnosis of primitive neuroectodermal tumor. After total penectomy, the patient received adjuvant chemotherapy with ifosfamide-based regimen for 48 weeks. As a series of therapies, the patient underwent penile reconstruction surgery after completing adjuvant chemotherapy. The patient has not shown any evidence of recurrence for the 7 years after penile reconstruction surgery, and voiding function is completely normal. A favorable outcome was observed by multimodal therapy including aggressive resection for local control, intensive adjuvant chemotherapy, and penile reconstruction with cosmetic and functional success. Similar therapeutic approaches might be selected for children with primary malignant tumors of the penis.

  7. Neoadjuvant Chemotherapy and Short-term Morbidity in Patients Undergoing Mastectomy With and Without Breast Reconstruction

    PubMed Central

    Abt, Nicholas B.; Flores, José M.; Baltodano, Pablo A.; Sarhane, Karim A.; Abreu, Francis M.; Cooney, Carisa M.; Manahan, Michele A.; Stearns, Vered; Makary, Martin A.; Rosson, Gedge D.

    2015-01-01

    IMPORTANCE Neoadjuvant chemotherapy (NC) is increasingly being used in patients with breast cancer, and evidence-based reports related to its independent effects on morbidity after mastectomy with immediate breast reconstruction are limited. OBJECTIVE To determine the effect of NC on 30-day postoperative morbidity in women undergoing mastectomy with or without immediate breast reconstruction. DESIGN, SETTING, AND PARTICIPANTS All women undergoing mastectomy with or without immediate breast reconstruction from January 1, 2005, through December 31, 2011, at university and private hospitals internationally were analyzed using the American College of Surgeons National Surgical Quality Improvement Program 2005-2011 databases. Patients who received NC were compared with those without a history of NC to estimate the relative odds of 30-day postoperative overall, systemic, and surgical site morbidity using model-wise multivariable logistic regression. EXPOSURE Neoadjuvant chemotherapy. MAIN OUTCOMES AND MEASURES Thirty-day postoperative morbidity (overall, systemic, and surgical site). RESULTS Of 85 851 women, 66 593 (77.6%) underwent mastectomy without breast reconstruction, with 2876 (4.3%) receiving NC; 7893 patients were excluded because of missing exposure data. The immediate breast reconstruction population included 19 258 patients (22.4%), with 820 (4.3%) receiving NC. After univariable analysis, NC was associated with a 20% lower odds of overall morbidity in the group undergoing mastectomy without breast reconstruction (odds ratio [OR], 0.80; 95% CI, 0.71-0.91) but had no significant effect in the immediate breast reconstruction group (OR, 0.98; 95% CI, 0.79-1.23). After adjustment for confounding, NC was independently associated with lower overall morbidity in the group undergoing mastectomy without breast reconstruction (OR, 0.61; 95% CI, 0.51-0.73) and the immediate tissue expander reconstruction subgroup (OR, 0.49; 95% CI, 0.30-0.84). Neoadjuvant chemotherapy

  8. Patient Satisfaction with Implant Based Breast Reconstruction Associated with Implant Volume and Mastectomy Specimen Weight Ratio

    PubMed Central

    Baek, Woo Yeol; Byun, Il Hwan; Kim, Young Seok; Lew, Dae Hyun; Jeong, Joon

    2017-01-01

    Purpose Breast volume assessment is one of the most important steps during implant-based breast reconstruction because it is critical in selecting implant size. According to previous studies, there is a close relationship between the mastectomy specimen weight and resected breast volume. The aim of this study was to evaluate long-term patient satisfaction with implant-based breast reconstruction guided by the ratio of implant volume to mastectomy specimen weight. In doing so, we describe the ideal ratio for patient satisfaction. Methods A total of 84 patients who underwent implant-based breast reconstruction for breast cancer were included in this study. The patients were grouped by the ratio of implant size to mastectomy specimen weight (group 1, <65%; group 2, 65%–75%; and group 3, >75%). Outcome analysis was performed using a questionnaire of patient satisfaction and the desired implant size. Results Patient satisfaction scores concerning the postoperative body image, size, and position of the reconstructed breast were significantly higher in group 2. The average ratio of the ideal implant volume to mastectomy specimen weight for each group was 71.9% (range, 54.5%–96.7%), with the differences across the three groups being not significant (p=0.244). Conclusion Since there is an increase in breast reconstruction, selecting the appropriate breast implant is undoubtedly important. Our novel technique using the ratio of implant volume to mastectomy specimen weight provides physicians a firm guide to intraoperative selection of the proper implant in reconstructive breast surgery. PMID:28382100

  9. Fast 3D spine reconstruction of postoperative patients using a multilevel statistical model.

    PubMed

    Lecron, Fabian; Boisvert, Jonathan; Mahmoudi, Saïd; Labelle, Hubert; Benjelloun, Mohammed

    2012-01-01

    Severe cases of spinal deformities such as scoliosis are usually treated by a surgery where instrumentation (hooks, screws and rods) is installed to the spine to correct deformities. Even if the purpose is to obtain a normal spine curve, the result is often straighter than normal. In this paper, we propose a fast statistical reconstruction algorithm based on a general model which can deal with such instrumented spines. To this end, we present the concept of multilevel statistical model where the data are decomposed into a within-group and a between-group component. The reconstruction procedure is formulated as a second-order cone program which can be solved very fast (few tenths of a second). Reconstruction errors were evaluated on real patient data and results showed that multilevel modeling allows better 3D reconstruction than classical models.

  10. Fixed reconstructions in partially edentulous patients using two-part ITI implants (Bonefit) as abutments.

    PubMed

    Brägger, U; Hämmerle, C; Weber, H P

    1990-12-01

    Fixed reconstructions on implant abutments may be a welcome modality in the treatment of partially edentulous patients following the principles of a prophylactically oriented comprehensive care. The option to create artificial tissue integrated abutments widens the range of indications for fixed reconstructions. Risky long-span bridges as well as the preparation of intact teeth for bridge abutments may frequently be avoided. Never should the contours of the prosthesis interfere with the patient's performance of optimal plaque control. Furthermore, supportive periodontal therapy with regular maintenance visits must be provided to optimize a long-term prognosis of the dention as well as the tissue-integrated artificial abutments.

  11. An Ecological Study of Anterior Cruciate Ligament Reconstruction, Part 2

    PubMed Central

    McGrath, Timothy M.; Waddington, Gordon; Scarvell, Jennie M.; Ball, Nick; Creer, Rob; Woods, Kevin; Smith, Damian; Adams, Roger

    2017-01-01

    Background: Additional high-quality prospective studies are needed to better define the objective criteria used in relation to return-to-sport decisions after anterior cruciate ligament (ACL) reconstruction in active populations. Purpose: To investigate prospectively the relationship between functional performance test results at 24 weeks postoperative and return-to-sport activity (Tegner activity score) at 12 and 24 months, respectively, after synthetic (ligament advanced reinforcement system [LARS]) and autograft (doubled semitendinosus/gracilis [2ST/2GR]) ACL reconstructions. Study Design: Case series; Level of evidence, 4. Methods: A total of 64 patients who underwent ACL reconstruction (32 LARS, 32 2ST/2GR autograft; mean age, 27.9 years; body mass index [BMI], 24.9 kg/m2) were assessed preoperatively and at staged intervals postoperatively up to 24 weeks for isokinetic testing of quadriceps and hamstring average power per repetition at 60 deg/s and 180 deg/s, a battery of hop tests, peak vertical ground-reaction force (vGRF), and time to peak vGRF (in seconds) during a step- and jump-down task onto a force platform and peak speed (m/s) using a global positioning system (GPS unit) during a running task. A cohort of 32 healthy matched participants (mean age, 26.31 years; BMI, 25.7 kg/m2) were also tested to act as reference. Pearson correlation was calculated to assess correlation of each performance measure at 24 weeks postoperative with activity outcomes (Tegner score) at 12 and 24 months. Results: The strongest correlation between physical performance tests and return-to-sport outcomes was observed with peak speed during running. Large correlations were also observed for hamstring isokinetic power and hop test for distance. Moderate correlations were observed for timed hop, peak vGRF during a jump-down task, and quadriceps isokinetic power. No statistical correlations were observed for time to peak vGRF during a step-down and jump-down task as well as peak v

  12. One - staged reconstruction of bladder exstrophy in male patients: long - term follow-up outcomes

    PubMed Central

    Giron, Amilcar Martins; Mello, Marcos Figueiredo; Carvalho, Paulo Afonso; Moscardi, Paulo Renato Marcelo; Lopes, Roberto Iglesias; Srougi, Miguel

    2017-01-01

    ABSTRACT Introduction The surgical correction of bladder exstrophy remains challenging. In our institution, the repair has evolved from a staged repair to one-stage reconstruction. The one-stage reconstruction includes; bladder closure, Cantwell-Ransley neourethroplasty and abdominoplasty using groin flaps, without the need of pelvic ostheotomies. Repair of urinary continence (UC) and vesicoureteral reflux (VUR) is done after development of the infant. Objective To present our experience of our modified one-stage reconstruction of bladder exstrophy in male patients. Materials and Methods Medical records of male patients submitted to one-stage reconstruction of bladder exstrophy were analyzed retrospectively. Fifteen exstrophy bladder patients with mean age 4.2±7 years were treated at our institution between 1999-2013. Results 2 5 Conclusions One-stage reconstruction minimizes the number of surgical procedures required to achieve UC and potentiates bladder-neck function. The advantages of using groin flaps over current techniques for complete repair are the small risk for penile tissue loss and the avoidance of ostheotomies. PMID:28124539

  13. Automatic Carrier Landing System (ACLS) Category 3 Certification Manual

    DTIC Science & Technology

    1982-07-01

    INSTRUMENT LANDING SYSTEM .... ......... J-1 APPENDIX K: FRESNEL LENS OPTICAL LANDING SYSTEM .. ......... K-I APPENDIX L: PILOT ACLS RATINGS...surface elements of the ACLS consist of the AN/SPN-42A Landing Control Central with the AN/SPN-41 Instrument Landing System and Fresnel Lens Optical...radar antennas. c. The Fresnel lens calibration pole and three hand held radios be provided. d. Instrumentation seivicing and recording playback

  14. 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.

  15. Comparison of Patient-reported Outcomes after Implant Versus Autologous Tissue Breast Reconstruction Using the BREAST-Q

    PubMed Central

    Pirro, Ortensia; Vindigni, Vincenzo; Sukop, Andrej; Hromadkova, Veronika; Nguyenova, Alena; Vitova, Lenka; Bassetto, Franco

    2017-01-01

    Background: The demand for reconstructive breast procedures of various types has accelerated in recent years. Coupled with increased patient expectations, it has fostered the development of oncoplastic and reconstructive techniques in breast surgery. In the setting of postmastectomy reconstruction, patient satisfaction and quality of life are the most significant outcome variables when evaluating surgical success. The aim of this study was to evaluate the quality of life after implant breast reconstruction compared with autologous breast reconstruction. Materials and Methods: A cross-sectional study design was used. A total of 65 women who had completed postmastectomy implant-based or autologous reconstruction in the participating center were asked to complete the BREAST-Q (Reconstruction Module). Results: Data analysis demonstrated that women with autologous breast reconstruction were significantly more satisfied with their breasts (P = 0.0003) and with the overall outcome (P = 0.0001) compared with women with implant breast reconstruction. All other BREAST-Q parameters that were considered and observed were not significantly different between the 2 patient groups. Conclusions: Through statistical analysis, our results showed that patients who underwent autologous tissue reconstruction had better satisfaction with the reconstructed breast and the outcome, while both techniques appear to equally improve psychosocial well-being, sexual well-being, and chest satisfaction. PMID:28203513

  16. Hydrogel fibers for ACL prosthesis: design and mechanical evaluation of PVA and PVA/UHMWPE fiber constructs.

    PubMed

    Bach, Jason S; Detrez, Fabrice; Cherkaoui, Mohammed; Cantournet, Sabine; Ku, David N; Corté, Laurent

    2013-05-31

    Prosthetic devices for anterior cruciate ligament (ACL) reconstruction have been unsuccessful due to mechanical failure or chronic inflammation. Polymer hydrogels combine biocompatibility and unique low friction properties; however, their prior use for ligament reconstruction has been restricted to coatings due to insufficient tensile mechanics. Here, we investigate new constructs of polyvinyl alcohol (PVA) hydrogel fibers. In water, these fibers swell to an equilibrium water content of 50% by weight, retaining a tensile modulus greater than 40 MPa along the fiber axis at low strain. Rope constructs were assembled for ACL replacement and mechanical properties were compared with data from the literature. Pure PVA hydrogel constructs closely reproduce the non-linear tensile stiffness of the native ACL with an ultimate strength of about 2000 N. An additional safety factor in tensile strength was achieved with composite braids by adding ultrahigh molecular weight polyethylene (UHMWPE) fibers around a core of PVA cords. Composition and braiding angle are adjusted to produce a non-linear tensile behavior within the range of the native ligament that can be predicted by a simple rope model. This design was found to sustain over one million cycles between 50 and 450 N with limited damage and less than 20% creep. The promising mechanical performances of these systems provide justification for more extensive in vivo evaluation.

  17. Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis

    PubMed Central

    2017-01-01

    Background Nipple-areola complex (NAC) reconstruction transforms a mound of soft tissue into a breast and often marks the final stage of breast reconstruction after mastectomy. Methods A systematic review and meta-analysis were conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Articles were classified based on the nipple reconstructive technique—either composite nipple sharing or local flap with nipple-sparing mastectomy (NSM) used as a control. A standardized “Satisfaction Score” (SS) for “nipple appearance” and “nipple sensation” was calculated for each technique. A Fisher’s exact test was used to compare the SS with local flap reconstruction with NSM. Results Twenty-three studies met the systematic review inclusion criteria. Nine NSM articles were identified with patient satisfaction data from 473 patients. The weighted average SS for NSM was 80.5%. Fourteen local flap technique articles were identified with satisfaction data from 984 patients and a weighted average SS of 73.9%. This was a statistically significant difference (P=0.0079). C-V and badge local flap techniques were associated with the highest SS, 92.6% and 90.5%, respectively. C-V and modified C-V flap technique was associated with a higher SS when compared to those using one or more other flap techniques (P=0.0001). Conclusions While patient satisfaction with nipple reconstruction is high regardless of technique, it is higher with NSM. When NSM is not an option, local flap reconstruction with a C-V or modified C-V flap may be associated with higher satisfaction than alternative local flap techniques. PMID:28210547

  18. Gender Dimorphic ACL Strain In Response to Combined Dynamic 3D Knee Joint Loading: Implications for ACL Injury Risk

    PubMed Central

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

    2009-01-01

    While gender-based differences in knee joint anatomies/laxities are well documented, the potential for them to precipitate gender-dimorphic ACL loading and resultant injury risk has not been considered. To this end, we generated gender-specific models of ACL strain as a function of any six degrees of freedom (6DOF) knee joint load state via a combined cadaveric and analytical approach. Continuously varying joint forces and torques were applied to five male and five female cadaveric specimens and recorded along with synchronous knee flexion and ACL strain data. All data (~10,000 samples) were submitted to specimen-specific regression analyses, affording ACL strain predictions as a function of the combined 6 DOF knee loads. Following individual model verifications, generalized gender-specific models were generated and subjected to 6 DOF external load scenarios consistent with both a clinical examination and a dynamic sports maneuver. The ensuing model-based strain predictions were subsequently examined for gender-based discrepancies. Male and female specimen specific models predicted ACL strain within 0.51% ± 0.10% and 0.52% ± 0.07% of the measured data respectively, and explained more than 75% of the associated variance in each case. Predicted female ACL strains were also significantly larger than respective male values for both of simulated 6 DOF load scenarios. Outcomes suggest that the female ACL will rupture in response to comparatively smaller external load applications. Future work must address the underlying anatomical/laxity contributions to knee joint mechanical and resultant ACL loading, ultimately affording prevention strategies that may cater to individual joint vulnerabilities. PMID:19464897

  19. 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.

  20. Extensor-tendons reconstruction using autogenous palmaris longus tendon grafting for rheumatoid arthritis patients

    PubMed Central

    Chu, Po-Jung; Lee, Hung-Maan; Hou, Yao-Tung; Hung, Sheng-Tsai; Chen, Jung-Kuei; Shih, Jui-Tien

    2008-01-01

    Background The purpose of the study is to retrospectively review the clinical outcome of our study population of middle-aged RA patients who had suffered extensor-tendon rupture. We reported the outcome of autogenous palmaris tendon grafting of multiple extensor tendons at wrist level in 14 middle-aged rheumatoid patients. Methods Between Feb. 2000 to Feb. 2004, thirty-six ruptured wrist level extensor tendons were reconstructed in fourteen rheumatoid patients (11 women and three men) using autogenous palmaris longus tendon as a free interposition graft. In each case, the evaluation was based on both subjective and objective criteria, including the range of MCP joint flexion after surgery, the extension lag at the metacarpophalangeal joint before and after surgery, and the ability of the patient to work. Results and Discussion The average of follow-up was 54.1 months (range, 40 to 72 months). The average range of MCP joint flexion after reconstruction was 66°. The extension lag at the metacarpophalangeal joint significantly improved from a preoperative mean of 38° (range, 25°–60°) to a postoperative mean of 16° (range, 0°–30°). Subjectively all patients were satisfied with the clinical results, and achieved a return to their level of ability before tendon rupture. We found good functional results in our series of interposition grafting using palmaris longus to reconstruct extensor tendon defects in the rheumatoid patients. Conclusion Reconstruction for multiple tendon ruptures is a salvage procedure that is often associated with extensor lag and impairment of overall function. Early aggressive treatment of extensor tendon reconstruction using autogenous palmaris longus tendon as a free interposition graft in the rheumatoid wrist is another viable option to achieve good clinical functional result. PMID:18435845

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

    PubMed

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

    2012-08-01

    Anterior cruciate ligament (ACL) injury is a common injury encountered by sport medicine clinicians. Surgical reconstruction is the recommended treatment of choice for those athletes wishing to return to full-contact sports participation and for sports requiring multi-directional movement patterns. The aim of ACL reconstruction is to restore knee joint mechanical stability such that the athlete can return to sporting participation. However, knowledge regarding the extent to which lower limb kinematic profiles are restored following ACL reconstruction is limited. In the present study the hip and knee joint kinematic profiles of 13 ACL reconstructed (ACL-R) and 16 non-injured control subjects were investigated during the performance of a diagonal jump landing task. The ACL-R group exhibited significantly less peak knee joint flexion (P=0.01). Significant between group differences were noted for time averaged hip joint sagittal plane (P<0.05) and transverse plane (P<0.05) kinematic profiles, as well as knee joint frontal plane (P<0.05) and sagittal plane (P<0.05) kinematic profiles. These results suggest that aberrant hip and knee joint kinematic profiles are present following ACL reconstruction, which could influence future injury risk.

  2. [Total alloplastic temporomandibular joint reconstruction combined with orthodontic treatment in a patient with idiopathic condylar resorption].

    PubMed

    Chung, Chooryung J; Choi, Yoon-Jeong; Kim, In-Sil; Huh, Jong-Ki; Kim, Hyung-Gon; Kim, Kyung-Ho

    2012-09-01

    This case report describes the successful treatment of an adult patient with skeletal Class II open-bite malocclusion secondary to idiopathic condylar resorption. Total alloplastic joint reconstruction and counterclockwise rotation of the maxillomandibular complex combined with orthodontic treatment provided a satisfying outcome with maximum functional and esthetic improvement.

  3. Total alloplastic temporomandibular joint reconstruction combined with orthodontic treatment in a patient with idiopathic condylar resorption.

    PubMed

    Chung, Chooryung J; Choi, Yoon-Jeong; Kim, In-Sil; Huh, Jong-Ki; Kim, Hyung-Gon; Kim, Kyung-Ho

    2011-09-01

    This case report describes the successful treatment of an adult patient with skeletal Class II open-bite malocclusion secondary to idiopathic condylar resorption. Total alloplastic joint reconstruction and counterclockwise rotation of the maxillomandibular complex combined with orthodontic treatment provided a satisfying outcome with maximum functional and esthetic improvement.

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

    PubMed Central

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

    2015-01-01

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

  5. Outcome of double bundle anterior cruciate ligament reconstruction using crosspin and aperture fixation

    PubMed Central

    Joshi, Deepak; Jain, Vineet; Goyal, Ankit; Bahl, Vibhu; Modi, Prashant; Chaudhary, Deepak

    2014-01-01

    Background: Double bundle anterior cruciate ligament (DBACL) reconstruction is said to reproduce the native anterior cruciate ligament (ACL) anatomy better than single bundle anterior cruciate ligament, whether it leads to better functional results is debatable. Different fixation methods have been used for DBACL reconstruction, the most common being aperture fixation on tibial side and cortical suspensory fixation on the femoral side. We present the results of DBACL reconstruction technique, wherein on the femoral side anteromedial (AM) bundle is fixed with a crosspin and aperture fixation was done for the posterolateral (PL) bundle. Materials and Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Results: The KT-1000 results were evaluated using paired t test with the P value set at 0.001. At the end of 1

  6. Readability of online patient education materials on adult reconstruction Web sites.

    PubMed

    Polishchuk, Daniil L; Hashem, Jenifer; Sabharwal, Sanjeev

    2012-05-01

    Recommended readability of patient education materials is sixth-grade level or lower. Readability of 212 patient education materials pertaining to adult reconstruction topics available from the American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, and 3 other specialty and private practitioner Web sites was assessed using the Flesch-Kincaid grade formula. The mean Flesch-Kincaid score was 11.1 (range, 3-26.5). Only 5 (2%) articles had a readability level of sixth grade or lower. Readability of most of the articles for patient education on adult reconstruction Web sites evaluated may be too advanced for a substantial portion of patients. Further studies are needed to assess the optimal readability level of health information on the Internet.

  7. Treatment of Anterior Cruciate Ligament Injury in Skeletally Immature Patients

    PubMed Central

    Hudgens, Joshua L.; Dahm, Diane L.

    2012-01-01

    The incidence of ACL tears is rising in the pediatric and adolescent populations as these individuals succumb to traumatic and nontraumatic athletic injuries. Management of this condition in the skeletally immature patient poses a challenge and is controversial. Operative reconstruction carries the concern for damage to the physis with resultant limb length inequality and angular joint deformity but provides stability to the knee and allows return of function in most patients. On the other hand, nonoperative treatment has been shown to carry an increased risk of meniscal and articular cartilage damage and is difficult from a compliance standpoint in this demographic. For the majority of skeletally immature patients, operative treatment is recommended as it has shown good clinical and functional results with minimal risk of growth disturbance. This paper aims to address the natural course of ACL injuries in the skeletally immature patient, treatment options with associated complications, and current preventative strategies. PMID:22315624

  8. 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

  9. 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

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

    PubMed

    Mascarenhas, Randy; MacDonald, Peter B

    2008-01-01

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

  11. Utility of endoscopic retrograde cholangiopancreatography on biliopancreatic diseases in patients with Billroth II-reconstructed stomach

    PubMed Central

    Sakai, Yuji; Tsuyuguchi, Toshio; Mikata, Rintaro; Sugiyama, Harutoshi; Yasui, Shin; Miyazaki, Masaru; Yokosuka, Osamu

    2017-01-01

    AIM To examine the utility of endoscopic retrograde cholangiopancreatography (ERCP) on biliopancreatic diseases in the patients with Billroth II-reconstructed stomach. METHODS For 26 cases of biliopancreatic diseases in patients with Billroth II-reconstructed stomach, ERCP was conducted using a straight-view scope or a retrograde oblique-viewing endoscope. All the cases were patients aiming at selective insertion into the bile duct. One patient aimed at diagnosis, and 25 patients aimed at treatment. The cases in which the endoscope reached the duodenal papilla and anastomosis, and insertion into the bile duct became possible, were considered successful. RESULTS The rate of reaching the duodenal papilla and anastomosis was 84.7% (22/26 patients). Among the cases without reaching the duodenal papilla and anastomosis, there were 2 in which the endoscope did not pass due to tumor-induced duodenal infiltration. In 1 case, the fiber did not reach the duodenal papilla due to long afferent loop. The success rate of insertion into the bile duct in patients in which the endoscope reached the duodenal papilla and anastomosis was 90.9% (20/22 patients), and the success rate of procedures including treatment was 86.3% (19/22 patients). After treatment, mild cholangitis was observed in 1 patient (4.5%, 1/22 patients) but relieved conservatively. No other accidental symptom was observed. CONCLUSION It was considered that the ERCP for biliopancreatic diseases in patients with Billroth II-reconstructed stomach will become a less invasive, safe and useful examination and treatment approach. PMID:28360974

  12. Successful free osteocutaneous scapular flap transfer for mandibular reconstruction in a 93-year-old patient.

    PubMed

    Niitsuma, Katsunori; Hatoko, Mitsuo; Kuwahara, Masamitsu; Tanaka, Aya; Iioka, Hiroshi; Fukuda, Takehiko; Yane, Katsunari

    2004-01-01

    With the extension of the average life span and the development of surgical technique, anesthesia, and pre- and postoperative management, operations for elderly patients have become more widely accepted. In the field of plastic surgery, free-flap transfers using microvascular techniques have become a common surgical procedure in reconstruction of the head and neck region after surgical removal of a cancer. There have been several reports of free-flap transfer in patients older than 90 years, but the authors know of no reports of free osteocutaneous flap transfer for mandibular reconstruction, which is a very invasive free-flap surgery, for such patients. The mandible plays a significant role in various kinds of dynamic functions, such as mastication, deglutition, and articulation. Disorder of these functions causes a deterioration in the patient's quality of life. The authors have performed a mandibular reconstruction using an osteocutaneous scapular free flap after resection of a gingival cancer invading the mandibular bone in a 93-year-old Japanese woman. In our case, an osteocutaneous scapular free flap, which permits the patient rapid rehabilitation of the lower leg, is thought to be a good choice because it allows the patient to get out of bed as quickly as possible in the postoperative period to minimize additional complications.

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

    PubMed

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

    2012-05-01

    While cryotherapy has been shown to decrease postoperative pain after anterior cruciate ligament (ACL) reconstruction, less is known of the effects of combined cryotherapy and compression. The goal of this study was to compare subjective and objective patient outcomes following ACL reconstruction with combined compression and cryotherapy compared with traditional ice therapy alone. Patients undergoing ACL reconstruction were randomized to cryotherapy/compression device (group 1) or a standardized ice pack (group 2). Both groups were instructed to use the ice or cryotherapy/compression device three times per day and return to the clinic at 1, 2, and 6 weeks postoperatively. Patient-derived outcome measurements used in this study consisted of the visual analog scale (VAS), the Lysholm knee score, Short Form-36 (SF-36), and single assessment numerical evaluation (SANE). Circumferential measurements of the knee at three locations (1 cm proximal to patella, mid-patella, and 1 cm distal to patella) were also obtained as a measure of postoperative edema. Narcotic medication use was recorded by questionnaire. The primary outcome measure (VAS) was significantly different among groups in the preoperative measurement, despite similarities in group demographics. Baseline VAS for group 1 was 54.9 compared with group 2 at 35.6 (p = 0.01). By 6 weeks, this had lowered to 28.1 and 40.3, respectively, resulting in a significant 27-point decrease in mean VAS for group 1 (p < 0.0001). However, the small increase in VAS for group 2 was not significant (p = 0.34). No significant differences were noted for the Lysholm, SF-36, or SANE scores either between groups or time points. Furthermore, no significant differences were noted for any of the circumferential measurements either between groups or time points. Of all patients, 83% of group 1 discontinued narcotic use by 6 weeks, compared with only 28% of group 2 (p = 0.0008). The use of combined cryotherapy and compression in the

  14. Tissue-engineered autologous urethras for patients who need reconstruction: an observational study

    PubMed Central

    Raya-Rivera, Atlantida; Esquiliano, Diego R; Yoo, James J; Lopez-Bayghen, Esther; Soker, Shay; Atala, Anthony

    2014-01-01

    Background Complex urethral problems can occur as a result of injury, disease, or congenital defects and treatment options are often limited. Urethras, similar to other long tubularised tissues, can stricture after reconstruction. We aimed to assess the effectiveness of tissue-engineered urethras using patients’ own cells in patients who needed urethral reconstruction. Methods Five boys who had urethral defects were included in the study. A tissue biopsy was taken from each patient, and the muscle and epithelial cells were expanded and seeded onto tubularised polyglycolic acid:poly(lactide-co-glycolide acid) scaffolds. Patients then underwent urethral reconstruction with the tissue-engineered tubularised urethras. We took patient history, asked patients to complete questionnaires from the International Continence Society (ICS), and did urine analyses, cystourethroscopy, cystourethrography, and flow measurements at 3, 6, 12, 24, 36, 48, 60, and 72 months after surgery. We did serial endoscopic cup biopsies at 3, 12, and 36 months, each time in a different area of the engineered urethras. Findings Patients had surgery between March 19, 2004, and July 20, 2007. Follow-up was completed by July 31, 2010. Median age was 11 years (range 10–14) at time of surgery and median follow-up was 71 months (range 36–76 months). AE1/AE3, α actin, desmin, and myosin antibodies confirmed the presence of cells of epithelial and muscle lineages on all cultures. The median end maximum urinary flow rate was 27·1 mL/s (range 16–28), and serial radiographic and endoscopic studies showed the maintenance of wide urethral calibres without strictures. Urethral biopsies showed that the engineered grafts had developed a normal appearing architecture by 3 months after implantation. Interpretation Tubularised urethras can be engineered and remain functional in a clinical setting for up to 6 years. These engineered urethras can be used in patients who need complex urethral reconstruction

  15. The relationship between isokinetic quadriceps strength and laxity on gait analysis parameters in anterior cruciate ligament reconstructed knees.

    PubMed

    Gokeler, Alli; Schmalz, Thomas; Knopf, Elmar; Freiwald, Jürgen; Blumentritt, Siegmar

    2003-11-01

    Gait alterations after ACL reconstruction have been reported in the literature. The current study examined a group of 14 patients who all had an ACL reconstruction with a patellar tendon autograft. Kinetic and kinematic data were obtained from the knee during walking. The flexion-extension deficit (FED) calculated from the angular difference between maximal flexion and maximal extension during the stance phase in the ACL-reconstructed and the normal knee was measured. We investigated whether these alterations in gait are related to quadriceps strength and residual laxity of the knee. It may be that patients modify their gait patterns to protect the knee from excessive anterior translation of the tibia by reducing the amount of extension during stance. On the other hand, persistent quadriceps weakness may also cause changes in gait patterns as the quadriceps is functioning as an important dynamic stabilizer of the knee during stance. Results showed that patients had a significantly higher FED value (4.9+/-4.0) than a healthy control group in a previous study (1.3+/-0.9). This is caused mainly by an extension deficit during midstance. External extension moments of the knee (TZMAX were significantly lower in the current patients group than in a healthy control group (TZMAX -0.27+/-0.19 Nm/kg in patients vs. -0.08+/-0.06 Nm/kg in controls). There were no significant correlations between quadriceps strength and gait analysis parameters. Furthermore no correlation was found between the amount of laxity of the knee and gait. The relevance of this study lies in the fact that apparently the measured gait alterations cannot be explained solely by often used biomechanical indicators such as laxity and strength. The measured gait alterations may be a result of the surgical procedure with subsequent modified motor programming.

  16. Long-term outcomes of urinary tract reconstruction in patients with neurogenic urinary tract dysfunction.

    PubMed

    Johnson, E U; Singh, Gurpreet

    2013-10-01

    The advent of specialized spinal units and better understanding of the pathophysiology of neurogenic urinary tract dysfunction has made long-term survival of these patients a reality. This has, in turn, led to an increase in quality and choice of management modalities offered to these patients including complex anatomic urinary tract reconstructive procedures tailored to the unique needs of each individual with variable outcomes. We performed a literature review evaluating the long-term outcomes of these reconstructive procedures. To achieve this, we conducted a world-wide electronic literature search of long-term outcomes published in English. As the premise of this review is long-term outcomes, we have focused on pathologies where evidence of long-term outcome is available such as patients with spinal injuries and spina bifida. Therapeutic success following urinary tract reconstruction is usually measured by preservation of renal function, improvement in quality-of-life, the satisfactory achievement of agreed outcomes and the prevention of serious complications. Prognostic factors include neuropathic detrusor overactivity; sphincter dyssynergia; bladder over distension; high pressure storage and high leak point pressures; vesicoureteric reflex, stone formation and urinary tract infections. Although, the past decade has witnessed a reduction in the total number of bladder reconstructive surgeries in the UK, these procedures are essentially safe and effective; but require long-term clinical and functional follow-up/monitoring. Until tissue engineering and gene therapy becomes more mainstream, we feel there is still a place for urinary tract reconstruction in patients with neurogenic lower urinary tract dysfunction.

  17. Long-term outcomes of urinary tract reconstruction in patients with neurogenic urinary tract dysfunction

    PubMed Central

    Johnson, E. U.; Singh, Gurpreet

    2013-01-01

    The advent of specialized spinal units and better understanding of the pathophysiology of neurogenic urinary tract dysfunction has made long-term survival of these patients a reality. This has, in turn, led to an increase in quality and choice of management modalities offered to these patients including complex anatomic urinary tract reconstructive procedures tailored to the unique needs of each individual with variable outcomes. We performed a literature review evaluating the long-term outcomes of these reconstructive procedures. To achieve this, we conducted a world-wide electronic literature search of long-term outcomes published in English. As the premise of this review is long-term outcomes, we have focused on pathologies where evidence of long-term outcome is available such as patients with spinal injuries and spina bifida. Therapeutic success following urinary tract reconstruction is usually measured by preservation of renal function, improvement in quality-of-life, the satisfactory achievement of agreed outcomes and the prevention of serious complications. Prognostic factors include neuropathic detrusor overactivity; sphincter dyssynergia; bladder over distension; high pressure storage and high leak point pressures; vesicoureteric reflex, stone formation and urinary tract infections. Although, the past decade has witnessed a reduction in the total number of bladder reconstructive surgeries in the UK, these procedures are essentially safe and effective; but require long-term clinical and functional follow-up/monitoring. Until tissue engineering and gene therapy becomes more mainstream, we feel there is still a place for urinary tract reconstruction in patients with neurogenic lower urinary tract dysfunction. PMID:24235796

  18. Cranial Reconstruction in a Pediatric Patient Using a Tissue Expander and Custom-made Hydroxyapatite Implant.

    PubMed

    Akamatsu, Tadashi; Hanai, Ushio; Kobayashi, Megumi; Nakajima, Serina; Kuroki, Takahiko; Miyasaka, Muneo; Imai, Masaaki

    2015-06-20

    A tissue expansion technique in conjunction with a custom-made artificial bone implant was effective for a large cranial reconstruction in a pediatric patient. The patient was an eight-year-old boy with cranial bone fracture, acute subdural hematoma in the left lobe, and acute epidural hematoma in the right lobe due to an accident. Wound dehiscence and artificial dura infection were observed as postoperative complications. Because of insufficiency of the skin flap caused by scar contracture, a scalp skin expansion using a tissue expander was necessary before reconstruction with the artificial bone implant. This combined procedure provided safe coverage of the implant and resulted in good wound healing. There are relatively few reports involving the use of tissue expanders for cranioplasty; furthermore, our search of the literature did not reveal any reports involving children. We believe that this procedure is safe and effective for early rehabilitation in pediatric patients.

  19. Near-complete Humerus Reconstruction in the Pediatric Patient with Vascularized Free Fibula Transfer

    PubMed Central

    Shuck, John; Zarella, Christopher; Oh, Albert K.; Henshaw, Robert M.; Rogers, Gary F.

    2016-01-01

    Summary: Vascularized free fibula transfer remains the gold standard for reconstruction of large segmental diaphyseal defects of the upper extremity. In the pediatric patient, before skeletal maturity, free fibula transfer with the fibular head provides an active physis for growth and an articular interface for glenohumeral joint reconstruction. Clinical and cadaveric studies have demonstrated that the vascular supply to the fibular head originates, in most cases, from the anterior tibial system. However, anatomical variation exists, and we report a case in which a vascularized fibula autograft including the physis was transferred on the peroneal artery in a 5-year-old patient with Ewing’s sarcoma. At 15-month follow-up, the patient has functional range of motion of the shoulder. PMID:28293503

  20. DIEP Flap for Breast Reconstruction Using Epidural Anesthesia with the Patient Awake

    PubMed Central

    Camacho, Marco; de la Garza, Jonatan

    2016-01-01

    Background: Many articles have been published about breast reconstruction using the deep inferior epigastric perforator (DIEP) flap; however, few articles have been published in plastic/reconstructive surgery journals describing the difference between anesthetic techniques and recovery in microsurgical patients. Methods: We analyzed 16 patients who underwent DIEP flap for breast reconstruction. Patients were divided into 2 groups: group 1: general anesthesia (n = 9); group 2: epidural block with the patient awake (n = 7). In group 2, the peridural block was done at 2 levels: thoracic (T2–T3) and lumbar (L2–L3). Results: The success rate was 100% with no partial or total loss of the flap. There was no difference between groups in regard to postoperative pain in the first 5 days (Visual Analog Scale). Analgesia used in group 1 was buprenorphine and ketorolac, and in group 2, only ketorolac without opioid derivatives. Immediate postoperative recovery was better in the peridural group than in the group administered general anesthesia (P = 0.0001). Conclusions: DIEP flap with peridural block and the patient awake during surgery is a feasible technique with better recovery in the immediate postoperative period, achieving good analgesia level with minimal intravenous medication. PMID:27579248

  1. Impact of patient comorbidities on head and neck microvascular reconstruction. A report on 423 cases.

    PubMed

    Vandersteen, Clair; Dassonville, Olivier; Chamorey, Emmanuel; Poissonnet, Gilles; Nao, Eric Edi Martial; Pierre, Cédric Sandy; Leyssale, Axel; Peyrade, Frédéric; Falewee, Marie Noelle; Sudaka, Anne; Haudebourg, Juliette; Demard, François; Santini, José; Bozec, Alexandre

    2013-05-01

    The aim of this study was to assess the impact of the different subtypes of patient comorbidities on the outcomes of head and neck microvascular reconstruction. A total of 423 patients who underwent head and neck free flap reconstruction in our institution between 2000 and 2010 were included in this retrospective study. The impact of the different subtypes of patient comorbidities (as defined by the Kaplan-Feinstein Index) and other global health status-related factors on free flap success, local and general complications, postoperative mortality and length of stay was assessed in univariate and multivariate analysis. We found no correlation between patient comorbidities and free flap failure. In multivariate analysis, we demonstrated a significant correlation between tobacco consumption (p = 0.04) and local complications. Gastro-intestinal comorbidity (p = 0.005) and malnutrition (p = 0.02) were associated with a higher risk of fistula formation. Diabetes mellitus (p = 0.003), gastro-intestinal (p = 0.02), systemic (p = 0.02) and cardiac comorbidities (p = 0.03) were significant predictors of medical complications. We concluded that the different subtypes of patient comorbidities were relevant predictors of complications in head and neck microvascular reconstruction.

  2. Detection and correction of patient movement in prostate brachytherapy seed reconstruction

    NASA Astrophysics Data System (ADS)

    Lam, Steve T.; Cho, Paul S.; Marks, Robert J., II; Narayanan, Sreeram

    2005-05-01

    Intraoperative dosimetry of prostate brachytherapy can help optimize the dose distribution and potentially improve clinical outcome. Evaluation of dose distribution during the seed implant procedure requires the knowledge of 3D seed coordinates. Fluoroscopy-based seed localization is a viable option. From three x-ray projections obtained at different gantry angles, 3D seed positions can be determined. However, when local anaesthesia is used for prostate brachytherapy, the patient movement during fluoroscopy image capture becomes a practical problem. If uncorrected, the errors introduced by patient motion between image captures would cause seed mismatches. Subsequently, the seed reconstruction algorithm would either fail to reconstruct or yield erroneous results. We have developed an algorithm that permits detection and correction of patient movement that may occur between fluoroscopy image captures. The patient movement is decomposed into translational shifts along the tabletop and rotation about an axis perpendicular to the tabletop. The property of spatial invariance of the co-planar imaging geometry is used for lateral movement correction. Cranio-caudal movement is corrected by analysing the perspective invariance along the x-ray axis. Rotation is estimated by an iterative method. The method can detect and correct for the range of patient movement commonly seen in the clinical environment. The algorithm has been implemented for routine clinical use as the preprocessing step for seed reconstruction.

  3. Image-based reconstruction of 3D myocardial infarct geometry for patient specific applications

    NASA Astrophysics Data System (ADS)

    Ukwatta, Eranga; Rajchl, Martin; White, James; Pashakhanloo, Farhad; Herzka, Daniel A.; McVeigh, Elliot; Lardo, Albert C.; Trayanova, Natalia; Vadakkumpadan, Fijoy

    2015-03-01

    Accurate reconstruction of the three-dimensional (3D) geometry of a myocardial infarct from two-dimensional (2D) multi-slice image sequences has important applications in the clinical evaluation and treatment of patients with ischemic cardiomyopathy. However, this reconstruction is challenging because the resolution of common clinical scans used to acquire infarct structure, such as short-axis, late-gadolinium enhanced cardiac magnetic resonance (LGE-CMR) images, is low, especially in the out-of-plane direction. In this study, we propose a novel technique to reconstruct the 3D infarct geometry from low resolution clinical images. Our methodology is based on a function called logarithm of odds (LogOdds), which allows the broader class of linear combinations in the LogOdds vector space as opposed to being limited to only a convex combination in the binary label space. To assess the efficacy of the method, we used high-resolution LGE-CMR images of 36 human hearts in vivo, and 3 canine hearts ex vivo. The infarct was manually segmented in each slice of the acquired images, and the manually segmented data were downsampled to clinical resolution. The developed method was then applied to the downsampled image slices, and the resulting reconstructions were compared with the manually segmented data. Several existing reconstruction techniques were also implemented, and compared with the proposed method. The results show that the LogOdds method significantly outperforms all the other tested methods in terms of region overlap.

  4. Reconstruction of action potential of repolarization in patients with congenital long-QT syndrome

    NASA Astrophysics Data System (ADS)

    Kandori, Akihiko; Shimizu, Wataru; Yokokawa, Miki; Kamakura, Shiro; Miyatake, Kunio; Murakami, Masahiro; Miyashita, Tsuyoshi; Ogata, Kuniomi; Tsukada, Keiji

    2004-05-01

    A method for reconstructing an action potential during the repolarization period was developed. This method uses a current distribution—plotted as a current-arrow map (CAM)—calculated using magnetocardiogram (MCG) signals. The current arrows are summarized during the QRS complex period and subtracted during the ST-T wave period in order to reconstruct the action-potential waveform. To ensure the similarity between a real action potential and the reconstructed action potential using CAM, a monophasic action potential (MAP) and an MCG of the same patient with type-I long-QT syndrome were measured. Although the MAP had one notch that was associated with early afterdepolarization (EAD), the reconstructed action potential had two large and small notches. The small notch timing agreed with the occurrence of the EAD in the MAP. On the other hand, the initiation time of an abnormal current distribution coincides with the appearance timing of the first large notch, and its end time coincides with that of the second small notch. These results suggest that a simple reconstruction method using a CAM based on MCG data can provide a similar action-potential waveform to a MAP waveform without having to introduce a catheter.

  5. Fournier gangrene: a review of 41 patients and strategies for reconstruction.

    PubMed

    Chen, Shih-Yi; Fu, Ju-Peng; Wang, Chih-Hsin; Lee, Tzu-Peng; Chen, Shyi-Gen

    2010-06-01

    Fournier gangrene is an acute and potentially fatal infection of the scrotum, perineum, and abdominal wall. It is characterized by necrotizing fasciitis with loss of subcutaneous tissue and skin. The aim of this study was to analyze the prognosis and treatment effectiveness of this fulminant infectious disease. Forty-one patients were admitted to our hospital with the diagnosis of Fournier gangrene between January 1998 and December 2006. The patients' age, sex, predisposing factors, duration of symptoms and hospital stay, time to operation, size of the skin defect, bacteria isolated, treatment modalities, and outcomes were reviewed. The data were analyzed by chi2 analysis and Student t test. A P-value <0.05 was considered significant. The mean age of the patients was 57.2 years. The most common predisposing factor was diabetes mellitus in 21 patients (51.2%), followed by cirrhosis of the liver, uremia, alcoholism, and underlying malignancy. The most common symptoms were fever (87.8%) and pain or swelling over the genital region (85.4%). The initial treatment included extensive debridement and open drainage. Time to operation ranged from 1 to 10 days. Reconstructive surgery was performed for 22 patients. The mortality rate was 19.5%. Delayed debridement was a significant factor affecting the survival rate. Our study is a retrospective study of patients with Fournier gangrene undergoing debridement and reconstructive procedure. Because of the fulminant course of Fournier gangrene, it may be difficult to design a prospective study. Fournier gangrene is a severe infectious disease with a high mortality rate. Early and aggressive debridement is a significant prognostic factor in the management of Fournier gangrene. Several reconstructive modalities are useful to correct the tissue defect. Early debridement and reconstructive surgery for wound coverage improve the quality of life.

  6. Comparison of aesthetic breast reconstruction after skin-sparing or conventional mastectomy in patients receiving preoperative radiation therapy.

    PubMed

    Chang, Eric I; Ly, Daphne P; Wey, Philip D

    2007-07-01

    Many options exist for the surgical treatment of breast cancer in terms of tumor extirpation and reconstruction. Skin-sparing mastectomy (SSM) with immediate reconstruction offers patients a superior result, but this can be jeopardized by preoperative radiotherapy. We compared the outcomes of reconstruction after SSM or conventional mastectomy (CM) in the previously irradiated breast. We evaluated 41 patients over an 8-year period, who were divided into 3 categories: preoperative radiotherapy prior to SSM (n = 8), CM after preoperative radiation therapy (n = 9), and no chest wall irradiation prior to SSM (n = 20). The first group demonstrated significantly higher frequency of native flap compromise and capsular contracture formation than the other 2 groups.SSM with TRAM or latissimus with implant reconstruction is an esthetically optimal option for the treatment of patients without previous radiotherapy. However, for patients with preoperative chest wall radiation, TRAM flap reconstruction was superior to latissimus flap with implant after SSM.

  7. New concepts of rehabilitation following anterior cruciate reconstruction.

    PubMed

    Stanish, W D; Lai, A

    1993-01-01

    Can a knee joint with a torn ACL of 2 years' duration ever be able to return to high performance? Very unlikely indeed. Some realistic expectations follow: 1. The knee joint can never be normal after an ACL reconstruction. 2. Surgery must take place as early after the injury as possible, before secondary joint degeneration takes place. 3. The surgery must employ a tissue that best matches the normal ACL in strength and structure. 4. The surgery must involve as little trauma as possible while restoring knee joint mechanics. 5. Stress, although guarded, must be faced by the knee joint as soon as possible after surgery. 6. Progressive weight bearing starts immediately, combined with quadriceps isometrics. ROM of the knee joint, particularly full extension, is conserved and protected. 7. Progressive active ROM without formal resistance continues for 4 weeks. 8. Progressive formal resistance exercises continue for at least 1 year. 9. Sport-specific tasks commence at 16 weeks, depending on the requirement of the sport and the response of the individual athlete. 10. Recovery will plateau at several stages, with the final plateau at approximately 18 months. Knee instability is an exciting but perplexing problem. Although we have advanced profoundly from the era of Jones, Smiley, and others, we still face many of the same challenges as our predecessors. New technology should not fool us. We are still addressing a major structural failure within the knee joint. Our attempts have been non-surgical and surgical, with repair, reconstruction, and replacement. However, fundamental to all of these hopes has been the reconditioning of the extremity after ACL surgery. Can we do better than our forefathers like Licht and others? No one is certain. This article offers an approach, in some areas our approach, but should not be perceived as a cookbook. Individual responses by our patients, athletes, dictate whether any protocol is too hasty or tardy. It is fundamental that we listen to

  8. Management of Acute Combined ACL-Medial and Posteromedial Instability of the Knee.

    PubMed

    Medvecky, Michael J; Tomaszewski, Paul

    2015-06-01

    Medial collateral ligament (MCL) injuries are the most common ligamentous injury of the knee. The extent of injury can range from a minor first-degree (1-degree) sprain to an extensive third-degree (3-degree) sprain that can propagate across the knee, rupturing one or both cruciate ligaments, and result in a knee subluxation or dislocation. A common pattern involves the combined anterior cruciate ligament (ACL) and MCL injury that is the focus of this chapter. The vast majority of these combined medial-sided injuries are treated nonoperatively with delayed reconstruction of the ACL injury in athletically active individuals. The MCL and associated medial structures are carefully assessed on physical examination, and classification of injury is based upon abnormal limits of joint motion. In vitro cadaveric biomechanical testing has given us a better understanding of ligament deficiency and altered joint motion. Consistency in terminology is necessary for proper classification of injury and reproducible categorization of injury patterns to be able to compare both nonoperative and operative treatment of various injury patterns.

  9. A comparison of the outcome of CPR according to AHA 2005 ACLS and AHA 2010 ACLS guidelines in cardiac arrest: multicenter study.

    PubMed

    Ocal, Oktay; Ozucelik, Dogac Niyazi; Avci, Akkan; Yazicioglu, Mustafa; Aydin, Yilmaz; Ayvaci, Baris Murat; Dogan, Halil; Aciksari, Kurtulus; Cukurova, Zafer

    2015-01-01

    The aim of this study was to evaluate whether there is a difference in the return of spontaneous circulation (ROSC) and survival with sequel-free recovery rates between the patients who underwent cardiopulmonary resuscitation (CPR) according to 2005 and 2010 guidelines. This study was conducted in the Bakırköy Dr. Sadi Konuk and Kartal Lütfi Kırdar Training and Research Hospital between dates of October 2010 and 28 February 2011 after approval of Ethics Committee. In the first months of the study, CPR was performed according to AHA 2005 ACLS guidelines (Group-1), while CPR was performed according to AHA 2010 ACLS guidelines after November 2010 (Group-2). Patients were assessed for neurological deficit with Cerebral Performance Categories Scale. Mean age was found as 69.01±13.05 (minimum: 21, maximum: 92) in 86 patients included. Of the 33 patients underwent CPR in the Group 1, ROSC was achieved in 51.5%; and 6.1% of these patients were discharged. Of the 53 patients underwent CPR in the Group 2, ROSC was achieved in 37.7%; and 9.4% of these patients were discharged. Although the number of living patients in Group 2 was higher than Group 1, the difference was not found statistically significant (5 versus 2), (P>0.05). But, neurological outcomes were found better with 2010 compared to 2005 guidelines (3/7 versus 0/2 good cerebral performance). It was found that the 2005 CPR guidelines practices in ED were more successful than the 2010 CPR guidelines practices in ROSC, but less successful in the rate of discharge from hospital and neurological sequel-free discharge rate.

  10. Anterior Cruciate Ligament Reconstruction with cadaveric graft in Adolescents with Active Growth Cartilage

    PubMed Central

    Mantilla, Ronnald; Rosell, Italo; Pedregal, Carlos; Revoredo, Rafael; Makino, Arturo

    2017-01-01

    The immature skeleton ACL reconstruction is controversial, due to the possibility of injuring the physis, producing discrepancies in length and angular deformities. The purpose of this study, is presenting our experience of 11 cases, describing the surgical technique Arthroscopic intra-articular respecting them physis. Objectives: The purpose of this study is to present our surgical technique, control and monitoring in patients with active growth cartilage. Material and Methods: Between 2010 and 2015 treated 11 patients from 12 to 16 years, with a injury of the ACL with active growth cartilage evaluated clinically and radiologically. We use a scale of Tanner, x-ray of wrist and MRI for evaluation. They showed no tibial spine avulsions. The acute injury was inclusive criterion. We indicate Arthroscopic cadaveric graft reconstruction, without passing through the physis. We use rehabilitation protocol, immobilizer and crutches. Tracking through scale IKDC and resonance. Description of the surgical technique: Arthroscopic portals habitual plus supramedial accesory portal, identified the injury of the ACL; using fluoroscopy identified the physis active, put kirschner’s pins as guides without crossing them physis, drilled tunnels, check indemnity of the physis, spent the graft, fixing femoral with endobutton and tibial with biodegradable screw. Results: Of the 11 patients, there were 3 meniscal injuries, only 1 sutured. We didn’t have cartilaginous lesions. One patient presented surface Erythema that solved with antibiotic. Slight pain according to scale of pain. Not instability was present. The 60% had sport return without complications. There were no failures of the graft or comorbidities. They showed no growth disorders. Conclusion: The discussion is in repair without producing complications, considering that the natural evolution will lead to a potential damage. Authors show reports of shortening by perforation of the physis, our series presents one more

  11. Rates of Reconstruction Failure in Patients Undergoing Immediate Reconstruction With Tissue Expanders and/or Implants and Postmastectomy Radiation Therapy

    SciTech Connect

    Fowble, Barbara; Park, Catherine; Wang, Frederick; Peled, Anne; Alvarado, Michael; Ewing, Cheryl; Esserman, Laura; Foster, Robert; Sbitany, Hani; Hanlon, Alex

    2015-07-01

    Objectives: Mastectomy rates for breast cancer have increased, with a parallel increase in immediate reconstruction. For some women, tissue expander and implant (TE/I) reconstruction is the preferred or sole option. This retrospective study examined the rate of TE/I reconstruction failure (ie, removal of the TE or I with the inability to replace it resulting in no final reconstruction or autologous tissue reconstruction) in patients receiving postmastectomy radiation therapy (PMRT). Methods and Materials: Between 2004 and 2012, 99 women had skin-sparing mastectomies (SSM) or total nipple/areolar skin-sparing mastectomies (TSSM) with immediate TE/I reconstruction and PMRT for pathologic stage II to III breast cancer. Ninety-seven percent had chemotherapy (doxorubicin and taxane-based), 22% underwent targeted therapies, and 78% had endocrine therapy. Radiation consisted of 5000 cGy given in 180 to 200 cGy to the reconstructed breast with or without treatment to the supraclavicular nodes. Median follow-up was 3.8 years. Results: Total TE/I failure was 18% (12% without final reconstruction, 6% converted to autologous reconstruction). In univariate analysis, the strongest predictor of reconstruction failure (RF) was absence of total TE/I coverage (acellular dermal matrix and/or serratus muscle) at the time of radiation. RF occurred in 32.5% of patients without total coverage compared to 9% with coverage (P=.0069). For women with total coverage, the location of the mastectomy scar in the inframammary fold region was associated with higher RF (19% vs 0%, P=.0189). In multivariate analysis, weight was a significant factor for RF, with lower weight associated with a higher RF. Weight appeared to be a surrogate for the interaction of total coverage, thin skin flaps, interval to exchange, and location of the mastectomy scar. Conclusions: RFs in patients receiving PMRT were lowered with total TE/I coverage at the time of radiation by avoiding inframammary fold incisions and

  12. Spatial reconstruction by patients with hippocampal damage is dominated by relational memory errors.

    PubMed

    Watson, Patrick D; Voss, Joel L; Warren, David E; Tranel, Daniel; Cohen, Neal J

    2013-07-01

    Hippocampal damage causes profound yet circumscribed memory impairment across diverse stimulus types and testing formats. Here, within a single test format involving a single class of stimuli, we identified different performance errors to better characterize the specifics of the underlying deficit. The task involved study and reconstruction of object arrays across brief retention intervals. The most striking feature of patients' with hippocampal damage performance was that they tended to reverse the relative positions of item pairs within arrays of any size, effectively "swapping" pairs of objects. These "swap errors" were the primary error type in amnesia, almost never occurred in healthy comparison participants, and actually contributed to poor performance on more traditional metrics (such as distance between studied and reconstructed location). Patients made swap errors even in trials involving only a single pair of objects. The selectivity and severity of this particular deficit creates serious challenges for theories of memory and hippocampus.

  13. The Effect of Different Sagittal Angles of the Tibial Guide on Aperture Widening of the Tibial Tunnel during Modified Transtibial Anterior Cruciate Ligament Reconstruction: A Randomized In Vivo Study

    PubMed Central

    Kim, Young Chan; Tawonsawatruk, Tulyapruek; Woon, Hyeong Hwa; Yum, Ji Woong; Shin, Myung Jin; Bravo, Rodolfo S.; Nha, Kyung Wook

    2017-01-01

    Purpose The effect of sagittal plane angle of the tibial tunnel on the severity of tibial intra-articular aperture expansion caused by iatrogenic re-reaming in anterior cruciate ligament (ACL) reconstruction using a modified transtibial technique is unknown. The purpose of this study was to compare the severity of intra-articular aperture widening at different angles (40°, 45°, and 50°) of the tibial guide (TG). Materials and Methods Ninety-seven patients who underwent modified transtibial ACL reconstruction were randomly allocated to TG 40°, 45°, and 50° groups. Intra-articular tibial aperture width (TW) and tibial tunnel length (TTL) were measured intraoperatively using an arthroscopic ruler and a depth gauge. Results The TG 50° group had significantly greater tibial aperture widening than the TG 40° group. There was a significant difference among TG 40°, 45°, and 50° groups and the percentage of knees with TTL <35 mm was 8%, 9% and 3%, respectively. There were 2 females with TTL <35 mm in TG 40° and 45° groups each. The average mediolateral length of the tibial plateau was 75 mm. Conclusions This study shows that the TG angle of 40° would reduce the severity of intra-articular aperture widening of the tibial tunnel compared to 45° or 50° in modified transtibial ACL reconstruction. PMID:28231645

  14. Biochemical markers in patients with open reconstructions with peripheral arterial disease.

    PubMed

    Stone, Patrick A; Thompson, Stephanie N; Williams, David; AbuRahma, Zachary; Grome, Luke; Schlarb, Haley; AbuRahma, Ali F

    2016-10-01

    The purpose of our study was to determine outcome differences as a function of baseline high-sensitivity C-reactive protein (hsCRP) and B-type natriuretic peptide (BNP) levels in patients receiving lower extremity open reconstructions for the treatment of peripheral arterial occlusive disease. We retrospectively examined patients who underwent surgical reconstructions performed by a single operator during a seven-year time span who received preoperative hsCRP and BNP testing and post-procedure imaging. Outcomes of interest included major adverse limb events, a composite end point of target vessel revascularization, limb amputation, and disease progression, and major adverse cardiovascular events comprised of stroke, myocardial infarction, and death. A total of 89 limbs in 82 patients were included in analysis. Multivariate analysis demonstrated that higher hsCRP levels (>3.0 mg/L) trended toward, but failed to significantly associate with major adverse limb events at 24 months (hazard ratio: 2.2 [1.0-5.2], p = 0.06), however the use of a vein bypass conduit (vs. prosthetic reconstruction) significantly predicted major adverse limb events (hazard ratio: 3.2 [1.5-6.9], p < 0.01). Elevated BNP levels (>100 pg/ml), but not hsCRP, associated with major adverse cardiovascular events (hazard ratio: 3.5 [1.2-10.3], p = 0.03). Preoperative biochemical markers may assist in clinical decision making and stratifying patients regarding adverse events following open reconstructions.

  15. Efficacy of Osteoconductive Ceramics in Bioresorbable Screws for Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Barth, Johannes; Akritopoulos, Panagiotis; Graveleau, Nicolas; Barthelemy, Renaud; Toanen, Cécile; Saffarini, Mo

    2016-01-01

    Background: Osteoconductive additives are used in resorbable interference screws for anterior cruciate ligament (ACL) reconstruction to improve graft incorporation and mitigate adverse effects. There are no published studies that compare biological performances of bioresorbable and biocomposite screws without artifacts due to different follow-up times and intrinsic patient characteristics. Purpose/Hypothesis: The purpose of this study was to evaluate the efficacy of osteoconductive agents in bioresorbable screws for ACL reconstruction at minimum follow-up of 2 years by intrapatient comparison. The hypothesis was that osteoconductive ceramics would result in slower resorption, improved ossification, and less tunnel widening. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 28 ACL reconstructions at 2 centers were randomly assigned into 2 comparable groups: (1) the graft was fixed in the tibia using standard bioresorbable screws and in the femur using biocomposite screws with osteoconductive agents (biphasic calcium phosphate), and (2) the graft was fixed in the femur using a standard bioresorbable screw and in the tibia using a biocomposite screw with osteoconductive agents. Results: Twenty-seven patients completed evaluations at 29.9 ± 4.0 months. Resorption was complete for more bioresorbable (81%) than biocomposite (37%) screws (P = .0029), whereas satisfactory ossification was observed in more biocomposite (52%) than bioresorbable (15%) screws (P = .0216). The tunnel shape was normal in more biocomposite (81%) than bioresorbable (48%) screws (P = .0126), and marked cortical formation was twice more frequent for biocomposite (78%) than bioresorbable (37%) screws (P = .0012). Bioresorbable screws exhibited faster resorption in the femur (P = .0202) but not in the tibia (not significant). Conversely, biocomposite screws demonstrated better ossification, less tunnel widening, and more cortical formation in the tibia (P < .0001, P = .0227, and P

  16. Association of ACL tears and single nucleotide polymorphisms in the collagen 12 A1 gene in the Indian population - a preliminary case-control study

    PubMed Central

    John, Rakesh; Prabhakar, Sharad; Dhillon, Mandeep Singh; Anand, Akshay; Minhas, Gillipsie

    2016-01-01

    Summary Background Genetic predisposition to ACL tears has received tremendous interest in the past few years with many SNPs of different genes being linked to ACL tear. Study Objectives To examine if specific sequence variants in COL12A1 gene are associated with ACL tears in Indian population. Study design Case-control study. Materials and methods 50 patients with surgically diagnosed ACL tear and 52 healthy, age-matched controls without any ligament/tendon injuries were genotyped for rs970547 and rs240736 SNPs using real time PCR method. Results The AG and GG genotypes were significantly under-represented in study group patients in rs970547 region (p=0.0361). However, there was no significant difference in genotype/allele frequencies in the rs240736 region. Conclusions The COL12A1 rs970547 SNP is associated with ACL tears in the Indian population. However, these results need to be validated further so that predisposed individuals can be screened in the future for counselling and intervention. Level of evidence III PMID:27900301

  17. Value-based Clinical Quality Improvement (CQI) for Patients Undergoing Abdominal Wall Reconstruction.

    PubMed

    Stephan, Bradley; Ramshaw, Bruce; Forman, Brandie

    2015-05-01

    Patients with complex ventral/incisional hernias often undergo an abdominal wall reconstruction (AWR). These operations have a high cost of care and often result in a long hospital stay and high complication rates. Using the principles of clinical quality improvement (CQI), several attempts at process improvement were implemented in one hernia program over a 3-year period. For consecutive cases of patients undergoing abdominal wall reconstruction, process improvement attempts included the use of a long-term resorbable synthetic mesh (TIGR® Resorbable Matrix, Novus Scientific, Uppsala, Sweden) in place of a biologic mesh, the use of the transversus abdominis release approach in place of an open or endoscopic component separation (external oblique release) technique, and the use of a preoperative transversus abdominis plane (TAP) block using a long-acting local anesthetic (Exparel®, Pacira Pharmaceutical, Parsippany, NJ) as a part of perioperative multi-modal pain management and an enhanced recovery program. After over 60 cases, improvement in materials costs and postoperative outcomes were documented. No mesh-related complications occurred and no mesh removal was required. In this real-world, value-based application of CQI, several attempts at process improvement led to decreased costs and improved outcomes for patients who underwent abdominal wall reconstruction for complex ventral/incisional hernias. Value-based CQI could be a tool for improved health care value globally.

  18. Reconstruction of lower extremity with perforator free flaps by free style approach in pediatric patients.

    PubMed

    Song, Jin Woo; Ben-Nakhi, Muneera; Hong, Joon Pio

    2012-11-01

    Pediatric reconstruction using microsurgery is accepted normal practice, and the use of perforator flaps is slowly increasing. This study presents clinical work using various perforator free flaps by free style approach to reconstruct lower extremity soft tissue defects in pediatric patients and evaluates its efficacy. Between June 2002 and February 2011, 32 cases (mean age: 10.1 years) were reconstructed with free style perforator free flaps. Retrospective evaluations for flap survival, growth character, and other associated morbidities were performed. Flaps used in this series are anterolateral thigh (ALT) perforator, superficial circumflex iliac artery perforator (SCIP), upper medial thigh perforator, and posterior interosseous perforator free flaps. The free style approach for pedicle dissection was successful in all cases. Early postoperative complications were 15.6% from hematoma collection to partial loss of flap. Although there was no total loss in this series, one case needed additional flap coverage to cover the partial loss of the flap. The long-term follow-up showed contracture along the margin, with 16% needing a releasing procedure. Bone growth was not affected by flap contracture. The overall results show perforator flaps using the free style approach to be a reliable and feasible approach for lower extremity reconstruction in the pediatric population.

  19. All-inside ACL: retroconstruction controversies.

    PubMed

    Lubowitz, James H

    2010-03-01

    All-inside anterior cruciate ligament reconstruction is controversial because the technique is new; as a result, evidence-based clinical outcome studies have yet to be published. The purpose of this article is to consider the following controversies (considered alphabetically): anatomy, biomechanics, biology, bioabsorbables, divergence of the femoral interference screw, expansion or widening of tunnels, fixation, future considerations, graft choice, the learning curve, technique, tensioning, and tibia blow-out fracture. The technique should be learned in stages. In the opinion of the author, the history of sports medicine and arthroscopy has been a progression toward less invasive techniques. In the future, all-inside anterior cruciate ligament reconstruction techniques should become more simple and reproducible, and clinical outcomes must be analyzed with long-term follow-up.

  20. Strength and Functional Performance Recovery After Anterior Cruciate Ligament Reconstruction in Preadolescent Athletes

    PubMed Central

    Greenberg, Elliot M.; Greenberg, Eric T.; Ganley, Theodore J.; Lawrence, J. Todd R.

    2014-01-01

    Background: In the skeletally immature population, the incidence of anterior cruciate ligament (ACL) injuries and ACL reconstructions appears to be increasing. Differences in surgical techniques, physiology, and emotional maturity may alter the rehabilitation progression and impact the outcomes when compared with adults. Reports of objective strength recovery and performance-based outcome measures after pediatric ACL reconstruction (ACLR) are limited. Study Design: Retrospective case series. Level of Evidence: Level 4. Methods: All patients that underwent all-epiphyseal ACLR from January 2008 to August 2010 were identified. Isokinetic peak quadriceps/hamstring torque values and functional performance measures in unilateral hopping tasks were extracted and compared with the noninjured limb. A limb symmetry index (LSI) of ≥90% was considered satisfactory. Results: Complete data were available for 16 patients (mean age, 12.28 years; range, 8.51-14.88 years). By a mean 7 months (range, 3.02-12.56 years) postoperatively, only 9 of 16 (56%) were able to achieve a satisfactory LSI for quadriceps strength. For hamstring strength, 15 of 16 (94%) were able to achieve satisfactory LSI. By a mean of 12 months (range, 5.39-24.39 months) postoperatively, only 6 of 16 subjects (38%) were able to achieve satisfactory performance on all functional hop tests. At a mean 15.42 months (range, 8.58-24.39 months) postsurgery, only 4 of 16 (25%) subjects were able to achieve an LSI of ≥90% on all testing parameters. Conclusion: For some pediatric patients, significant strength and functional deficits may be present at greater than 1 year after ACLR. This population may require more prolonged rehabilitation programs to allow for adequate recovery of strength and function because of unique characteristics of normal growth and development. PMID:24982702

  1. 50 CFR 648.100 - Summer flounder Annual Catch Limit (ACL).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) The Summer Flounder Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial... recommended by the SSC. (1) Sector allocations. The commercial and recreational fishing sector ACLs will be... sector ACLs may be established on an annual basis for up to 3 years at a time, dependent on whether...

  2. 50 CFR 648.64 - Yellowtail flounder sub-ACLs and AMs for the scallop fishery.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Yellowtail flounder sub-ACLs and AMs for...-ACLs and AMs for the scallop fishery. (a) As specified in § 648.55(d), and pursuant to the biennial... Georges Bank and Southern New England/Mid-Atlantic stocks of yellowtail flounder. The sub-ACLs for...

  3. 50 CFR 648.100 - Summer flounder Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) The Summer Flounder Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial... recommended by the SSC. (1) Sector allocations. The commercial and recreational fishing sector ACLs will be... sector ACLs may be established on an annual basis for up to 3 years at a time, dependent on whether...

  4. 50 CFR 648.230 - Spiny dogfish Annual Catch Limits (ACLs).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false Spiny dogfish Annual Catch Limits (ACLs... Management Measures for the Spiny Dogfish Fishery § 648.230 Spiny dogfish Annual Catch Limits (ACLs). (a) The... make recommendations to the Councils for changes in measures intended to ensure ACLs are not...

  5. Preventing ACL Injuries in Females: What Physical Educators Need to Know

    ERIC Educational Resources Information Center

    Toscano, Lisa; Carroll, Brianne

    2015-01-01

    Anterior cruciate ligament (ACL) injuries happen at a frequent rate, especially in girls and women. While there are many factors that contribute to ACL tears, teaching proper landing techniques and strengthening certain muscles can decrease the incidence of ACL tears, especially in women. This article reviews some of the high-risk factors that…

  6. 50 CFR 648.140 - Black sea bass Annual Catch Limit (ACL).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Black Sea Bass Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial and...) Sector allocations. The commercial and recreational fishing sector ACLs will be established consistent... Management Plan. (2) Periodicity. The black sea bass commercial and recreational sector ACLs may...

  7. 50 CFR 648.100 - Summer flounder Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) The Summer Flounder Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial... recommended by the SSC. (1) Sector allocations. The commercial and recreational fishing sector ACLs will be... sector ACLs may be established on an annual basis for up to 3 years at a time, dependent on whether...

  8. 50 CFR 648.64 - Yellowtail flounder sub-ACLs and AMs for the scallop fishery.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Yellowtail flounder sub-ACLs and AMs for...-ACLs and AMs for the scallop fishery. (a) As specified in § 648.55(d), and pursuant to the biennial... Georges Bank and Southern New England/Mid-Atlantic stocks of yellowtail flounder. The sub-ACLs for...

  9. 50 CFR 648.140 - Black sea bass Annual Catch Limit (ACL).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Black Sea Bass Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial and...) Sector allocations. The commercial and recreational fishing sector ACLs will be established consistent... Management Plan. (2) Periodicity. The black sea bass commercial and recreational sector ACLs may...

  10. 50 CFR 648.230 - Spiny dogfish Annual Catch Limits (ACLs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Spiny dogfish Annual Catch Limits (ACLs... Management Measures for the Spiny Dogfish Fishery § 648.230 Spiny dogfish Annual Catch Limits (ACLs). (a) The... make recommendations to the Councils for changes in measures intended to ensure ACLs are not...

  11. 50 CFR 648.140 - Black sea bass Annual Catch Limit (ACL).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Black Sea Bass Monitoring Committee shall recommend to the MAFMC separate ACLs for the commercial and...) Sector allocations. The commercial and recreational fishing sector ACLs will be established consistent... Management Plan. (2) Periodicity. The black sea bass commercial and recreational sector ACLs may...

  12. 50 CFR 648.230 - Spiny dogfish Annual Catch Limits (ACLs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Spiny dogfish Annual Catch Limits (ACLs... Management Measures for the Spiny Dogfish Fishery § 648.230 Spiny dogfish Annual Catch Limits (ACLs). (a) The... make recommendations to the Councils for changes in measures intended to ensure ACLs are not...

  13. Reconstruction of organ dose for external radiotherapy patients in retrospective epidemiologic studies

    NASA Astrophysics Data System (ADS)

    Lee, Choonik; Jung, Jae Won; Pelletier, Christopher; Pyakuryal, Anil; Lamart, Stephanie; Kim, Jong Oh; Lee, Choonsik

    2015-03-01

    Organ dose estimation for retrospective epidemiological studies of late effects in radiotherapy patients involves two challenges: radiological images to represent patient anatomy are not usually available for patient cohorts who were treated years ago, and efficient dose reconstruction methods for large-scale patient cohorts are not well established. In the current study, we developed methods to reconstruct organ doses for radiotherapy patients by using a series of computational human phantoms coupled with a commercial treatment planning system (TPS) and a radiotherapy-dedicated Monte Carlo transport code, and performed illustrative dose calculations. First, we developed methods to convert the anatomy and organ contours of the pediatric and adult hybrid computational phantom series to Digital Imaging and Communications in Medicine (DICOM)-image and DICOM-structure files, respectively. The resulting DICOM files were imported to a commercial TPS for simulating radiotherapy and dose calculation for in-field organs. The conversion process was validated by comparing electron densities relative to water and organ volumes between the hybrid phantoms and the DICOM files imported in TPS, which showed agreements within 0.1 and 2%, respectively. Second, we developed a procedure to transfer DICOM-RT files generated from the TPS directly to a Monte Carlo transport code, x-ray Voxel Monte Carlo (XVMC) for more accurate dose calculations. Third, to illustrate the performance of the established methods, we simulated a whole brain treatment for the 10 year-old male phantom and a prostate treatment for the adult male phantom. Radiation doses to selected organs were calculated using the TPS and XVMC, and compared to each other. Organ average doses from the two methods matched within 7%, whereas maximum and minimum point doses differed up to 45%. The dosimetry methods and procedures established in this study will be useful for the reconstruction of organ dose to support

  14. Reconstruction of organ dose for external radiotherapy patients in retrospective epidemiologic studies.

    PubMed

    Lee, Choonik; Jung, Jae Won; Pelletier, Christopher; Pyakuryal, Anil; Lamart, Stephanie; Kim, Jong Oh; Lee, Choonsik

    2015-03-21

    Organ dose estimation for retrospective epidemiological studies of late effects in radiotherapy patients involves two challenges: radiological images to represent patient anatomy are not usually available for patient cohorts who were treated years ago, and efficient dose reconstruction methods for large-scale patient cohorts are not well established. In the current study, we developed methods to reconstruct organ doses for radiotherapy patients by using a series of computational human phantoms coupled with a commercial treatment planning system (TPS) and a radiotherapy-dedicated Monte Carlo transport code, and performed illustrative dose calculations. First, we developed methods to convert the anatomy and organ contours of the pediatric and adult hybrid computational phantom series to Digital Imaging and Communications in Medicine (DICOM)-image and DICOM-structure files, respectively. The resulting DICOM files were imported to a commercial TPS for simulating radiotherapy and dose calculation for in-field organs. The conversion process was validated by comparing electron densities relative to water and organ volumes between the hybrid phantoms and the DICOM files imported in TPS, which showed agreements within 0.1 and 2%, respectively. Second, we developed a procedure to transfer DICOM-RT files generated from the TPS directly to a Monte Carlo transport code, x-ray Voxel Monte Carlo (XVMC) for more accurate dose calculations. Third, to illustrate the performance of the established methods, we simulated a whole brain treatment for the 10 year-old male phantom and a prostate treatment for the adult male phantom. Radiation doses to selected organs were calculated using the TPS and XVMC, and compared to each other. Organ average doses from the two methods matched within 7%, whereas maximum and minimum point doses differed up to 45%. The dosimetry methods and procedures established in this study will be useful for the reconstruction of organ dose to support

  15. Anterior cruciate ligament- specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial

    PubMed Central

    2013-01-01

    Background Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk. Methods/Design 80 athletes that have undergone a unilateral ACLR and wish to return to level 1 or 2 activities will be recruited for this study and randomized to one of two treatment groups. A standard care group will receive prevention exercises, quadriceps strengthening and agility exercises, while the perturbation group will receive the same exercise program with the addition of perturbation training. The primary outcomes measures will include gait biomechanics, clinical and functional measures, and knee joint loading. Return to sport rates, return to pre-injury level of activity rates, and second injury rates will be secondary measures. Discussion The results of this ACL-Specialized Post-Operative Return To Sports (ACL-SPORTS) Training program will help clinicians to better determine an effective post-operative treatment program that will improve modifiable impairments that influence outcomes after ACLR. Trial registration Randomized Control Trial NIH 5R01AR048212-07. ClinicalTrials.gov: NCT01773317 PMID:23522373

  16. Clinical outcomes in breast cancer expander-implant reconstructive patients with radiation therapy.

    PubMed

    Chen, Tiffany A; Momeni, Arash; Lee, Gordon K

    2016-01-01

    Immediate expander-implant breast reconstruction (EIBR) with external beam radiation therapy (XRT) is pursued by many breast cancer patients; however, there is still a lack of consensus on the expected clinical outcomes. We performed a critical analysis of postoperative outcomes in EIBR patients with XRT exposure through a retrospective review from January 2007 to December 2013. Patients were stratified into three groups: exposure to preoperative XRT (XRT-pre), postoperative XRT (XRT-post), or no XRT (control). A subset of XRT patients with bilateral EIBR was assessed using a matched-pair analysis with the patients serving as their own controls. A total of 76 patients were included in the study. Major complications were observed in 6 of 8, 26 of 38, and 14 of 30 patients in the XRT-pre, XRT-post, and control groups, respectively, and were not statistically different (p > 0.05). EIBR failure rates were 13.3% in the control group compared to 50.0% in the XRT-pre group (p = 0.044) and 26.3% in the XRT-post group (p > 0.05). In the matched-pair analysis, 16 of 26 irradiated breasts developed complications compared to only 7 of 26 contralateral non-irradiated breasts (p = 0.043). In conclusion, we detected a significantly increased risk of complications in patients with pre-mastectomy radiotherapy. Patients with this history of XRT should strongly consider autologous reconstruction instead of EIBR to avoid the high risk of developing complications and subsequently losing their implant. Increased complications in irradiated breasts when compared to the contralateral non-irradiated breasts in bilateral EIBR patients confirmed the detrimental role of XRT in the setting of EIBR.

  17. Autograft Choice in Young Female Patients: Patella Tendon versus Hamstring.

    PubMed

    Shakked, Rachel; Weinberg, Maxwell; Capo, Jason; Jazrawi, Laith; Strauss, Eric

    2017-03-01

    With the increasing incidence of anterior cruciate ligament (ACL) reconstruction in women and younger patients, the optimal graft choice in the young female patient has become the subject of much debate. This study aimed to evaluate patient-reported outcomes, objective knee stability, complication rates, and the incidence of failure after ACL reconstruction using bone-patellar tendon-bone (BPTB) autograft compared with hamstring (HS) autograft in young female patients. Female patients who underwent primary ACL reconstruction with BPTB or HS autograft between ages 15 and 25 years were identified. Medical records were reviewed for postoperative complications and subsequent procedures on the operative knee. Patients were evaluated with functional surveys, physical examination including Lachman and pivot-shift tests, and arthrometric testing with a KT-1000 arthrometer. There were 37 patients in the BPTB group and 28 patients in the HS group. For patients who did not undergo revision, significant differences were not found in visual analog score (p = 0.94), Lysholm score (p = 0.81), Kujala score (p = 0.85), or Tegner level (p = 0.81). No difference was detected in the rate of return to a level of activity at or above the same level prior to injury (p = 0.31). Significantly more patients in the BPTB group were graded 1a Lachman and negative pivot shift compared with the HS group (p < 0.001). There was a significant difference in mean side-to-side manual maximum arthrometric testing (p < 0.001). There were significantly fewer subsequent procedures and a lower rate of graft failures in the BPTB group. We detected no difference in subjective functional outcomes following ACL reconstruction. However, a higher failure rate in the HS reconstructions and greater laxity by arthrometric testing may indicate increased objective stability with the use of BPTB autograft in the young female patient population. The level of evidence for this article is

  18. Clinical and functional evaluation of forefoot reconstruction in patients with rheumatoid arthritis☆☆☆

    PubMed Central

    Costa, Marco Túlio; Backer, Ricardo Cardoso; Ferreira, Ricardo Cardenuto

    2014-01-01

    Objective to evaluate the long-term results from reconstruction of the forefoot in patients with rheumatoid arthritis who underwent arthrodesis of the metatarsophalangeal joint of the hallux, resection arthroplasty of the heads of the lateral metatarsals and correction of the deformities of the smaller toes through arthrodesis of the proximal interphalangeal joint or closed manipulation. Methods seventeen patients (27 feet) who underwent forefoot reconstruction surgery by means of arthrodesis of the first metatarsophalangeal joint, resection of the heads of the lateral metatarsals and correction of the deformities of the smaller toes, were studied retrospectively. The mean follow-up was 68 months (12–148 months); the mean age was 52 years (range: 20–75 months); and four patients were male and 13 were female. Results the results were classified as excellent in 17 feet, good in two, fair in four and poor in two. The mean score on the AOFAS scale was 70 points; 21 feet (78%) were found to be asymptomatic; and six feet (22%) presented some type of symptom. Three feet presented pseudarthrosis, and one of these successfully underwent revision of the arthrodesis. There was no significant difference in scoring on the AOFAS scale or in the consolidation rate, between using a plate and screws and using Kirschner wires for fixation of the arthrodesis. Conclusion arthrodesis of the first metatarsophalangeal joint with resection arthroplasty on the heads of the lateral metatarsals and correction of the deformities of the smaller toes, which was used in forefoot reconstruction in rheumatoid patients, showed good long-term results with a high satisfaction rate among the patients and clinical-functional improvement. PMID:26229794

  19. Reconstructive and rehabilitating methods in patients with dysphagia and nutritional disturbances

    PubMed Central

    Motsch, Christiane

    2005-01-01

    As diverse as the causes of oropharyngeal dysphagia can be, as broad is the range of potential therapeutical approaches. In the past two decades, methods of plastic-reconstructive surgery, in particular microsurgically revascularised tissue transfer and minimally invasive, endoscopic techniques of every hue have substantially added to the portfolio of reconstructive surgery available for rehabilitating deglutition. Numerically, reconstructing the pharyngolaryngeal tract following resection of squamous-cell carcinomas in the oral cavity, the pharynx and the larynx has been gaining ground, as has functional deglutitive therapy performed to treat posttherapeutical sequelae. Dysphagia and malnutrition are closely interrelated. Every third patient hospitalised in Germany suffers from malnutrition; ENT tumour patients are not excluded. For patients presenting with advancing malnutrition, the mortality, the morbidity and the individual complication rate have all been observed to increase; also a longer duration of stay in hospital has been noted and a lesser individual toleration of treatment, diminished immunocompetence, impaired general physical and psychical condition and, thus, a less favourable prognosis on the whole. Therefore, in oncological patients, the dietotherapy will have to assume a key role in supportive treatment. It is just for patients, who are expected to go through a long process of deglutitive rehabilitation, that enteral nutrition through percutaneous endoscopically controlled gastrostomy (PEG) performed at an early stage can provide useful and efficient support to the therapeutic efforts. Nutrition and oncology are mutually influencing fields where, sooner or later, a change in paradigms will have to take place, i.e. gradually switching from therapy to prevention. While cancer causes malnutrition, feasible changes in feeding and nutrition-associated habits, including habitual drinking and smoking, might lower the incidence of cancer worldwide by 30

  20. Perception of patient appearance following various methods of reconstruction after orbital exenteration.

    PubMed

    Kuiper, Justin J; Zimmerman, M Bridget; Pagedar, Nitin A; Carter, Keith D; Allen, Richard C; Shriver, Erin M

    2016-08-01

    This article compares the perception of health and beauty of patients after exenteration reconstruction with free flap, eyelid-sparing, split-thickness skin graft, or with a prosthesis. Cross-sectional evaluation was performed through a survey sent to all students enrolled at the University of Iowa Carver College of Medicine. The survey included inquiries about observer comfort, perceived patient health, difficulty of social interactions, and which patient appearance was least bothersome. Responses were scored from 0 to 4 for each method of reconstruction and an orbital prosthesis. A Friedman test was used to compare responses among each method of repair and the orbital prosthesis for each of the four questions, and if this was significant, then post-hoc pairwise comparison was performed with p values adjusted using Bonferroni's method. One hundred and thirty two students responded to the survey and 125 completed all four questions. Favorable response for all questions was highest for the orbital prosthesis and lowest for the split-thickness skin graft. Patient appearance with an orbital prosthesis had significantly higher scores compared to patient appearance with each of the other methods for all questions (p value < 0.0001). Second highest scores were for the free flap, which were higher than eyelid-sparing and significantly higher compared to split-thickness skin grafting (p value: Question 1: < 0.0001; Question 2: 0.0005; Question 3: 0.006; and Question 4: 0.019). The orbital prosthesis was the preferred post-operative appearance for the exenterated socket for each question. Free flap was the preferred appearance for reconstruction without an orbital prosthesis. Split-thickness skin graft was least preferred for all questions.

  1. The ACLS Survey of Scholars: Views on Publications, Computers, Libraries.

    ERIC Educational Resources Information Center

    Morton, Herbert C.; Price, Anne Jamieson

    1986-01-01

    Reviews results of a survey by the American Council of Learned Societies (ACLS) of 3,835 scholars in the humanities and social sciences who are working both in colleges and universities and outside the academic community. Areas highlighted include professional reading, authorship patterns, computer use, and library use. (LRW)

  2. The Humanities in the Schools. ACLS Occasion Paper, No. 20.

    ERIC Educational Resources Information Center

    American Council of Learned Societies, New York, NY.

    Designed to serve as a record of the initial public activity of the American Council of Learned Societies (ACLS) Program in Humanities Curriculum Development, this collection of three articles offers different perspectives on the humanities in the schools. In the first article, "The Humanities and Public Education," Stanley N. Katz discusses the…

  3. Individuality of Item Interpretation in Interchangeable ACL Scales

    ERIC Educational Resources Information Center

    Fiske, Donald W.; Barack, Leonard I.

    1976-01-01

    The diversity among interpretations of single items in personality questionnaires has been noted previously. Using adjectives from the Adjective Check List (ACL), the study sought evidence bearing on these questions: Does such diversity make the responses to an item not comparable across subjects? If so, what are the implications for scores based…

  4. Rapid prototyped patient specific implants for reconstruction of orbital wall defects.

    PubMed

    Stoor, Patricia; Suomalainen, Anni; Lindqvist, Christian; Mesimäki, Karri; Danielsson, Daniel; Westermark, Anders; Kontio, Risto K

    2014-12-01

    Defects of orbital walls can be reconstructed using implants. The authors report a safe and accurate method to reconstruct bone defects in the orbital area using patient specific implants. A detailed process description of computer aided design (CAD) reconstructive surgery (CRS) is introduced in this prospective study. The 3D volumetric virtual implant was design using MSCT data and PTCProEngineer™ 3D software. The intact orbital cavity of twelve patients was mirrored to the injured side. Specific ledges steered the implant into correct place. Postoperatively the position was assessed using image fusion. One implant (8%) was rejected due to chemical impurities, two (16%) had a false shape due to incorrect CAD. Data of thin bone did not transfer correctly to CAD and resulted in error. One implant (8%) was placed incorrectly. Duration of the CRS was in average 1.17 h, correspondingly 1.57 h using intraoperative bending technique. The CRS process has several critical stages, which are related to converting data and to incompatibility between software. The CRS process has several steps that need further studies. The data of thin bone may be lost and disturb an otherwise very precise technique. The risk of incorporating impurities into the implant must be carefully controlled.

  5. Neuromuscular efficiency of the vastus medialis obliquus and postural balance in professional soccer athletes after anterior cruciate ligament reconstruction

    PubMed Central

    Chaves, Shalimá Figueirêdo; Marques, Natália Pereira; Silva, Rômulo Lemos e; Rebouças, Nahra Santos; de Freitas, Luise Monteiro; de Paula Lima, Pedro Olavo; de Oliveira, Rodrigo Ribeiro

    2012-01-01

    Summary The purpose of this study was to evaluate the neuromuscular efficiency of the vastus medialis obliquus and postural balance in high-performance soccer athletes after anterior cruciate ligament (ACL) reconstruction, compared to the uninvolved leg. A cross-sectional study was conducted with 22 male professional soccer players after ACL reconstruction (4–12 months postoperatively). The athletes were submitted to functional rehabilitation with an accelerated protocol on the soccer team. They were evaluated using isokinetic dynamometer, surface electromyography and electronic baropodometer. There was no decrease or difference between neuromuscular efficiency of the VMO when comparing both the limbs after ACL reconstruction in the professional soccer athletes under treatment. The same result was found in postural balance. It can be concluded that the NME of the VMO in the involved member and postural balance were successfully re-established after the reconstruction procedure of the ACL in the sample group studied. PMID:23738285

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

    PubMed Central

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

    2016-01-01

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

  7. Reconstruction with vascularized composite tissue in patients with excessive injury following surgery and irradiation

    SciTech Connect

    Serafin, D.; DeLand, M.; Lesesne, C.B.; Smith, P.J.; Noell, K.T.; Georgiade, N.

    1982-01-01

    The biological effects of a single high dose of radiation are examined. Both cellular injury and repair are reviewed during early, intermediate, and late phases. Anticipated composite tissue morbidity is detailed for therapeutic radiation doses administered to the head and neck, breast and thorax, and perineum. Patients who demonstrated excessive time-dose fractionation values were irradiated with lower x-ray energies. Those in whom there was an overlap of treatment fields presented a serious challenge to the reconstructive surgeon. Judicious selection of well-vascularized composite tissue outside the portals of irradiation, preferably with a long vascular pedicle, facilitated reconstruction. When possible, both donor and recipient vasculature should be outside the irradiated area to ensure uninterrupted blood flow to the transferred or transplanted tissue.

  8. Teaching core competencies of reconstructive microsurgery with the use of standardized patients.

    PubMed

    Son, Ji; Zeidler, Kamakshi R; Echo, Anthony; Otake, Leo; Ahdoot, Michael; Lee, Gordon K

    2013-04-01

    The Accreditation Council of Graduate Medical Education has defined 6 core competencies that residents must master before completing their training. Objective structured clinical examinations (OSCEs) using standardized patients are effective educational tools to assess and teach core competencies. We developed an OSCE specific for microsurgical head and neck reconstruction. Fifteen plastic surgery residents participated in the OSCE simulating a typical new patient consultation, which involved a patient with oral cancer. Residents were scored in all 6 core competencies by the standardized patients and faculty experts. Analysis of participant performance showed that although residents performed well overall, many lacked proficiency in systems-based practice. Junior residents were also more likely to omit critical elements of the physical examination compared to senior residents. We have modified our educational curriculum to specifically address these deficiencies. Our study demonstrates that the OSCE is an effective assessment tool for teaching and assessing all core competencies in microsurgery.

  9. Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: a critical study of unilateral immediate breast reconstruction using patient-reported outcomes instrument BREAST-Q.

    PubMed

    Liu, Chunjun; Zhuang, Yan; Momeni, Arash; Luan, Jie; Chung, Michael T; Wright, Eric; Lee, Gordon K

    2014-07-01

    Staged expander-implant breast reconstruction (EIBR) and microsurgical abdominal flap breast reconstruction (MAFBR) are the most common modes of breast reconstruction (BR) in the United States. Whether the mode of breast reconstruction has an impact on patient quality of life (QoL) and satisfaction remains a question. A retrospective study was conducted identifying a population of 119 patients who underwent unilateral immediate BR. Only patients who were eligible for either EIBR or MAFBR based on preoperative characteristics were included in the study. The following parameters were retrieved: demographics, mode of reconstruction, cancer, recovery, QoL, and patient satisfaction. The latter two parameters were determined using the BREAST-Q BR module questionnaire. Two-way analysis of variance with mode of reconstruction and occurrence of complication as independent variables was used to determine the effect on patient satisfaction and QoL. The association between mode of reconstruction and patient response with each item of the QoL and satisfaction survey domains was analyzed. The overall response rate was 62.2 %. Non-respondents and respondents did not significantly differ in demographics, surgery type, cancer staging, adjuvant therapy, and complication rate. Age and BMI were significantly higher in MAFBR, while level of education was higher in EIBR. MAFBR had higher scores in psychosocial and sexual wellbeing, satisfaction with outcome, breast, information, and plastic surgeon when compared with patients who underwent EIBR. For patients eligible for both MAFBR and EIBR, MAFBR is associated with higher levels of satisfaction and QoL. Comprehensive pre-operative information of pros and cons of both modes of BR is crucial for patients to make a well-informed decision, thus, resulting in higher levels of satisfaction.

  10. Femoral and Tibial Tunnel Widening following Anterior Cruciate Ligament Reconstruction using Various Modalities of Fixation: A Prospective Observational Study

    PubMed Central

    Kanthila, Mahesha; Saya, Rama Prakasha; Vidyasagar, JVS

    2016-01-01

    Introduction Bone tunnel enlargement after Anterior Cruciate Ligament Reconstruction (ACL-R) is a well-accepted phenomenon but there are very few published data comparing the extent of tunnel widening by various methods of fixation after ACL-R. Aim To compare the femoral and tibial tunnel widening following ACL-R with different methods of fixation using CT scan. Materials and Methods This one year prospective study included all patients with chronic Anterior Cruciate Ligament (ACL) injury who underwent primary arthroscopic ACL-R using tripled hamstring tendon autograft. The graft was fixed to the tibial tunnel by Interference Screw (IFS) or Suture Disc (SD) and to the femoral tunnel by IFS, SD, Cross-Pin (CP) or Endo-button CL (Smith & Nephew). The widening of the tibial and femoral tunnels in different methods of fixation was assessed by Computed Tomography (CT) at 12 months follow-up; and was compared using paired sample test. Results A total of 63 patients were included in the study of which 58 (92%) were males and 5 (8%) were females, with a mean age of 29.1 ± 5.9 years. The tibial tunnel widening at one year follow-up was 1.680 ± 1.08794 (19.37%) and 1.517 ± 0.94834 mm (17.39%) by IFS and SD methods respectively. Femoral tunnel widening at one year follow-up was 1.294 ± 0.231, 1.809 ± 0.912, 1.320 ± 0.238, 1.779 ± 0.889 mm by IFS, SD, EB, and CP methods respectively. Femoral tunnel widening following suture disc method of fixation was very highly significant (p<0.001) in comparison with other methods. Conclusion Femoral tunnel and tibial tunnel widening varies with different methods of fixation and was maximum with suture disc method compared to others at one year follow-up after ACL-R. PMID:28050456

  11. The Effects of a Valgus Collapse Knee Position on In Vivo ACL Elongation

    PubMed Central

    Utturkar, G. M.; Irribarra, L. A.; Taylor, K. A.; Spritzer, C. E.; Taylor, D. C.; Garrett, W. E.; DeFrate, Louis E.

    2013-01-01

    There are conflicting data regarding what motions increase ACL injury risk. More specifically, the mechanical role of valgus collapse positions during ACL injury remains controversial. Our objective was to evaluate ACL elongation in a model that mimics knee movements thought to occur during ACL injury. Eight healthy male subjects were imaged using MR and biplanar fluoroscopy to measure the in vivo elongation of the ACL and its functional bundles during three static knee positions: full extension, 30° of flexion, and a position intended to mimic a valgus collapse position described in the literature. For this study, the valgus collapse position consisted of 30° of knee flexion, internal rotation of the hip, and 10° of external tibial rotation. ACL length decreased significantly from full extension (30.2 ± 2.6 mm) to 30° of flexion (27.1 ± 2.2 mm). ACL length further decreased in the valgus collapse position (25.6 ± 2.4 mm). Both functional bundles of the ACL followed similar trends with regards to decreases in length in each of the three positions. Since strain would follow patterns of ACL length, landing on an extended knee may be a more relevant risk factor for ACL injuries than the valgus collapse position in males. Future studies should evaluate the effects of dynamic motion patterns on in vivo ACL strains. PMID:22855117

  12. The effects of a valgus collapse knee position on in vivo ACL elongation.

    PubMed

    Utturkar, G M; Irribarra, L A; Taylor, K A; Spritzer, C E; Taylor, D C; Garrett, W E; Defrate, Louis E

    2013-01-01

    There are conflicting data regarding what motions increase ACL injury risk. More specifically, the mechanical role of valgus collapse positions during ACL injury remains controversial. Our objective was to evaluate ACL elongation in a model that mimics knee movements thought to occur during ACL injury. Eight healthy male subjects were imaged using MR and biplanar fluoroscopy to measure the in vivo elongation of the ACL and its functional bundles during three static knee positions: full extension, 30° of flexion, and a position intended to mimic a valgus collapse position described in the literature. For this study, the valgus collapse position consisted of 30° of knee flexion, internal rotation of the hip, and 10° of external tibial rotation. ACL length decreased significantly from full extension (30.2 ± 2.6 mm) to 30° of flexion (27.1 ± 2.2 mm). ACL length further decreased in the valgus collapse position (25.6 ± 2.4 mm). Both functional bundles of the ACL followed similar trends with regards to decreases in length in each of the three positions. Since strain would follow patterns of ACL length, landing on an extended knee may be a more relevant risk factor for ACL injuries than the valgus collapse position in males. Future studies should evaluate the effects of dynamic motion patterns on in vivo ACL strains.

  13. Penile Reconstruction

    PubMed Central

    Salgado, Christopher J.; Chim, Harvey; Tang, Jennifer C.; Monstrey, Stan J.; Mardini, Samir

    2011-01-01

    A variety of surgical options exists for penile reconstruction. The key to success of therapy is holistic management of the patient, with attention to the psychological aspects of treatment. In this article, we review reconstructive modalities for various types of penile defects inclusive of partial and total defects as well as the buried penis, and also describe recent basic science advances, which may promise new options for penile reconstruction. PMID:22851914

  14. Aortic annuloplasty with aortic root reconstruction to prevent patient-prosthesis mismatch.

    PubMed

    Hopkins, Richard A

    2006-07-01

    Part of the ongoing argument concerning patient-prosthesis mismatch (PPM) following aortic valve replacement (AVR) is due to the perception that aortic annulus enlargement procedures increase the risk and technical difficulty of aortic valve surgery. Here, an aortic root reconstruction that involves enlargement of the annulus and tailoring of the aortic root to accommodate larger stented prostheses is presented that has been personally performed in 196 patients with no technique-related surgical deaths or complications, and thus can be carried out without additional risk. This aortic root enlargement aortoplasty and annuloplasty method can be calibrated to all AVRs involving stented manufactured prostheses when these are deemed the prosthesis of choice for the patient with a relatively small annulus and/or aortic root, severe left ventricular hypertrophy, compromised LV function or a very active lifestyle, to achieve predicted EOA values > or = 1.00 cm2/m2.

  15. Bilateral Sciatic Neuropathy after an Autologous Breast Reconstruction in a Massive Weight Loss Patient

    PubMed Central

    Ablavsky, Michael; Shteynberg, Aleksandr

    2017-01-01

    Summary: Perioperative compression neuropathy is a known potential complication of prolonged surgical procedures. Sciatic postoperative neuropathy has rarely been reported. We present a 34-year-old woman who underwent right breast reconstruction with supercharged (venous anastomosis) transverse rectus abdominis flap and developed bilateral sciatic compression neuropathy. Her history was remarkable for sleeve gastrectomy 2 years earlier resulting in 105 pound weight loss 1 year before breast reconstruction. During the procedure, the patient was in the supine position for 8 hours and in the semirecumbent position for an additional 2 hours with the torso flexed at 30 degrees and knees flexed at approximately 45 degrees in addition to standard padding. Postoperatively, the patient was found to have loss of sensation and motor paralysis distal to her knees bilaterally. Pain sensation was preserved distally and no other neurological abnormalities were noted. Laboratory tests, magnetic resonance imaging, electromyography, and nerve conduction studies all revealed no evidence of neurological lesions and peroneal or lumbosacral radiculopathy. Motor strength gradually returned to her lower extremities over 4–5 weeks, whereas sensory function continued to improve over 7 weeks. The patient had complete neurological recovery 2 months postoperatively. PMID:28203505

  16. Patient-Adaptive Reconstruction and Acquisition in Dynamic Imaging with Sensitivity Encoding (PARADISE)

    PubMed Central

    Sharif, Behzad; Derbyshire, J. Andrew; Faranesh, Anthony Z.; Bresler, Yoram

    2010-01-01

    MR imaging of the human heart without explicit cardiac synchronization promises to extend the applicability of cardiac MR to a larger patient population and potentially expand its diagnostic capabilities. However, conventional non-gated imaging techniques typically suffer from low image quality or inadequate spatio-temporal resolution and fidelity. Patient-Adaptive Reconstruction and Acquisition in Dynamic Imaging with Sensitivity Encoding (PARADISE) is a highly-accelerated non-gated dynamic imaging method that enables artifact-free imaging with high spatio-temporal resolutions by utilizing novel computational techniques to optimize the imaging process. In addition to using parallel imaging, the method gains acceleration from a physiologically-driven spatio-temporal support model; hence, it is doubly accelerated. The support model is patient-adaptive, i.e., its geometry depends on dynamics of the imaged slice, e.g., subject’s heart-rate and heart location within the slice. The proposed method is also doubly adaptive as it adapts both the acquisition and reconstruction schemes. Based on the theory of time-sequential sampling, the proposed framework explicitly accounts for speed limitations of gradient encoding and provides performance guarantees on achievable image quality. The presented in-vivo results demonstrate the effectiveness and feasibility of the PARADISE method for high resolution non-gated cardiac MRI during a short breath-hold. PMID:20665794

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2015-11-13

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

  19. Left ventricular assist device implantation in patients after left ventricular reconstruction.

    PubMed

    Palmen, Meindert; Braun, Jerry; Beeres, Saskia L M A; Klautz, Robert J M

    2016-12-01

    Left ventricular assist device (LVAD) implantation can be challenging in patients with a prior surgical ventricular restoration (SVR). In this case series of heart failure patients with a history of SVR, we describe the surgical technique and outcome of a customized approach for inflow cannula orientation. Seven patients with a history of SVR with end-stage chronic heart failure were accepted for long-term LVAD support. In all patients, the Dacron patch was removed through left ventriculotomy and a Hegar 22 dilator was inserted at the estimated optimal position of the LVAD inflow cannula. The left ventricle was reconstructed around the dilator from the left ventricular (LV) apex to the base. Finally, the LVAD sewing ring was sutured onto the remaining apical defect and a HeartWare® LVAD was implanted. LVAD implantation was successful in all 7 patients. Transoesophageal echocardiography ensured an adequate LVAD position and inflow and outflow cannula Doppler flow recordings. The mean intensive care unit stay was 5.8 ± 2.6 days, and the hospital stay after surgery was 32 ± 16 days. All patients follow regular visits (follow-up 20 ± 16 months) at the outpatient clinic without any remarkable event. Using the technique described, LVAD implantation in patients after SVR is feasible and safe.

  20. Anterior Cruciate Ligament Reconstruction With Autologous Hamstring

    PubMed Central

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

    2016-01-01

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

  1. Infections in Anterior Cruciate Ligament Reconstruction

    PubMed Central

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

    2013-01-01

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

  2. Effect of ACL graft material on anterior knee force during simulated in vivo ovine motion applied to the porcine knee: An in vitro examination of force during 2000 cycles.

    PubMed

    Boguszewski, Daniel V; Wagner, Christopher T; Butler, David L; Shearn, Jason T

    2015-12-01

    This study determined how anterior cruciate ligament (ACL) reconstruction affected the magnitude and temporal patterns of anterior knee force and internal knee moment during 2000 cycles of simulated gait. Porcine knees were tested using a six degree-of-freedom robot, examining three porcine allograft materials compared with the native ACL. Reconstructions were performed using: (1) bone-patellar tendon-bone allograft (BPTB), (2) reconstructive porcine tissue matrix (RTM), or (3) an RTM-polymer hybrid construct (Hybrid). Forces and moments were measured over the entire gait cycle and contrasted at heel strike, mid stance, toe off, and peak flexion. The Hybrid construct performed the best, as magnitude and temporal changes in both anterior knee force and internal knee moment were not different from the native ACL knee. Conversely, the RTM knees showed greater loss in anterior knee force during 2000 cycles than the native ACL knee at heel strike and toe off, with an average force loss of 46%. BPTB knees performed the least favorably, with significant loss in anterior knee force at all key points and an average force loss of 61%. This is clinically relevant, as increases in post-operative knee laxity are believed to play a role in graft failure and early onset osteoarthritis.

  3. Open arterial reconstruction of multiple hepatic artery aneurysms in a patient with hereditary hemorrhagic telangiectasia

    PubMed Central

    Ozawa, Hirotsugu; Ohki, Takao; Kanaoka, Yuji; Maeda, Koji; Hagiwara, Shin

    2016-01-01

    Abstract Background: Hereditary hemorrhagic telangiectasia (HHT) is characterized by mucocutaneous telangiectasia and visceral vascular malformations (VMs). Liver involvement with VMs may lead to high-output cardiac failure, portal hypertension, and biliary disease. There is no curative treatment for the disease, and liver transplantation is indicated for life-threatening complications. Herein, we report a case of multiple hepatic artery aneurysms (HAAs) in a patient with HHT in which open arterial reconstruction was performed. There have only been a few case reports on HAA occurring with HHT. Thus, this case provides important information for the management of HHT-associated HAAs. Case summary: A 62-year-old female with known HHT was referred to our facility to seek further treatment for a giant HAA. She denied any symptoms except recurrent epistaxis. A computed tomography (CT) scan revealed a right HAA with a diameter of 72 mm, in addition to 2 other minor HAAs. The CT scan also revealed the VMs that were scattered in the liver, and a continuously dilated and tortuous artery existing from the celiac trunk to the right and left hepatic arteries. We performed open arterial reconstruction of the HAAs. Her postoperative course was uneventful. Conclusions: When treating HAAs, there are a variety of options. However, hepatic VMs might affect HHT patients in various ways postprocedurally. Ligation and embolization of the hepatic artery may lead to complications, such as massive hepatic necrosis. Hepatectomy should be avoided if possible, because a postoperative hyperperfusive state in the remaining liver can cause adverse events. We believe that arterial reconstruction of HHT-associated HAAs might reduce the risk of postprocedural complications with minimal hemodynamic changes in the liver, thus obviating the need for hepatectomy or liver transplantation. PMID:27861387

  4. Dose reconstruction for real-time patient-specific dose estimation in CT

    SciTech Connect

    De Man, Bruno Yin, Zhye; Wu, Mingye; FitzGerald, Paul; Kalra, Mannudeep

    2015-05-15

    Purpose: Many recent computed tomography (CT) dose reduction approaches belong to one of three categories: statistical reconstruction algorithms, efficient x-ray detectors, and optimized CT acquisition schemes with precise control over the x-ray distribution. The latter category could greatly benefit from fast and accurate methods for dose estimation, which would enable real-time patient-specific protocol optimization. Methods: The authors present a new method for volumetrically reconstructing absorbed dose on a per-voxel basis, directly from the actual CT images. The authors’ specific implementation combines a distance-driven pencil-beam approach to model the first-order x-ray interactions with a set of Gaussian convolution kernels to model the higher-order x-ray interactions. The authors performed a number of 3D simulation experiments comparing the proposed method to a Monte Carlo based ground truth. Results: The authors’ results indicate that the proposed approach offers a good trade-off between accuracy and computational efficiency. The images show a good qualitative correspondence to Monte Carlo estimates. Preliminary quantitative results show errors below 10%, except in bone regions, where the authors see a bigger model mismatch. The computational complexity is similar to that of a low-resolution filtered-backprojection algorithm. Conclusions: The authors present a method for analytic dose reconstruction in CT, similar to the techniques used in radiation therapy planning with megavoltage energies. Future work will include refinements of the proposed method to improve the accuracy as well as a more extensive validation study. The proposed method is not intended to replace methods that track individual x-ray photons, but the authors expect that it may prove useful in applications where real-time patient-specific dose estimation is required.

  5. Reconstructive options in patients with late complications after surgery and radiotherapy for head and neck cancer: remember the deltopectoral flap.

    PubMed

    Krijgh, David D; Mureau, Marc A M

    2013-08-01

    During the past 40 years, free vascularized flaps have become the golden standard in the reconstruction of postoncologic head and neck defects. When there is a need for an osteofasciocutaneous free flap, the free fibula flap is the first choice because of the advantages of its long bone structure, high reliability, and minimal donor-site morbidity. However, most of these patients receive adjuvant radiation therapy, which sometimes causes symptomatic fibrosis, contractures, and (osteo)radionecrosis. In case of these late complications, locoregional reconstructive options are often limited, and complex secondary free flap procedures are not always feasible or preferred by the patient. The present paper discusses regional and free flap reconstructive options and demonstrates with 3 cases that the delayed deltopectoral flap remains a very safe, reliable, and easy flap, which still has a place in the management of these complex reconstructive challenges.

  6. Evaluation of the Microsoft Kinect for screening ACL injury.

    PubMed

    Stone, Erik E; Butler, Michael; McRuer, Aaron; Gray, Aaron; Marks, Jeffrey; Skubic, Marjorie

    2013-01-01

    A study was conducted to evaluate the use of the skeletal model generated by the Microsoft Kinect SDK in capturing four biomechanical measures during the Drop Vertical Jump test. These measures, which include: knee valgus motion from initial contact to peak flexion, frontal plane knee angle at initial contact, frontal plane knee angle at peak flexion, and knee-to-ankle separation ratio at peak flexion, have proven to be useful in screening for future knee anterior cruciate ligament (ACL) injuries among female athletes. A marker-based Vicon motion capture system was used for ground truth. Results indicate that the Kinect skeletal model likely has acceptable accuracy for use as part of a screening tool to identify elevated risk for ACL injury.

  7. Knee Extension Range of Motion at 4 Weeks Is Related to Knee Extension Loss at 12 Weeks After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Noll, Sarah; Garrison, J. Craig; Bothwell, James; Conway, John E.

    2015-01-01

    Background: The anterior cruciate ligament (ACL) is commonly torn, and surgical reconstruction is often required to allow a patient to return to their prior level of activity. Avoiding range of motion (ROM) loss is a common goal, but little research has been done to identify when ROM loss becomes detrimental to a patient’s future function. Purpose: To determine whether there is a relationship between early knee side-to-side extension difference after ACL reconstruction and knee side-to-side extension difference at 12 weeks. The hypothesis was that early (within the first 8 weeks) knee side-to-side extension difference will be predictive of knee side-to-side extension difference seen at 12 weeks. Study Design: Cohort study; Level of evidence, 3. Methods: Knee side-to-side extension difference measures were taken on 74 patients undergoing ACL reconstruction rehabilitation at the initial visit and 4, 8, and 12 weeks postoperatively. Visual analog scores (VAS) and International Knee Documentation Committee (IKDC) scores were also recorded at these time frames. Results: There was a strong relationship between knee extension ROM at 4 and 12 weeks (r = 0.639, P < .001) and 8 and 12 weeks (r = 0.742, P < .001). When the variables of knee extension ROM at initial visit and 4 and 8 weeks were entered into a regression analysis, the predictor variable explained 61% (R2 = 0.611) of variance for knee extension ROM at 12 weeks, with 4 weeks (R2 = 0.259) explaining the majority of this variance. Conclusion: This study found that a patient’s knee extension at 4 weeks was strongly correlated with knee extension at 12 weeks. Clinical Relevance: This information may be useful for clinicians treating athletic patients who are anxious for return to sport by providing them an initial goal to work toward in hopes of ensuring successful rehabilitation of their knee. PMID:26675061

  8. Posteriorly based lateral tongue flap for reconstruction of large palatal-alveolar fistulas in cleft patients

    PubMed Central

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2015-01-01

    Background: Large palatal fistula in cleft patients is a difficult situation, especially with previous multiple surgeries, which have led to severe scars in the palatal mucosa. Tongue flaps are useful aids in such situations. Materials and Methods: Seven cleft patients who were reconstructed by posteriorly based lateral tongue flap between 2005 and 2012 were studied. Variables such as flap-ability to close the fistula, remaining tongue shape at least 1 year after operation, and speech improvement (patients’ self-assessment) were evaluated. Results: Age range of the patients was 14‒45 years. The male-to-female ratio was 2/7. Posteriorly based lateral tongue flap effectively closed the large fistula in 6/7 of patients. The largest dimensions of fistula closed by this flap was 5 cm × 1.5 cm. Follow-up of 2‒7 years showed that the tongue never returned to the original size and remained asymmetrical. In addition, the nasal speech did not improve dramatically after the closure of large palatal/alveolar fistulas in this age group. Conclusion: Posteriorly based lateral tongue flap is an effective method to solve the problem of large palatal fistulas in adult cleft patients. The most useful indication for this flap is a large longitudinal palatal fistula, extending to the alveolar process. Asymmetrical tongue shape after surgery is the rule and speech improvement depends on patient's age and location of fistula. PMID:26981466

  9. Effectiveness and safety of cryotherapy after arthroscopic anterior cruciate ligament reconstruction. A systematic review of the literature.

    PubMed

    Martimbianco, Ana Luiza Cabrera; Gomes da Silva, Brenda Nazaré; de Carvalho, Alan Pedrosa Viegas; Silva, Valter; Torloni, Maria Regina; Peccin, Maria Stella

    2014-11-01

    Cryotherapy is widely used in rehabilitation; however, its effectiveness after anterior cruciate ligament (ACL) reconstruction remains uncertain. To investigate the effectiveness and safety of cryotherapy following ACL reconstruction through a systematic review, randomized and quasi-randomized clinical trials were searched in the databases: MEDLINE, EMBASE, CENTRAL, PEDro, SportDiscus, CINAHL, LILACS (June 2013). The primary outcomes measures were pain, edema and adverse events; the secondary outcomes were knee function, analgesic medication use, range of motion, blood loss, hospital stay, quality of life and patient satisfaction. The methodological quality of studies was evaluated using the Cochrane Collaboration risk-of-bias tool. Ten trials (a total of 573 patients) were included. Results of meta-analysis showed that the use of cold compression devices produced a significant reduction in pain scores 48 h after surgery (p < 0.00001), compared to no cryotherapy. The risk for adverse events did not differ between patients receiving cryotherapy versus no treatment (p = 1.00). The limited evidence currently available is insufficient to draw definitive conclusions on the effectiveness of cryotherapy for other outcomes. There is a need for well designed, good quality randomized trials to answer other questions related to this intervention and increase the precision of future systematic reviews.

  10. Risk reducing mastectomy, breast reconstruction and patient satisfaction in Norwegian BRCA1/2 mutation carriers.

    PubMed

    Hagen, Anne Irene; Mæhle, Lovise; Vedå, Nina; Vetti, Hildegunn Høberg; Stormorken, Astrid; Ludvigsen, Trond; Guntvedt, Bente; Isern, Anne Elisabeth; Schlichting, Ellen; Kleppe, Geir; Bofin, Anna; Gullestad, Hans Petter; Møller, Pål

    2014-02-01

    The aim of this study was to evaluate the outcome of risk-reducing mastectomy in BRCA1/2 mutation carriers with and without breast cancer. Uptake, methods of operation and reconstruction, complications, patient satisfaction and histopathological findings were registered at all five departments of genetics in Norway. Data from 267 affected and unaffected BRCA1/2 mutation carriers were analyzed, including a study-specific questionnaire returned by 178 mutation carriers. There was a steady increase in the uptake of risk-reducing mastectomies during the study period. Complications were observed in 106/266 (39.7%) women. Patient satisfaction was high. The majority of women expressed great relief after risk-reducing mastectomy and would have chosen the same option again.

  11. An Ecological Study of Anterior Cruciate Ligament Reconstruction, Part 1

    PubMed Central

    McGrath, Timothy M.; Waddington, Gordon; Scarvell, Jennie M.; Ball, Nick; Creer, Rob; Woods, Kevin; Smith, Damian; Adams, Roger

    2016-01-01

    Background: Additional high-quality prospective studies are needed to better define the objective criteria used in relation to return-to-sport decisions after synthetic (ligament advanced reinforcement system [LARS]) and autograft (hamstring tendon [2ST/2GR]) anterior cruciate ligament (ACL) reconstruction in active populations. Purpose: To prospectively investigate and describe the recovery of objective clinical outcomes after autograft (2ST/2GR) and synthetic (LARS) ACL reconstructions, as well as to investigate the relationship between these clinimetric test outcomes and return-to-sport activity (Tegner activity scale [TAS] score) at 12 and 24 months postoperatively. Study Design: Case series; Level of evidence, 4. Methods: A total of 64 patients who underwent ACL reconstruction (32 LARS, 32 2ST/2GR autograft) and 32 healthy reference participants were assessed for joint laxity (KT-1000 arthrometer), clinical outcome (2000 International Knee Documentation Committee [IKDC] knee examination), and activity (TAS score) preoperatively and at 12, 16, 20, and 24 weeks and 12 and 24 months postoperatively. Results: There was no significant correlation observed between clinical results using the 2000 IKDC knee examination and TAS score at 24 months (r s = 0.188, P = .137), nor were results for side-to-side difference (r s = 0.030, P = .814) or absolute KT-1000 arthrometer laxity of the surgical leg at 24 months postoperatively (r s = 0.076, P = .553) correlated with return-to-sport activity. Nonetheless, return-to-sport rates within the surgical cohort were 81% at 12 months and 83% at 24 months, respectively. No statistically significant differences were observed between physiological laxity of the uninjured knee within the surgical group compared with healthy knees within the reference group (P = .522). Conclusion: The results indicate that although relatively high levels of return-to-sport outcomes were achieved at 24 months compared with those previously reported in

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  14. Comparison of Reconstruction Intervals in Routine ECG-Pulsed 64-Row-MSCT Coronary Angiography in Frequency Controlled Patients

    SciTech Connect

    Frydrychowicz, Alex Pache, Gregor; Saueressig, Ulrich; Foell, Daniela; Kotter, Elmar; Langer, Mathias; Bley, Thorsten A.

    2007-02-15

    Purpose. In light of the increasing use and acceptance of multislice computed tomography (MSCT) coronary angiography it was the purpose of this study to compare reconstruction intervals used in a routine ECG-pulsed MSCT coronary artery angiography setting with frequency controlled patients. Methods. Examinations were performed on a Siemens Somatom Sensation 64 scanner with a total of 110 ml of contrast agent and ECG pulsing (interval from 40% to 70%) after oral application of a {beta}-blocker if the heart rate was higher than 65 bpm. All human subjects were referred for the evaluation of suspected coronary artery disease. Coronary artery segments were evaluated by two experienced radiologists in a consensus reading. A ranking of diagnostic image quality (from 1 (no evaluation possible) to 5 (excellent image quality)) was statistically evaluated by Wilcoxon Signed Rank Test. Results. In 45 patients (30 male, 15 female, age 63.8 {+-} 12.1 years) we detected a significant advantage of the 60% reconstruction interval over 40%, 50%, and 70% (for each p < 0.05). In cases of sudden arrhythmia or movement during the scan, additional reconstruction intervals within the ECG-pulsed reconstruction intervals remained necessary for diagnosis. Conclusion. In a routine diagnostic setting with frequency controlled patients and ECG pulsing the 60% reconstruction interval can be considered superior for the initial diagnosis in 64-row multislice computed tomography coronary angiography. However, further information can be derived from various reconstruction intervals such as 40% and 70%.

  15. Gait Asymmetries Persist 1 Year After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    White, Kathleen; Logerstedt, David; Snyder-Mackler, Lynn

    2013-01-01

    Background: After anterior cruciate ligament reconstruction (ACLR), motivation to return to previous levels of activity is high. Very few studies have used return-to-activity criteria to determine when to permit athletic play. Return-to-activity measures objectively evaluate functional limb symmetry; however, previous biomechanical studies have found gait deviations in these individuals that persist up to 2 years after surgery. Purpose: To evaluate gait biomechanics in a specific cohort of ACL patients 1 year after surgery and retrospectively compare individuals who pass return-to-activity criteria 6 months after surgery with those who fail. Study Design: Prospective analysis. Methods: A total of 40 athletes who participated regularly (>50 h/y) in cutting, jumping, and pivoting activities and who sustained an isolated, unilateral ACL rupture were included in this study. All participants underwent reconstruction by the same surgeon and received individualized postoperative rehabilitation. Performance-based and self-report data were measured 6 months after surgery to assess readiness to return to activity (90% outcome required to pass); 20 subjects passed return-to-activity criteria and 20 subjects did not. Motion analysis was performed 1 year after surgery, and knee flexion angles, moments, and excursions were measured during gait and evaluated for all subjects. Results: There was no limb × group interaction or effect of group for all measures. Decreased knee measures were seen on the involved limb compared with the uninvolved limb for all subjects, and failed subjects demonstrated larger differences between limbs. Conclusion: Patients continued to demonstrate biomechanical limb asymmetries 1 year after ACLR, regardless of performance-based measures at 6 months. Early return to activity did not ensure limb symmetry at 1 year. Clinical Relevance: Gait asymmetries were seen in all subjects 1 year after surgery regardless of status at 6 months. Potentially prolonging

  16. Carotid artery resection and reconstruction in patients with squamous cell carcinomas of the neck.

    PubMed

    Iván, L; Paczona, R; Czigner, J

    1999-01-01

    The authors performed a retrospective review of their 10-year experience of carotid artery resection with vascular reconstruction for advanced squamous cell carcinoma of the neck. From 1986 to 1997, four patients underwent elective and one patient acute carotid artery resection with revascularization at the Department of Otolaryngology, Albert Szent-Györgyi Medical University, Szeged, Hungary. Primary lesions were three laryngeal and two hypopharyngeal squamous cell carcinomas. All five resected specimens had metastatic invasion by tumor of the carotid adventitia on pathological examination, while only four specimens exhibited tumorous destruction of the arterial wall. No cerebrovascular accident occurred in any patient, although one patient died postoperatively from cardiac failure. The four remaining patients died of local-regional recurrences or metastatic disease within 17 months after their carotid artery resections. Our findings show that carotid artery resection with replacement is superior to ligation alone in avoiding neurological complications. This approach can provide local control of tumor, but may fail to achieve significant disease-free survival.

  17. Evaluation of semiempirical VMAT dose reconstruction on a patient dataset based on biplanar diode array measurements.

    PubMed

    Stambaugh, Cassandra; Opp, Daniel; Wassrman, Stuart; Zhang, Geoffrey; Feygelman, Vladimir

    2014-03-01

    We report the results of a preclinical evaluation of recently introduced commercial tools for 3D patient IMRT/VMAT dose reconstruction, the Delta(4) Anatomy calculation algorithm. Based on the same initial measurement, volumetric dose can be reconstructed in two ways. Three-dimensional dose on the Delta(4) phantom can be obtained by renormalizing the planned dose distribution by the measurement values (D4 Interpolation). Alternatively, incident fluence can be approximated from the phantom measurement and used for volumetric dose calculation on an arbitrary (patient) dataset with a pencil beam algorithm (Delta(4) PB). The primary basis for comparison was 3D dose obtained by previously validated measurement-guided planned dose perturbation method (ACPDP), based on the ArcCHECK dosimeter with 3DVH software. For five clinical VMAT plans, D4 Interpolation agreed well with ACPDP on a homogeneous cylindrical phantom according to gamma analysis with local dose-error normalization. The average agreement rates were 98.2%±1.3% (1 SD), (range 97.0%-100%) and 92.8%±3.9% (89.5%-99.2%), for the 3%/3 mm and 2%/2 mm criteria, respectively. On a similar geometric phantom, D4 PB demonstrated substantially lower agreement rates with ACPDP: 88.6%±6.8% (81.2%-96.1%) and 72.4%±8.4% (62.1%-81.1%), for 3%/3 mm and 2%/2 mm, respectively. The average agreement rates on the heterogeneous patients' CT datasets are lower yet: 81.2%±8.6% (70.4%-90.4%) and 64.6%±8.4% (56.5%-74.7%), respectively, for the same two criteria sets. For both threshold combinations, matched analysis of variance (ANOVA) multiple comparisons showed statistically significant differences in mean agreement rates (p<0.05) for D4 Interpolation versus ACPDP on one hand, and D4 PB versus ACPDP on either cylindrical or patient dataset on the other hand. Based on the favorable D4 Interpolation results for VMAT plans, the resolution of the reconstruction method rather than hardware design is likely to be responsible

  18. Evaluation of semiempirical VMAT dose reconstruction on a patient dataset based on biplanar diode array measurements.

    PubMed

    Stambaugh, Cassandra; Opp, Daniel; Wasserman, Stuart; Zhang, Geoffrey; Feygelman, Vladimir

    2014-03-06

    We report the results of a preclinical evaluation of recently introduced commercial tools for 3D patient IMRT/VMAT dose reconstruction, the Delta4 Anatomy calculation algorithm. Based on the same initial measurement, volumetric dose can be reconstructed in two ways. Three-dimensional dose on the Delta4 phantom can be obtained by renormalizing the planned dose distribution by the measurement values (D4 Interpolation). Alternatively, incident fluence can be approximated from the phantom measurement and used for volumetric dose calculation on an arbitrary (patient) dataset with a pencil beam algorithm (Delta4 PB). The primary basis for comparison was 3D dose obtained by previously validated measurement-guided planned dose perturbation method (ACPDP), based on the ArcCHECK dosimeter with 3DVH software. For five clinical VMAT plans, D4 Interpolation agreed well with ACPDP on a homogeneous cylindrical phantom according to gamma analysis with local dose-error normalization. The average agreement rates were 98.2% ± 1.3% (1 SD), (range 97.0%-100%) and 92.8% ± 3.9% (89.5%-99.2%), for the 3%/3 mm and 2%/2 mm criteria, respectively. On a similar geometric phantom, D4 PB demonstrated substantially lower agreement rates with ACPDP: 88.6% ± 6.8% (81.2%-96.1%) and 72.4% ± 8.4% (62.1%-81.1%), for 3%/3 mm and 2%/2 mm, respectively. The average agreement rates on the heterogeneous patients' CT datasets are lower yet: 81.2% ± 8.6% (70.4%-90.4%) and 64.6% ± 8.4% (56.5%-74.7%), respectively, for the same two criteria sets. For both threshold combinations, matched analysis of variance (ANOVA) multiple comparisons showed statistically significant differences in mean agreement rates (p < 0.05) for D4 Interpolation versus ACPDP on one hand, and D4 PB versus ACPDP on either cylindrical or patient dataset on the other hand. Based on the favorable D4 Interpolation results for VMAT plans, the resolution of the reconstruction method rather than hardware design is likely to be responsible

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

    PubMed Central

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

    1999-01-01

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

  20. Aspergillus Collagen-Like Genes (acl): Identification, Sequence Polymorphism, and Assessment for PCR-Based Pathogen Detection

    PubMed Central

    Tuntevski, Kiril; Durney, Brandon C.; Snyder, Anna K.; LaSala, P. Rocco; Nayak, Ajay P.; Green, Brett J.; Beezhold, Donald H.; Rio, Rita V. M.; Holland, Lisa A.

    2013-01-01

    The genus Aspergillus is a burden to public health due to its ubiquitous presence in the environment, its production of allergens, and wide demographic susceptibility among cystic fibrosis, asthmatic, and immunosuppressed patients. Current methods of detection of Aspergillus colonization and infection rely on lengthy morphological characterization or nonstandardized serological assays that are restricted to identifying a fungal etiology. Collagen-like genes have been shown to exhibit species-specific conservation across the noncollagenous regions as well as strain-specific polymorphism in the collagen-like regions. Here we assess the conserved region of the Aspergillus collagen-like (acl) genes and explore the application of PCR amplicon size-based discrimination among the five most common etiologic species of the Aspergillus genus, including Aspergillus fumigatus, A. flavus, A. nidulans, A. niger, and A. terreus. Genetic polymorphism and phylogenetic analysis of the aclF1 gene were additionally examined among the available strains. Furthermore, the applicability of the PCR-based assay to identification of these five species in cultures derived from sputum and bronchoalveolar fluid from 19 clinical samples was explored. Application of capillary electrophoresis on nanogels was additionally demonstrated to improve the discrimination between Aspergillus species. Overall, this study demonstrated that Aspergillus acl genes could be used as PCR targets to discriminate between clinically relevant Aspergillus species. Future studies aim to utilize the detection of Aspergillus acl genes in PCR and microfluidic applications to determine the sensitivity and specificity for the identification of Aspergillus colonization and invasive aspergillosis in immunocompromised subjects. PMID:24123732

  1. Panoramic Measurement and Analysis of Strain Distribution in the Human ACL Using a Photoelastic Coating Method

    NASA Astrophysics Data System (ADS)

    Hirokawa, Shunji; Yamamoto, Kouji; Kawada, Takashi

    Large and highly variable deformations of the ACL cannot be adequately quantified by one-dimensional and/or localized measurements. Since the complex anatomy of the ACL makes uniform loading of all fiber bundles almost impossible, strains on specific portions being tested are considerably altered during knee movement. To observe the ACL's entire surface, we propose a photoelastic coating method. A simulator jig was used to allow a natural motion of the knee whose medial and lateral femoral bone parts were removed in order to expose the ACL for observation. The simulator jig with the knee was mounted on a universal stand which allows tilt and swivel rotations, so that the exposed ACL might be viewed from any direction. Measurements were performed on the strain distributions over the ACL at various knee angles. The panoramic images of the photoelastic fringe patterns yielded significant results. Special attention was paid for insight into the relation between strain distribution and the directions of fiber run.

  2. Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations - update 2010.

    PubMed

    Hewett, Timothy E; Ford, Kevin R; Hoogenboom, Barbara J; Myer, Gregory D

    2010-12-01

    This invited clinical commentary summarizes the current state of knowledge in the area of prevention of anterior cruciate ligament (ACL) injuries. ACL injuries occur with a four to six fold greater incidence in female compared to male athletes playing the same high risk sports. The combination of increased risk of ACL injury and a 10-fold increase in sports participation since the enactment of Title IX in 1972 has led to an almost epidemic rise in ACL injuries in female athletes. Examination of the mechanisms responsible for this sex disparity in ACL rupture accelerated in the last two decades. A summary of these findings and a synthesis and framework for understanding the results of the intense investigation of this research are detailed herein. This clinical commentary focuses on the current understanding, identification and interventional targeting of the primary neuromuscular and biomechanical risk factors associated with the ACL injury mechanism in high-risk individuals.

  3. Preoperative TRAM free flap volume estimation for breast reconstruction in lean patients.

    PubMed

    Minn, Kyung Won; Hong, Ki Yong; Lee, Sang Woo

    2010-04-01

    To obtain pleasing symmetry in breast reconstruction with transverse rectus abdominis myocutaneous (TRAM) free flap, a large amount of abdominal flap is elevated and remnant tissue is trimmed in most cases. However, elevation of abundant abdominal flap can cause excessive tension in donor site closure and increase the possibility of hypertrophic scarring especially in lean patients. The TRAM flap was divided into 4 zones in routine manner; the depth and dimension of the 4 zones were obtained using ultrasound and AutoCAD (Autodesk Inc., San Rafael, CA), respectively. The acquired numbers were then multiplied to obtain an estimate of volume of each zone and the each zone volume was added. To confirm the relation between the estimated volume and the actual volume, authors compared intraoperative actual TRAM flap volumes with preoperative estimated volumes in 30 consecutive TRAM free flap breast reconstructions. The estimated volumes and the actual elevated volumes of flap were found to be correlated by regression analysis (r = 0.9258, P < 0.01). According to this result, we could confirm the reliability of the preoperative volume estimation using our method. Afterward, the authors applied this method to 7 lean patients by estimation and revision of the design and obtained symmetric results with minimal donor site morbidity. Preoperative estimation of TRAM flap volume with ultrasound and AutoCAD (Autodesk Inc.) allow the authors to attain the precise volume desired for elevation. This method provides advantages in terms of minimal flap trimming, easier closure of donor sites, reduced scar widening and symmetry, especially in lean patients.

  4. Custom-Made Synthetic Scaffolds for Bone Reconstruction: A Retrospective, Multicenter Clinical Study on 15 Patients

    PubMed Central

    Macchi, Aldo; Luongo, Giuseppe

    2016-01-01

    Purpose. To present a computer-assisted-design/computer-assisted-manufacturing (CAD/CAM) technique for the design, fabrication, and clinical application of custom-made synthetic scaffolds, for alveolar ridge augmentation. Methods. The CAD/CAM procedure consisted of (1) virtual planning/design of the custom-made scaffold; (2) milling of the scaffold into the exact size/shape from a preformed synthetic bone block; (3) reconstructive surgery. The main clinical/radiographic outcomes were vertical/horizontal bone gain, any biological complication, and implant survival. Results. Fifteen patients were selected who had been treated with a custom-made synthetic scaffold for ridge augmentation. The scaffolds closely matched the shape of the defects: this reduced the operation time and contributed to good healing. A few patients experienced biological complications, such as pain/swelling (2/15: 13.3%) and exposure of the scaffold (3/15: 20.0%); one of these had infection and complete graft loss. In all other patients, 8 months after reconstruction, a well-integrated newly formed bone was clinically available, and the radiographic evaluation revealed a mean vertical and horizontal bone gain of 2.1 ± 0.9 mm and 3.0 ± 1.0 mm, respectively. Fourteen implants were placed and restored with single crowns. The implant survival rate was 100%. Conclusions. Although positive outcomes have been found with custom-made synthetic scaffolds in alveolar ridge augmentation, further studies are needed to validate this technique. PMID:28070512

  5. Free jejunal flap for pharyngoesophageal reconstruction in head and neck cancer patients: An evaluation of donor site complications

    PubMed Central

    Razdan, Shantanu N.; Albornoz, Claudia R.; Matros, Evan; Paty, Philip B.; Cordeiro, Peter G.

    2016-01-01

    Background Free jejunal transfer for pharyngoesophageal reconstruction has often been criticized for its associated donor site morbidity. Conversely, the same argument has been invoked to support use of fasciocutaneous flaps, given their low incidence of donor site complications. The purpose of the current study was to document donor site complication rate with free jejunal flaps for pharyngoesophageal reconstruction, in the hands of an experienced surgeon. Methods A retrospective chart review was performed of consecutive patients who underwent free jejunal transfer between 1992 and 2012 by the senior author. Demographic data, abdominal complications, surgical characteristics of small bowel anastomoses and postoperative bowel function were specifically noted. Results Ninety-two jejunal flap reconstructions were performed in 90 patients. Mean follow up time was 29 months. Twelve (13%) patients had prior abdominal surgery. Donor site complications included ileus (n=2), wound cellulitis (n=1), wound dehiscence (n=1) and small bowel obstruction (n=1). Mean time to initiation of tube feeds after reconstruction was 5 days. Seventy-seven (86.5%) patients were discharged on an oral diet. The perioperative mortality rate of 2% was not associated with any donor site complication. Conclusion Free jejunal transfer is associated with minimal and acceptable donor site complication rates. The choice of flap for pharyngoesophageal reconstruction should be determined by the type of defect, potential recipient site complications and the surgeon’s familiarity with the flap. Potential donor site complications should not be a deterrent for free jejunal flaps given the low rate described in this study. PMID:26220434

  6. Suggestions from the field for return-to-sport rehabilitation following anterior cruciate ligament reconstruction: alpine skiing.

    PubMed

    Kokmeyer, Dirk; Wahoff, Michael; Mymern, Matt

    2012-04-01

    Alpine skiing is a high-risk sport for injuries to the anterior cruciate ligament (ACL). While descending a hill, a skier must resist large centrifugal forces at a high velocity, while the knees are positioned in postures that place the ACL at risk of injury. Skiers who undergo ACL reconstructive surgery are prone to a high rate of reinjury to the same knee and even ACL injury in the uninjured knee. A rehabilitation program that integrates the best current evidence of ACL rehabilitation and the science of skiing is essential to a successful return to alpine skiing. Unlike rehabilitation programs developed for court or field athletes, a skiing program must place a large emphasis on slow eccentric-loading and weight-bearing (closed-chain) power and endurance. The purpose of this clinical commentary is to provide the rehabilitation specialist such a program directed toward safely returning the athlete to alpine skiing.

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

    PubMed Central

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

    2016-01-01

    [Purpose] The aim of this study was to examine the long-term interventions effects of robot-assisted therapy rehabilitation on functional activity levels after anterior cruciate ligament reconstruction. [Subjects and Methods] The subjects were 8 patients (6 males and 2 females) who received anterior cruciate ligament reconstruction. The subjects participated in robot-assisted therapy lasting for one month. The Timed Up-and-Go test, 10-Meter Walk test, Functional Reach Test, surface electromyography of the vastus lateralis and vastus medialis, and extensor strength of isokinetic movement of the knee joint were evaluated before and after the intervention. [Results] The average value of the of vastus medialis EMG, Functional Reach Test, and the maximum and average extensor strength of the knee joint isokinetic movement increased significantly, and the time of the 10-Meter Walk test decreased significantly. [Conclusion] These results suggest that walking ability and muscle strength can be improved by robotic walking training as a long-term intervention. PMID:27630396

  8. Patient specific implants (PSI) in reconstruction of orbital floor and wall fractures.

    PubMed

    Gander, Thomas; Essig, Harald; Metzler, Philipp; Lindhorst, Daniel; Dubois, Leander; Rücker, Martin; Schumann, Paul

    2015-01-01

    Fractures of the orbital wall and floor can be challenging due to the demanding three-dimensional anatomy and limited intraoperative overview. Misfitting implants and inaccurate surgical technique may lead to visual disturbance and unaesthetic results. A new approach using individually manufactured titanium implants (KLS Martin, Group, Germany) for daily routine is presented in the current paper. Preoperative CT-scan data were processed in iPlan 3.0.5 (Brainlab, Feldkirchen, Germany) to generate a 3D-reconstruction of the affected orbit using the mirrored non-affected orbit as template and the extent of the patient specific implant (PSI) was outlined and three landmarks were positioned on the planned implant in order to allow easy control of the implant's position by intraoperative navigation. Superimposition allows the comparison of the postoperative result with the preoperative planning. Neither reoperation was indicated due to malposition of the implant and the ocular bulb nor visual impairments could be assessed. PSI allows precise reconstruction of orbital fractures by using a complete digital workflow and should be considered superior to manually bent titanium mesh implants.

  9. Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty.

    PubMed

    Marbacher, Serge; Andereggen, Lukas; Erhardt, Salome; Fathi, Ali-Reza; Fandino, Javier; Raabe, Andreas; Beck, Jürgen

    2012-10-01

    Cranioplasty is a common neurosurgical procedure. Free-hand molding of polymethyl methacrylate (PMMA) cement into complex three-dimensional shapes is often time-consuming and may result in disappointing cosmetic outcomes. Computer-assisted patient-specific implants address these disadvantages but are associated with long production times and high costs. In this study, we evaluated the clinical, radiological, and cosmetic outcomes of a time-saving and inexpensive intraoperative method to mold custom-made implants for immediate single-stage or delayed cranioplasty. Data were collected from patients in whom cranioplasty became necessary after removal of bone flaps affected by intracranial infection, tumor invasion, or trauma. A PMMA replica was cast between a negative form of the patient's own bone flap and the original bone flap with exactly the same shape, thickness, and dimensions. Clinical and radiological follow-up was performed 2 months post-surgery. Patient satisfaction (Odom criteria) and cosmesis (visual analogue scale for cosmesis) were evaluated 1 to 3 years after cranioplasty. Twenty-seven patients underwent intraoperative template-molded patient-specific cranioplasty with PMMA. The indications for cranioplasty included bone flap infection (56%, n = 15), calvarian tumor resection (37%, n = 10), and defect after trauma (7%, n = 2). The mean duration of the molding procedure was 19 ± 7 min. Excellent radiological implant alignment was achieved in 94% of the cases. All (n = 23) but one patient rated the cosmetic outcome (mean 1.4 years after cranioplasty) as excellent (70%, n = 16) or good (26%, n = 6). Intraoperative cast-molded reconstructive cranioplasty is a feasible, accurate, fast, and cost-efficient technique that results in excellent cosmetic outcomes, even with large and complex skull defects.

  10. Long Term Gait Deviations in Anterior Cruciate Ligament Reconstructed Females

    PubMed Central

    Noehren, Brian; Wilson, Hilary; Miller, Casey; Lattermann, Christian

    2015-01-01

    Purpose Little is known of the potential long term gait alterations that occur after an anterior cruciate ligament (ACL) reconstruction. In particular, variables such as impact loading which have been previously associated with joint deterioration have not been studied in walking and running after an ACL reconstruction. The purpose of this study was to define the alterations in impact forces, loading rates, and the accompanying sagittal plane kinematic and kinetic mechanics at the time of impact between the ACL reconstructed group and a healthy control group. Methods 40 females (20 ACL reconstruction, 20 controls) participated in the study. An instrumented gait analysis was performed on all subjects. Between group and limb comparisons were made for initial vertical impact force, loading rate, sagittal plane knee and hip angles as well as moments. Results During walking and running the ACL cohort had significantly greater initial vertical impact force (p=0.002 and p= 0.001), and loading rates (p=0.03 and p= 0.01), as well as a smaller knee extensor moment and hip angle during walking (p=0.000 and p=0.01). There was a trend towards a smaller knee moment and hip angle during running (p=0.08 and p=0.06) as well as a larger hip extensor moment during walking (p=0.06) in the ACL group. No differences were found for hip extensor moment during running, knee angles between groups during walking or running. Lastly, no between limb differences were found for any variable. Conclusion Gait deviations such as elevated impact loading and loading rates do not resolve long term after the individual has resumed previous activity levels and may contribute to the greater risk of early joint degeneration in this population. PMID:23568090

  11. 50 CFR 648.64 - Yellowtail flounder sub-ACLs and AMs for the scallop fishery.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false Yellowtail flounder sub-ACLs and AMs for...-ACLs and AMs for the scallop fishery. (a) As specified in § 648.55(d), and pursuant to the biennial... specified in § 648.90(a)(4)(iii)(C) of the NE multispecies regulations, the sub-ACLs for the 2011...

  12. Automated segmentation and reconstruction of patient-specific cardiac anatomy and pathology from in vivo MRI*

    NASA Astrophysics Data System (ADS)

    Ringenberg, Jordan; Deo, Makarand; Devabhaktuni, Vijay; Filgueiras-Rama, David; Pizarro, Gonzalo; Ibañez, Borja; Berenfeld, Omer; Boyers, Pamela; Gold, Jeffrey

    2012-12-01

    This paper presents an automated method to segment left ventricle (LV) tissues from functional and delayed-enhancement (DE) cardiac magnetic resonance imaging (MRI) scans using a sequential multi-step approach. First, a region of interest (ROI) is computed to create a subvolume around the LV using morphological operations and image arithmetic. From the subvolume, the myocardial contours are automatically delineated using difference of Gaussians (DoG) filters and GSV snakes. These contours are used as a mask to identify pathological tissues, such as fibrosis or scar, within the DE-MRI. The presented automated technique is able to accurately delineate the myocardium and identify the pathological tissue in patient sets. The results were validated by two expert cardiologists, and in one set the automated results are quantitatively and qualitatively compared with expert manual delineation. Furthermore, the method is patient-specific, performed on an entire patient MRI series. Thus, in addition to providing a quick analysis of individual MRI scans, the fully automated segmentation method is used for effectively tagging regions in order to reconstruct computerized patient-specific 3D cardiac models. These models can then be used in electrophysiological studies and surgical strategy planning.

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

    PubMed

    Waters, Eric

    2012-04-01

    The purpose of this paper is to outline the final, functional phases of rehabilitation that address exercises, drills, and return-to-play criteria for the sport of basketball, following anterior cruciate ligament (ACL) reconstruction. ACL injuries can be debilitating and affect the quality of life for recreational and elite athletes alike. Tears of the ACL are common in both male and female basketball players, with a higher incidence rate in females. Incidence of a retear to the existing graft or contralateral knee within 5 years of ACL reconstruction with patellar tendon autograft in young (less than 18 to 25 years of age), active basketball players can be as high as 52%. Reducing the number of ACL injuries or reinjury, of which there are an estimated 80 000 per year at an associated cost of over a billion dollars, can have significant potential long-term fiscal and health benefits. Following surgical reconstruction of the ACL, implementing a tailored rehabilitation protocol can ensure a successful return to sport. When searching the literature for such protocols, clinicians may struggle to find specific exercises, drills, and return-to-play criteria for particular sports. The intent of this manuscript is to present such a rehabilitation protocol for basketball.

  14. 50 CFR 640.28 - Annual catch limits (ACLs) and accountability measures (AMs).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE SPINY LOBSTER FISHERY OF THE GULF... accountability measures (AMs). For recreational and commercial spiny lobster landings combined, the ACL is...

  15. Initial experience in primal-dual optimization reconstruction from sparse-PET patient data

    NASA Astrophysics Data System (ADS)

    Zhang, Zheng; Ye, Jinghan; Chen, Buxin; Perkins, Amy E.; Rose, Sean; Sidky, Emil Y.; Kao, Chien-Min; Xia, Dan; Tung, Chi-Hua; Pan, Xiaochuan

    2016-03-01

    There exists interest in designing a PET system with reduced detectors due to cost concerns, while not significantly compromising the PET utility. Recently developed optimization-based algorithms, which have demonstrated the potential clinical utility in image reconstruction from sparse CT data, may be used for enabling such design of innovative PET systems. In this work, we investigate a PET configuration with reduced number of detectors, and carry out preliminary studies from patient data collected by use of such sparse-PET configuration. We consider an optimization problem combining Kullback-Leibler (KL) data fidelity with an image TV constraint, and solve it by using a primal-dual optimization algorithm developed by Chambolle and Pock. Results show that advanced algorithms may enable the design of innovative PET configurations with reduced number of detectors, while yielding potential practical PET utilities.

  16. VMAT QA: Measurement-guided 4D dose reconstruction on a patient

    SciTech Connect

    Nelms, Benjamin E.; Opp, Daniel; Robinson, Joshua; Wolf, Theresa K.; Zhang, Geoffrey; Moros, Eduardo; Feygelman, Vladimir

    2012-07-15

    Purpose: To develop and validate a volume-modulated arc therapy (VMAT) quality assurance (QA) tool that takes as input a time-resolved, low-density ({approx}10 mm) cylindrical surface dose map from a commercial helical diode array, and outputs a high density, volumetric, time-resolved dose matrix on an arbitrary patient dataset. This first validation study is limited to a homogeneous 'patient.'Methods: A VMAT treatment is delivered to a diode array phantom (ARCCHECK, Sun Nuclear Corp., Melbourne, FL). 3DVH software (Sun Nuclear) derives the high-density volumetric dose using measurement-guided dose reconstruction (MGDR). MGDR cylindrical phantom results are then used to perturb the three-dimensional (3D) treatment planning dose on the patient dataset, producing a semiempirical volumetric dose grid. Four-dimensional (4D) dose reconstruction on the patient is also possible by morphing individual sub-beam doses instead of the composite. For conventional (3D) dose comparison two methods were developed, using the four plans (Multi-Target, C-shape, Mock Prostate, and Head and Neck), including their structures and objectives, from the AAPM TG-119 report. First, 3DVH and treatment planning system (TPS) cumulative point doses were compared to ion chamber in a cube water-equivalent phantom ('patient'). The shape of the phantom is different from the ARCCHECK and furthermore the targets were placed asymmetrically. Second, coronal and sagittal absolute film dose distributions in the cube were compared with 3DVH and TPS. For time-resolved (4D) comparisons, three tests were performed. First, volumetric dose differences were calculated between the 3D MGDR and cumulative time-resolved patient (4D MGDR) dose at the end of delivery, where they ideally should be identical. Second, time-resolved (10 Hz sampling rate) ion chamber doses were compared to cumulative point dose vs time curves from 4D MGDR. Finally, accelerator output was varied to assess the linearity of the 4D MGDR with

  17. Impact of adaptive statistical iterative reconstruction on radiation dose in evaluation of trauma patients

    PubMed Central

    Maxfield, Mark W.; Schuster, Kevin M.; McGillicuddy, Edward A.; Young, Calvin J.; Ghita, Monica; Bokhari, S.A. Jamal; Oliva, Isabel B.; Brink, James A.; Davis, Kimberly A.

    2013-01-01

    BACKGROUND A recent study showed that computed tomographic (CT) scans contributed 93% of radiation exposure of 177 patients admitted to our Level I trauma center. Adaptive statistical iterative reconstruction (ASIR) is an algorithm that reduces the noise level in reconstructed images and therefore allows the use of less ionizing radiation during CT scans without significantly affecting image quality. ASIR was instituted on all CT scans performed on trauma patients in June 2009. Our objective was to determine if implementation of ASIR reduced radiation dose without compromising patient outcomes. METHODS We identified 300 patients activating the trauma system before and after the implementation of ASIR imaging. After applying inclusion criteria, 245 charts were reviewed. Baseline demographics, presenting characteristics, number of delayed diagnoses, and missed injuries were recorded. The postexamination volume CT dose index (CTDIvol) and dose-length product (DLP)reported by the scanner for CT scans of the chest, abdomen, and pelvis and CT scans of the brain and cervical spine were recorded. Subjective image quality was compared between the two groups. RESULTS For CT scans of the chest, abdomen, and pelvis, the mean CTDIvol(17.1 mGy vs. 14.2 mGy; p < 0.001) and DLP (1,165 mGy·cm vs. 1,004 mGy·cm; p < 0.001) was lower for studies performed with ASIR. For CT scans of the brain and cervical spine, the mean CTDIvol(61.7 mGy vs. 49.6 mGy; p < 0.001) and DLP (1,327 mGy·cm vs. 1,067 mGy·cm; p < 0.001) was lower for studies performed with ASIR. There was no subjective difference in image quality between ASIR and non-ASIR scans. All CT scans were deemed of good or excellent image quality. There were no delayed diagnoses or missed injuries related to CT scanning identified in either group. CONCLUSION Implementation of ASIR imaging for CT scans performed on trauma patients led to a nearly 20% reduction in ionizing radiation without compromising outcomes or image quality

  18. Rehabilitation outcomes in patients with early and two-stage reconstruction of flexor tendon injuries

    PubMed Central

    Sade, Ilgin; İnanir, Murat; Şen, Suzan; Çakmak, Esra; Kablanoğlu, Serkan; Selçuk, Barin; Dursun, Nigar

    2016-01-01

    [Purpose] The primary aim of this study was to assess rehabilitation outcomes for early and two-stage repair of hand flexor tendon injuries. The secondary purpose of this study was to compare the findings between treatment groups. [Subjects and Methods] Twenty-three patients were included in this study. Early repair (n=14) and two-stage repair (n=9) groups were included in a rehabilitation program that used hand splints. This retrospective evaluated patients according to their demographic characteristics, including age, gender, injured hand, dominant hand, cause of injury, zone of injury, number of affected fingers, and accompanying injuries. Pain, range of motion, and grip strength were evaluated using a visual analog scale, goniometer, and dynamometer, respectively. [Results] Both groups showed significant improvements in pain and finger flexion after treatment compared with baseline measurements. However, no significant differences were observed between the two treatment groups. Similar results were obtained for grip strength and pinch grip, whereas gross grip was better in the early tendon repair group. [Conclusion] Early and two-stage reconstruction of patients with flexor tendon injuries can be performed with similarly favorable responses and effective rehabilitation programs. PMID:27630400

  19. Breast reconstruction with single-pedicle TRAM flap in breast cancer patients with low midline abdominal scar

    PubMed Central

    Wu, Jun-Dong; Huang, Wen-He; Qiu, Si-Qi; He, Li-Fang; Guo, Cui-Ping; Zhang, Yong-Qu; Zhang, Fan; Zhang, Guo-Jun

    2016-01-01

    Breast reconstruction with transverse rectus abdominis myocutaneous (TRAM) flap is challenging in patients with low midline abdominal scar. In this study, we aimed to investigate the clinical feasibility of immediate breast reconstruction using single-pedicle TRAM (SP-TRAM) flaps in patients with low midline abdominal scar. There were 4 strict selection criteria: 1) presence at least 3 perforators on the pedicle side; 2) perforators with regional average flow velocity of >20 cm/s; 3) upper edge of the abdominal scar at least 4 cm from the umbilicus; and 4) scar age >1 year. Eight breast cancer patients with low midline abdominal scar (scar group) and 20 without (control group) underwent immediate breast reconstruction with SP-TRAM flaps consisting of zone I and III and zone II tissues. Flap complications, donor-site complications, and cosmetic results were compared between the two groups. All flaps survived and both groups presented similar flap and donor site complications, including fat necrosis, seroma, hematoma, infection, delayed wound healing, and abdominal hernia, and patients in both groups had similar aesthetic results (p > 0.05). Thus, the study demonstrated that breast reconstruction using SP-TRAM flap was a safe approach in carefully selected patients with low midline abdominal scar. PMID:27406872

  20. Patient Specific Instruments for Complex Tumor Resection-Reconstruction Surgery within the Pelvis: A Series of 4 Cases.

    PubMed

    Cernat, Eduard; Docquier, Pierre-Louis; Paul, Laurent; Banse, Xavier; Codorean, Ion-Bogdan

    2016-01-01

    The pelvis bone resection-reconstruction surgery is one of the most challenging fields in orthopedics. Being applied for tumors, as for other complex reconstruction cases, this type of surgery needs careful planning and is time consuming, in order to obtain proper accuracy. Unfortunately not all the time the expected accuracy is met, with consequences for the patients. PSI proved to provide good cutting accuracy during simulated tumor surgery within the pelvis. This article present a series of 4 patients operated in our department between June 2014 and Mars 2015 for tumors resectionreconstructions. The patients were imaged using a CT and an MRI scan and the images were reconstructed in 3D. According to the bone bank stock, the most similar allograft was chosen and the stored CT scan was reconstructed in 3D. Patient specific instruments (PSI) were designed and manufactured using rapid-prototyping technology for the resection of the native tissues as for the resection of the careful selected hemipelvic allografts. Allografts fitting to the pelvis of the patients was excellent and allowed stable osteosynthesis.

  1. Image-based reconstruction of three-dimensional myocardial infarct geometry for patient-specific modeling of cardiac electrophysiology

    SciTech Connect

    Ukwatta, Eranga Arevalo, Hermenegild; Pashakhanloo, Farhad; Prakosa, Adityo; Vadakkumpadan, Fijoy; Rajchl, Martin; White, James; Herzka, Daniel A.; McVeigh, Elliot; Lardo, Albert C.; Trayanova, Natalia A.

    2015-08-15

    Purpose: Accurate three-dimensional (3D) reconstruction of myocardial infarct geometry is crucial to patient-specific modeling of the heart aimed at providing therapeutic guidance in ischemic cardiomyopathy. However, myocardial infarct imaging is clinically performed using two-dimensional (2D) late-gadolinium enhanced cardiac magnetic resonance (LGE-CMR) techniques, and a method to build accurate 3D infarct reconstructions from the 2D LGE-CMR images has been lacking. The purpose of this study was to address this need. Methods: The authors developed a novel methodology to reconstruct 3D infarct geometry from segmented low-resolution (Lo-res) clinical LGE-CMR images. Their methodology employed the so-called logarithm of odds (LogOdds) function to implicitly represent the shape of the infarct in segmented image slices as LogOdds maps. These 2D maps were then interpolated into a 3D image, and the result transformed via the inverse of LogOdds to a binary image representing the 3D infarct geometry. To assess the efficacy of this method, the authors utilized 39 high-resolution (Hi-res) LGE-CMR images, including 36 in vivo acquisitions of human subjects with prior myocardial infarction and 3 ex vivo scans of canine hearts following coronary ligation to induce infarction. The infarct was manually segmented by trained experts in each slice of the Hi-res images, and the segmented data were downsampled to typical clinical resolution. The proposed method was then used to reconstruct 3D infarct geometry from the downsampled images, and the resulting reconstructions were compared with the manually segmented data. The method was extensively evaluated using metrics based on geometry as well as results of electrophysiological simulations of cardiac sinus rhythm and ventricular tachycardia in individual hearts. Several alternative reconstruction techniques were also implemented and compared with the proposed method. Results: The accuracy of the LogOdds method in reconstructing 3D

  2. Allograft tissue irradiation and failure rate after anterior cruciate ligament reconstruction: A systematic review

    PubMed Central

    Dashe, Jesse; Parisien, Robert L; Cusano, Antonio; Curry, Emily J; Bedi, Asheesh; Li, Xinning

    2016-01-01

    AIM: To evaluate whether anterior cruciate ligament (ACL) allograft irradiation is effective for sterility without compromising graft integrity and increasing failure rate. METHODS: A literature search was conducted using PubMed, Cochrane, and Google. The following search terms were used: “Gamma irradiation AND anterior cruciate ligament AND allograft” with a return of 30 items. Filters used included: English language, years 1990-2015. There were 6 hits that were not reviewed, as there were only abstracts available. Another 5 hits were discarded, as they did not pertain to the topic of interest. There were 9 more articles that were excluded: Three studies were performed on animals and 6 studies were meta-analyses. Therefore, a total of 10 articles were applicable to review. RESULTS: There is a delicate dosing crossover where gamma irradiation is both effective for sterility without catastrophically compromising the structural integrity of the graft. Of note, low dose irradiation is considered less than 2.0 Mrad, moderate dose is between 2.1-2.4 Mrad, and high dose is greater than or equal to 2.5 Mrad. Based upon the results of the literature search, the optimal threshold for sterilization was found to be sterilization at less than 2.2 Mrad of gamma irradiation with the important caveat of being performed at low temperatures. The graft selection process also must include thorough donor screening and testing as well as harvesting the tissue in a sterile fashion. Utilization of higher dose (≥ 2.5 Mrad) of irradiation causes greater allograft tissue laxity that results in greater graft failure rate clinically in patients after ACL reconstruction. CONCLUSION: Allograft ACL graft gamma irradiated with less than 2.2 Mrad appears to be a reasonable alternative to autograft for patients above 25 years of age. PMID:27335815

  3. Amiodarone supplants lidocaine in ACLS and CPR protocols.

    PubMed

    Mizzi, Anna; Tran, Thanh; Mangar, Devanand; Camporesi, Enrico M

    2011-09-01

    Amiodarone is an antiarrhythmic medication used to treat and prevent certain types of serious, life-threatening ventricular arrhythmias. Amiodarone gained slow acceptance outside the specialized field of cardiac antiarrhythmic surgery because the side-effects are significant. Recent adoption of amiodarone in the ACLS (Advanced Cardiac Life Support) protocol has somewhat popularized this class of antiarrhythmics. Its use is slowly expanding in the acute medicine setting of anesthetics. This article summarizes the use of Amiodarone by anesthesiologists in the operating room and during cardiopulmonary resuscitation.

  4. Dual ACL Ganglion Cysts: Significance of Detailed Arthroscopy.

    PubMed

    Mittal, Samarth; Singla, Amit; Nag, H L; Meena, Sanjay; Lohiya, Ramprakash; Agarwal, Abhinav

    2014-01-01

    Intra-articular ganglion cysts of the knee joint are rare and most frequently are an incidental finding on MRI and arthroscopy. Most of the previous studies have reported a single ganglion cyst in the knee. There have been previous reports of more than one cyst in the same knee but not in the same structure within the knee. We are reporting a case of dual ACL (anterior cruciate ligament) ganglion cysts one of which was missed on radiological examination but later detected during arthroscopy. To the best of our knowledge, no such case has been reported in the indexed English literature till date.

  5. Association Between Lateral Posterior Tibial Slope, Body Mass Index, and ACL Injury Risk

    PubMed Central

    Bojicic, Katherine M.; Beaulieu, Mélanie L.; Imaizumi Krieger, Daniel Y.; Ashton-Miller, James A.; Wojtys, Edward M.

    2017-01-01

    Background: While body mass index (BMI), a modifiable parameter, and knee morphology, a nonmodifiable parameter, have been identified as risk factors for anterior cruciate ligament (ACL) rupture, the interaction between them remains unknown. An understanding of this interaction is important because greater compressive axial force (perhaps due to greater BMI) applied to a knee that is already at an increased risk because of its geometry, such as a steep lateral posterior tibial slope, could further increase the probability of ACL injury. Purpose: To quantify the relationship between BMI and select knee morphological parameters as potential risk factors for ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: Sagittal knee magnetic resonance imaging (MRI) files from 76 ACL-injured and 42 uninjured subjects were gathered from the University of Michigan Health System’s archive. The posterior tibial slope (PTS), middle cartilage slope (MCS), posterior meniscus height (PMH), and posterior meniscus bone angle (MBA) in the lateral compartment were measured using MRI. BMI was calculated from demographic data. The association between the knee structural factors, BMI, and ACL injury risk was explored using univariate and multivariate logistic regression. Results: PTS (P = .043) and MCS (P = .037) significantly predicted ACL injury risk. As PTS and MCS increased by 1°, odds of sustaining an ACL injury increased by 12% and 13%, respectively. The multivariate logistic regression analysis, which included PTS, BMI centered around the mean (cBMI), and their interaction, showed that this interaction predicted the odds of ACL rupture (P = .050; odds ratio, 1.03). For every 1-unit increase in BMI from the average that is combined with a 1° increase in PTS, the odds of an ACL tear increased by 15%. Conclusion: An increase in BMI was associated with increased risk of ACL tear in the presence of increased lateral posterior tibial slope. Larger values of PTS or

  6. Complete Immediate Paraplegia Reversal after Performing Aorto-Lumbar Bypass on the Patient who Underwent Aortoiliac Reconstruction.

    PubMed

    Banzic, Igor; Sladojevic, Milos; Ilic, Nikola; Koncar, Igor; Davidovic, Lazar; Brankovic, Milos

    2016-08-01

    Although both internal iliac arteries were saved during operation, the patient developed paraplegia immediately after aortoiliac reconstruction due to the spinal cord ischemia. We report a successfully treated immediate postoperative paraplegia by performing second operation and creating bypass from the bifurcated Dacron graft to the previously detected nonpaired huge lumbar artery.

  7. Total soft-tissue reconstruction of the middle and lower face with multiple simultaneous free flaps in a pediatric patient.

    PubMed

    Burt, J D; Burns, A J; Muzaffar, A R; Byrd, H S; Hobar, P C; Beran, S J; Adams, W P; Kenkel, J M

    2000-06-01

    A 2-year-old boy sustained a massive facial soft-tissue wound secondary to a dog attack. Essentially all the soft tissues of the face were absent, including innervation and intraoral lining. We describe the reconstruction of this defect with five simultaneous free tissue transfers. To our knowledge, this is the first report of five simultaneous free flaps in any patient.

  8. Free flap reconstruction for head and neck cancer can be safely performed in both young and elderly patients after careful patient selection.

    PubMed

    Peters, Thomas T A; Post, Sophie F; van Dijk, Boukje A C; Roodenburg, Jan L N; van der Laan, Bernard F A M; Werker, Paul M N; Halmos, Gyorgy B

    2015-10-01

    Surgical treatment of head and neck cancer often results in complex defects requiring reconstruction with microvascular free tissue transfer. However, in elderly patients, curative treatment with radical surgery and free flap reconstruction is often withheld. The objective of this study is to assess the outcomes of free flap surgery in elderly patients, using a standard surgical complication classification system. A retrospective review was conducted of patients who underwent primary free flap reconstruction following major surgery for head and neck cancer between 1995 and 2010. Complications were assessed using the Clavien Dindo classification system, and grades III-V were classified as major complications. Comorbidity was classified according to the adult comorbidity evaluation index 27. A comparison was done between patients <70 and ≥70 years. Two hundred-two patients were included in this study. Multivariate analysis showed that only disease stage was a significant predictor of recipient site complications, and comorbidity was the only significant predictor of medical complications. Age was not a predictor of complications. There were no significant differences in disease specific or overall survival between young and elderly patients. Optimal patient selection for free flap surgery is essential. This requires thorough pre-operative assessment, including analysis of comorbidity in both young and elderly patients. Patients' biological age, and not chronological age, should be individually determined to assess feasibility of major surgery. Patients should not be denied surgery based on age alone.

  9. Treating Anterior Cruciate Ligament Tears in Skeletally Immature Patients

    PubMed Central

    Vavken, Patrick; Murray, Martha M

    2011-01-01

    Purpose To systematically review the current evidence for conservative and surgical treatment of anterior cruciate ligament (ACL) tears in skeletally immature patients. Methods A systematic search of PubMed, CINAHL, EMBASE, CCTR, and CDSR was performed for surgical and/or conservative treatment of complete ACL tears in immature individuals. Studies with less than six months of follow-up were excluded. Study quality was assessed and data were collected on clinical outcome, growth disturbance, and secondary joint damage. Results We identified 48 studies meeting the inclusion criteria. Conservative treatment was found to result in poor clinical outcomes and a high incidence of secondary defects, including meniscal and cartilage injury. Surgical treatment had only very weak evidence for growth disturbance, yet strong evidence of good postoperative stability and function. No specific surgical treatment showed clearly superior outcomes, yet the studies using physeal-sparing techniques had no reported growth disturbances at all. Conclusions The current best evidence suggests that surgical stabilization should be considered the preferred treatment in immature patients with complete ACL tears. While physeal-sparing techniques are not associated with a risk of growth disturbance, transphyseal reconstruction is an alternative with a beneficial safety profile and a minimal risk of growth disturbance. Conservative treatment commonly leads to meniscal damage and cartilage destruction and should be considered a last resort. Level of Evidence Level IV, systematic review of Level II, III, and IV studies. PMID:21552340

  10. SU-F-18C-06: Prospective Patient Evaluation of Iterative Reconstruction in Radiation Oncology

    SciTech Connect

    Price, R; Vance, S; Cattaneo, R; Schultz, L; Elshaikh, M; Chetty, I; Glide-Hurst, C

    2014-06-15

    Purpose: This work incorporates iterative reconstruction (IR) into a dose reduction study to characterize image quality metrics, delineation, and dosimetric assessment, with the goal of reducing imaging dose in Radiation Oncology. Methods: Three-dimensional noise power spectrum (NPS) analysis characterized noise magnitude/texture (120 kVp, 50–200 mAs, IR levels 1–6 yielding noise reduction of 0.89–0.55 compared to filtered backprojection (FBP)). Task-specific Modulation Transfer Functions (MTFtask) were characterized across varied subject contrasts. A prospective dose reduction study (500 to 150 mAs) was conducted for 12 patients (43 inter-fraction CTs) for high-dose rate brachytherapy. Three physicians performed qualitative image assessment between full-dose FBP (FD-FBP, 500 mAs), low-dose FBP (LD-FBP, 150–250 mAs), and low-dose IRL5-6 (LD-IR) scans for image noise, cuff/bladder interface detectability, spatial resolution, texture, and segmentation confidence. Comparisons between LD-FBP and LD-IR were conducted for the following metrics: delineation (bladder and rectum evaluated via overlap indices (OI) and Dice similarity coefficients (DSC)), noise, boundary changes, dose calculation, and digitally reconstructed radiographs (DRRs). Results: NPS showed ∼50% reduction in noise magnitude and ∼0.1 1/mm spatial frequency shift with IRL6. The largest MTFtask decrease between FBP and IR was 0.08 A.U. Qualitative patient image evaluation revealed LD-IR was equivalent or slightly worse than FD-FBP, and superior to LD-FBP for all metrics except low contrast interface and texture. The largest CT number discrepancy from FBP occurred at a bone/tissue interface using IRL6 (−1.2 ± 4.9 HU (range: −17.6 – 12.5 HU)). No significant contour differences (OIs and DSCs = 0.85 – 0.95) and dose calculation discrepancy (<0.02%) were observed. DRRs preserved anatomical detail and demonstrated <2% difference in intensity between LD-FBP and LD-IRL6. Conclusion: While

  11. Posterolateral Corner Reconstruction Alone Using a Fibular-Based Technique in a Patient with Persistent Unstable Revision Total Knee Arthroplasty

    PubMed Central

    Cline, Joseph T.; Alentorn-Geli, Eduard; Choi, J. H. James; Stuart, Joseph J.; Kruger, Terry; Moorman III, Claude T.

    2015-01-01

    Posterolateral rotatory instability is a relatively uncommon cause of unstable total knee arthroplasty (TKA). In most cases, surgical treatment requires revision TKA into a more constrained design or thicker polyethylene liner. We present a case of a patient with unstable TKA who remained unstable after increasing thickness of the polyethylene liner and undergoing more constrained TKA. After several revision surgeries, the patient was still unstable. Posterolateral corner reconstruction with a fibular-based technique using a tibialis anterior allograft was performed. At 1-year follow-up, the patient was stable and asymptomatic and with excellent function. A soft-tissue procedure only (fibular-based posterolateral corner reconstruction) can be effective at restoring posterolateral rotatory stability in a patient with persistent instability after revision TKA. PMID:26881160

  12. Surgical Guides (Patient-Specific Instruments) for Pediatric Tibial Bone Sarcoma Resection and Allograft Reconstruction

    PubMed Central

    Bellanova, Laura; Paul, Laurent; Docquier, Pierre-Louis

    2013-01-01

    To achieve local control of malignant pediatric bone tumors and to provide satisfactory oncological results, adequate resection margins are mandatory. The local recurrence rate is directly related to inappropriate excision margins. The present study describes a method for decreasing the resection margin width and ensuring that the margins are adequate. This method was developed in the tibia, which is a common site for the most frequent primary bone sarcomas in children. Magnetic resonance imaging (MRI) and computerized tomography (CT) were used for preoperative planning to define the cutting planes for the tumors: each tumor was segmented on MRI, and the volume of the tumor was coregistered with CT. After preoperative planning, a surgical guide (patient-specific instrument) that was fitted to a unique position on the tibia was manufactured by rapid prototyping. A second instrument was manufactured to adjust the bone allograft to fit the resection gap accurately. Pathologic evaluation of the resected specimens showed tumor-free resection margins in all four cases. The technologies described in this paper may improve the surgical accuracy and patient safety in surgical oncology. In addition, these techniques may decrease operating time and allow for reconstruction with a well-matched allograft to obtain stable osteosynthesis. PMID:23533326

  13. Benefits of immediate dermoglandular preserving reconstruction following giant fibroadenoma excision in two patients.

    PubMed

    Chepla, K J; Armijo, B S; Ponsky, T A; Soltanian, H T

    2011-09-01

    Giant fibroadenoma is a rare, benign stromal tumor that typically occurs in adolescent women. This rapidly-growing tumor can result in a significant aesthetic and psychosocial morbidity due to gross asymmetry changes in the overlying skin envelope and concerns about malignancy. On initial work-up this lesion must be differentiated from other rare primary breast tumors, including phyllodes tumor, or metastatic disease. Appropriate treatment of giant fibroadenoma requires surgical excision; however, many surgeons are reluctant to perform a concomitant mastopexy or reconstruction at the time of tumor extirpation. This conservative approach results in a loose, ptotic, aesthetically displeasing breast postoperatively. While some degree of skin retraction is expected, patients may have to wait for up to a year to see final results, and further surgical correction may still be required. It is unknown whether these surgeons are not familiar with these techniques or hesitate to increase the amount of scarring on the breast mound of a young female. Using an immediate dermoglandular preserving mastopexy after giant fibroadenoma excision, we have decreased postoperative breast ptosis, removed much of the lax, poor-quality skin and achieved stable, long-term results in two patients. This technique improves the immediate aesthetic outcome, reduces the psychosocial comorbidity associated with waiting for skin retraction and decreases the likelihood of a second surgery.

  14. Surgical guides (patient-specific instruments) for pediatric tibial bone sarcoma resection and allograft reconstruction.

    PubMed

    Bellanova, Laura; Paul, Laurent; Docquier, Pierre-Louis

    2013-01-01

    To achieve local control of malignant pediatric bone tumors and to provide satisfactory oncological results, adequate resection margins are mandatory. The local recurrence rate is directly related to inappropriate excision margins. The present study describes a method for decreasing the resection margin width and ensuring that the margins are adequate. This method was developed in the tibia, which is a common site for the most frequent primary bone sarcomas in children. Magnetic resonance imaging (MRI) and computerized tomography (CT) were used for preoperative planning to define the cutting planes for the tumors: each tumor was segmented on MRI, and the volume of the tumor was coregistered with CT. After preoperative planning, a surgical guide (patient-specific instrument) that was fitted to a unique position on the tibia was manufactured by rapid prototyping. A second instrument was manufactured to adjust the bone allograft to fit the resection gap accurately. Pathologic evaluation of the resected specimens showed tumor-free resection margins in all four cases. The technologies described in this paper may improve the surgical accuracy and patient safety in surgical oncology. In addition, these techniques may decrease operating time and allow for reconstruction with a well-matched allograft to obtain stable osteosynthesis.

  15. Three-Dimensional Reconstruction Computed Tomography Evaluation of the Tunnel Location and Angle in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: A Comparison of the Anteromedial Portal and Outside-in Techniques

    PubMed Central

    Kim, Kang-Il; Lee, Sang Hak; Bae, Chanil; Bae, Sung Hae

    2017-01-01

    Purpose The purpose of this study was to compare the geometry and position of the femoral tunnel between the anteromedial portal (AMP) and outside-in (OI) techniques after anatomic single-bundle anterior cruciate ligament (ACL) reconstruction. Materials and Methods We evaluated 82 patients undergoing single-bundle ACL reconstruction with hamstring autografts using either the AMP (n=40) or OI (n=42) technique. The locations of the tunnel apertures were assessed by postoperative 3-dimensional computed tomography imaging. The femoral graft bending angle, femoral tunnel aperture shape, femoral tunnel length, and posterior wall breakage were also measured. Results The mean femoral tunnel position parallel to the Blumensaat line was more caudally positioned in the AMP group than in the OI group (p=0.025) The mean femoral graft angle in the OI group (99.6°±7.1°) was significantly more acute than that of the AMP group (108.9°±10.2°, p<0.001). The mean height/width ratio of the AMP group (1.21±0.20) was significantly more ellipsoidal than that of the OI group (1.07±0.09, p<0.001). Conclusions The mean femoral tunnel position was significantly shallower in the AMP technique than in the OI technique. The OI technique might be more disadvantageous than the AMP technique in terms of the more acute bending angle. PMID:28231643

  16. RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT WITH THE CENTRAL THIRD OF THE QUADRICEPS MUSCLE TENDON: ANALYSIS OF 10-YEAR RESULTS

    PubMed Central

    Guimarães, Marcus Valladares; Junior, Lúcio Honório de Carvalho; Terra, Dalton Lopes

    2015-01-01

    Objective: Assess clinical results using two different protocols, 10 years after ACL reconstruction surgery with the central third of quadriceps muscle tendon (QT). Method: Between November /1997 and April/1998, 25 patients were submitted to 25 ACL reconstructions with QT by transtibial technique. The bone portion of the graft was fixated on femoral tunnel with interference screw and the tendinous portion of tibial tunnel with screw with washer. Two patients injured the new when playing soccer. Six patients were not available for follow-up (24%). Seventeen patients were evaluated, 15 men and two women, with mean age at surgery time of 28.53 ± 6.64 years. All patients were examined at six months, one year, and ten years after surgery. Clinical evaluation was made by the Lysholm scale, and the knee evaluation, with the Hospital for Special Surgery scale. Results: The patients had their injuries operated after 9.87 ± 14.42 months of the accident. According to Lysholm scale, the results at the end of the first year were 98.71 ± 2.47 and, after 10 years, 97.35 ± 3.12. Using the Hospital for Special Surgery scale, the mean score was 95.07 ± 5.23 in one year, and 94.87 ± 4.16 in 10 years. All patients returned to their professional activities with the same previous status. Fifteen (88.24%) patients were able to return to their sports activities, one by modifying the practice, while another one switched to another sport. No patient complained of pain on the donor area in the medium and long term. The sports return rate was excellent, and no changes were found on the femoropatellar joint. PMID:27022511

  17. Combined laparoscopic and vaginal cervicovaginal reconstruction using split thickness skin graft in patients with congenital atresia of cervix

    PubMed Central

    Zhang, Xuyin; Han, Tiantian; Ding, Jingxin; Hua, Keqin

    2015-01-01

    Objective: The aim of this study was to introduce a new technique which is combined laparoscopic and vaginal cervicovaginal reconstruction using split thickness skin graft in patients with congenital atresia of cervix and to evaluate the feasibility and the safety of it. Methods: This is a prospective observational study of 10 patients with congenital atresia of cervix who underwent combined laparoscopic and vaginal cervicovaginal reconstruction using split thickness skin graft for cervicovaginal reconstruction from February 2013 to August 2014 in our hospital. All of the surgical procedures were carried out by the same operation team. Patient data were collected including operating time, estimated blood loss, hospital stay post-surgery, complications, total cost, and median vaginal length at 3 month, resumption of menstruation, vaginal stenosis and stricture of the cervix postoperatively. Results: The operative procedure lasted 237±46 (175-380) min. The estimated blood loss was 160±76 (50-300) ml. The hospital stay post-surgery was 12±2 (9-18) days. None of the patients had complications or required a blood transfusion. The mean total cost was $3352±1025. The average vaginal length at 3 month was 8.3±1.1 (8-10) cm. All patients had resumption of menstruation. The patients were followed for a mean of 5±2 (1-10) months. Cervical or vaginal stenosis did not occur in any of the patients. Conclusions: Our experiences of combined laparoscopic and vaginal cervicovaginal reconstruction using split thickness skin graft in10 patients with congenital atresia of cervix were positive, with successful results and without complications, and cervical or vaginal stenosis. PMID:26309703

  18. Successful endovascular reconstruction of a recurrent giant middle cerebral artery aneurysm with multiple telescoping flow diverters in a pediatric patient.

    PubMed

    Ikeda, Daniel S; Marlin, Evan S; Shaw, Andrew; Powers, Ciarán J

    2015-01-01

    Intracranial aneurysms of the pediatric population are rare, but giant fusiform aneurysms (GFAs) of the middle cerebral artery (MCA) are common within this cohort of patients. These aneurysms are difficult to treat and often require advanced microsurgical skills, as they are usually not amenable to direct clipping. Here, we report the successful treatment of a recurrent GFA of the MCA with three telescoping Pipeline Embolization Devices 6 months after attempted clip reconstruction in a pediatric patient.

  19. Role of the ACL2 locus in flower stalk elongation in Arabidopsis thaliana.

    PubMed

    Kato, Hiroaki; Komeda, Yoshibumi; Saito, Tamao; Ito, Hidetaka; Kato, Atsushi

    2015-01-01

    The acaulis2 (acl2) mutant of Arabidopsis thaliana shows a defect in flower stalk elongation. We identified the mutation point of acl2 by map-based cloning. The ACL2 locus is located within an approximately 320-kb region at around 100 map units on chromosome 1. One nucleotide substitution was detected in this region in the acl2 mutant, but no significant open reading frames were found around this mutation point. When wild-type DNA fragments containing the mutation point were introduced into acl2 mutant plants, some transgenic plants partially or almost completely recovered from the defect in flower stalk elongation. 3'-RACE experiments showed that bidirectional transcripts containing the acl2 mutation point were expressed, and the Plant MPSS database revealed that several small RNAs were produced from this region. Microarray analysis showed that transcription of many genes is activated in flower stalks of acl2 mutant plants. Overexpression of some of these genes caused a dwarf phenotype in wild-type plants. These results suggest the following novel mechanism for control of the elongation of flower stalks. Bidirectional non-coding RNAs are transcribed from the ACL2 locus, and small RNAs are generated from them in flower stalks. These small RNAs repress the transcription of a set of genes whose expression represses flower stalk elongation, and flower stalks are therefore fully elongated.

  20. ACL injury mechanisms and related factors in male and female carving skiers: a retrospective study.

    PubMed

    Ruedl, G; Webhofer, M; Linortner, I; Schranz, A; Fink, C; Patterson, C; Nachbauer, W; Burtscher, M

    2011-10-01

    In recreational alpine skiing, ACL injury risk is 3 times greater in females. However, since the introduction of carving skis ACL injury risk seems to have decreased. No study has yet investigated the distribution of ACL injury mechanisms in male and female carving skiers. Therefore, the aim of the study was to investigate potential gender specific differences of ACL injury mechanisms and related factors among carving skiers. In total, 220 recreational carving skiers (59 males and 161 females) suffering from an ACL injury volunteered for this study. Demographic data, skiing ability, equipment related and environmental factors, circumstances and causes for the fall, and type of fall (injury mechanisms) were collected by questionnaire. The forward twisting fall is the most reported ACL injury mechanism in both gender (p=0.672) accounting for 54% of all injuries, although male and female skiers differed significantly with regard to circumstances of fall (p=0.001) and actions when ACL injury occurred (p=0.04). Bindings not releasing at the time point of accident occurred 2.6 times more with females than with males (p=0.005). The forward twisting fall seems to have become the dominant ACL injury mechanism both in male and female recreational skiers since the introduction of carving skis.

  1. Role of gastrocnemius activation in knee joint biomechanics: gastrocnemius acts as an ACL antagonist.

    PubMed

    Adouni, M; Shirazi-Adl, A; Marouane, H

    2016-01-01

    Gastrocnemius is a premier muscle crossing the knee, but its role in knee biomechanics and on the anterior cruciate ligament (ACL) remains less clear when compared to hamstrings and quadriceps. The effect of changes in gastrocnemius force at late stance when it peaks on the knee joint response and ACL force was initially investigated using a lower extremity musculoskeletal model driven by gait kinematics-kinetics. The tibiofemoral joint under isolated isometric contraction of gastrocnemius was subsequently analyzed at different force levels and flexion angles (0°-90°). Changes in gastrocnemius force at late stance markedly influenced hamstrings forces. Gastrocnemius acted as ACL antagonist by substantially increasing its force. Simulations under isolated contraction of gastrocnemius confirmed this role at all flexion angles, in particular, at extreme knee flexion angles (0° and 90°). Constraint on varus/valgus rotations substantially decreased this effect. Although hamstrings and gastrocnemius are both knee joint flexors, they play opposite roles in respectively protecting or loading ACL. Although the quadriceps is also recognized as antagonist of ACL, at larger joint flexion and in contrast to quadriceps, activity in gastrocnemius substantially increased ACL forces (anteromedial bundle). The fact that gastrocnemius is an antagonist of ACL should help in effective prevention and management of ACL injuries.

  2. Perspectives on the Humanities and School-Based Curriculum Development. ACLS Occasional Paper No. 24.

    ERIC Educational Resources Information Center

    Blackman, Sandra; Chodorow, Stanley; Ohmann, Richard; Okura, Sandra; Purrington, Sandra Sanchez; Stein, Robert

    This paper records three plenary sessions held at the American Council of Learned Societies (ACLS) National Education Conference, August 27-29, 1993. The conference built on what was learned in the first year of the project and reported in ACLS Occasional Paper 20. Sessions allowed participants to talk with colleagues who had been project…

  3. 50 CFR 648.64 - Yellowtail flounder sub-ACLs and AMs for the scallop fishery.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 50 Wildlife and Fisheries 10 2011-10-01 2011-10-01 false Yellowtail flounder sub-ACLs and AMs for the scallop fishery. 648.64 Section 648.64 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT...-ACLs and AMs for the scallop fishery. (a) As specified in § 648.55(d), and pursuant to the...

  4. Liberal Arts Colleges in American Higher Education: Challenges and Opportunities. ACLS Occasional Paper, No. 59

    ERIC Educational Resources Information Center

    American Council of Learned Societies, 2005

    2005-01-01

    This American Council of Learned Societies (ACLS) Occasional Paper presents the proceedings of a conference on "Liberal Arts Colleges in American Higher Education: Challenges and Opportunities" convened by ACLS in November 2003 in Williamstown, Massachusetts with the support of the Oakley Center for the Humanities and Social Sciences at…

  5. 50 CFR 660.410 - Conservation objectives, ACLs, and de minimis control rules.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 13 2012-10-01 2012-10-01 false Conservation objectives, ACLs, and de... COAST STATES West Coast Salmon Fisheries § 660.410 Conservation objectives, ACLs, and de minimis control... Limits. Annual management measures will be designed to ensure escapement levels at or higher than...

  6. 50 CFR 660.410 - Conservation objectives, ACLs, and de minimis control rules.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 13 2013-10-01 2013-10-01 false Conservation objectives, ACLs, and de... COAST STATES West Coast Salmon Fisheries § 660.410 Conservation objectives, ACLs, and de minimis control... Limits. Annual management measures will be designed to ensure escapement levels at or higher than...

  7. Enhancing proliferation and ECM expression of human ACL fibroblasts by sonic vibration.

    PubMed

    Jiang, Yuan-Yuan; Park, Jung-Keug; Yoon, Hee-Hoon; Choi, Hynjin; Kim, Chan-Wha; Seo, Young-Kwon

    2015-01-01

    Effects of mechanical vibration on cell activity and behavior remain controversial: There has been evidence on both positive and negative effects. Furthermore, research on the anterior cruciate ligament (ACL) has as yet been limited and the frequency-related effects remain unknown, even though ACL injury is common and an injured ACL hardly spontaneously recovers. The object of this work was to address the influence of mechanical vibration on ACL fibroblasts, to determine the effects of frequencies, and to further study this effect at the cellular level. We found that sonic vibration affected ACL fibroblasts' proliferation and metabolism in a frequency-dependent manner, and 20 Hz gave rise to the most ACL cell activity and comprehensively increased extracellular matrix (ECM) contents, including collagen type I, collagen type III, fibronectin, elastin, tenascin, glycosaminoglycan (GAG), and the cytoskeleton protein vimentin. Thus, our results indicate that sonic vibration possesses frequency-dependent effects on proliferation and productivity of ACL fibroblast with an optimal frequency of 20 Hz under the present stimulation conditions, providing further information for future research in how vibrational stimulation manipulates ACL cellular behavior.

  8. Evaluating ACLS Algorithms for the International Space Station (ISS) - A Paradigm Revisited

    NASA Technical Reports Server (NTRS)

    Alexander, Dave; Brandt, Keith; Locke, James; Hurst, Victor, IV; Mack, Michael D.; Pettys, Marianne; Smart, Kieran

    2007-01-01

    The ISS may have communication gaps of up to 45 minutes during each orbit and therefore it is imperative to have medical protocols, including an effective ACLS algorithm, that can be reliably autonomously executed during flight. The aim of this project was to compare the effectiveness of the current ACLS algorithm with an improved algorithm having a new navigation format.

  9. Reconstruction versus conservative treatment after rupture of the anterior cruciate ligament: cost effectiveness analysis

    PubMed Central

    2011-01-01

    Background The decision whether to treat conservatively or reconstruct surgically a torn anterior cruciate ligament (ACL) is an ongoing subject of debate. The high prevalence and associated public health burden of torn ACL has led to continuous efforts to determine the best therapeutic approach. A critical evaluation of benefits and expenditures of both treatment options as in a cost effectiveness analysis seems well-suited to provide valuable information for treating physicians and healthcare policymakers. Methods A literature review identified four of 7410 searched articles providing sufficient outcome probabilities for the two treatment options for modeling. A transformation key based on the expert opinions of 25 orthopedic surgeons was used to derive utilities from available evidence. The cost data for both treatment strategies were based on average figures compiled by Orthopaedic University Hospital Balgrist and reinforced by Swiss national statistics. A decision tree was constructed to derive the cost-effectiveness of each strategy, which was then tested for robustness using Monte Carlo simulation. Results Decision tree analysis revealed a cost effectiveness of 16,038 USD/0.78 QALY for ACL reconstruction and 15,466 USD/0.66 QALY for conservative treatment, implying an incremental cost effectiveness of 4,890 USD/QALY for ACL reconstruction. Sensitivity analysis of utilities did not change the trend. Conclusion ACL reconstruction for reestablishment of knee stability seems cost effective in the Swiss setting based on currently available evidence. This, however, should be reinforced with randomized controlled trials comparing the two treatment strategies. PMID:22098703

  10. 50 CFR 622.12 - Annual catch limits (ACLs) and accountability measures (AMs) for Caribbean island management...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... lb (26,524 kg). (R) Spiny lobster—327,920 lb (148,742 kg). (ii) Recreational ACLs. The following ACLs... (15,242 kg). (N) Triggerfish and filefish, combined—24,980 lb (11,331 kg). (O) Spiny lobster—107,307...). (O) Spiny lobster—104,199 lb (47,264 kg). (ii) (4) Caribbean EEZ— (i) ACLs. The following ACLs...

  11. 50 CFR 622.12 - Annual catch limits (ACLs) and accountability measures (AMs) for Caribbean island management...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... lb (26,524 kg). (R) Spiny lobster—327,920 lb (148,742 kg). (ii) Recreational ACLs. The following ACLs... (15,242 kg). (N) Triggerfish and filefish, combined—24,980 lb (11,331 kg). (O) Spiny lobster—107,307...). (O) Spiny lobster—104,199 lb (47,264 kg). (ii) (4) Caribbean EEZ— (i) ACLs. The following ACLs...

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

    PubMed Central

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

    2016-01-01

    Background Although patients with an anterior cruciate ligament (ACL) injury ha